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Against this background, the present study investigated differences in the clinical characteristics, prescription of OACs, incidence of death, and cause of death in elderly AF patients, and evaluated whether OACs and comorbidities are independently associated with prognosis in these patients. Methods Study Patients and Data Collection The present study was a hospital-based retrospective observational study. All patients with AF (paroxysmal or sustained) as of 2017 according to the electronic medical record (EMR) system were picked up from 1997. Cardiologists and biomedical engineers reviewed the electrocardiograms (ECGs) and medical records, and ECG-documented A trial fibrillation (AF) is a common arrhythmia in elderly patents. The prevalence and incidence rate of AF increase with age, with more than 70% of those diagnosed with AF being ≥65 years of age. 1,2 Although comorbidities increase with age, 3 elderly AF patients are likely to have a greater number of comorbidities. 2,4,5 The risk of developing embolic events is 5-fold higher in patients with AF than in those with sinus rhythm, 6 leaving patients bedridden or requiring long-term care, and increasing the mortality rate. 7 Oral anticoagulants (OACs) significantly reduce the incidence of stroke in patients with AF. Allcause mortality and causes of death among patients with AF were recently examined in both randomized control trials 8 and in cohort studies. 9-12 The real-world cohort studies demonstrated that stroke-related deaths account for approximately 5-8% of all-cause deaths, with non-cardio

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Antihypertensive therapy is pivotal for reducing cardiovascular events. The 2019 Guidelines for the Management of Hypertension set a target blood pressure (BP) of <140/90 mmHg for persons older than 75 years of age. Optimal BP levels for older persons with frailty, however, are controversial because evidence for the relationship between BP level and prognosis by frailty status is limited. Here, we evaluated the relationship between systolic BP and frailty status with all-cause mortality in ambulatory older hypertensive patients using data from the Nambu Cohort study. A total of 535 patients (age 78 [70–84] years, 51% men, 37% with frailty) were prospectively followed for a mean duration of 41 (34–43) months. During the follow-up period, 49 patients died. Mortality rates stratified by systolic BP and frailty status were lowest in patients with systolic BP < 140 mmHg and non-frailty, followed by those with systolic BP ≥ 140 mmHg and non-frailty. Patients with frailty had the highest mortality regardless of the BP level. The adjusted hazard ratios (95% confidence intervals) of each category for all-cause mortality were as follows: ≥140 mmHg/Non-frailty 3.19 (1.12–11.40), <140 mmHg/Frailty 4.72 (1.67–16.90), and ≥140 mmHg/Frailty 3.56 (1.16–13.40) compared with <140 mmHg/Non-frailty as a reference. These results indicated that frail patients have a poor prognosis regardless of their BP levels. Non-frail patients, however, with systolic BP levels <140 mmHg had a better prognosis. Frailty may be a marker to differentiate patients who are likely to gain benefit from antihypertensive medication among older hypertensives.

Background:Optimal blood pressure levels in elderly patients are controversial. Our previous results demonstrated that systolic blood pressure (SBP) lowering to less than 140 mmHg might not improve the prognosis in elderly hypertensive patients with frailty. Optimal blood pressure levels for elderly patients with heart failure (HF) have not yet been established.Objective:To examine the association between SBP level and mortality in elderly outpatients with or without HF.Design and setting and participants: A prospective cohort study of older patients in an outpatient setting in Okinawa (Nambu Cohort Study) included 630 patients. Data were collected from 2017 to 2021. Patients were stratified into four categories according to SBP levels of more or less than 140mmHg and presence or absence of HF.Results:A total of 630 patients, with a median (IQR) age of 78 (71 - 84) years and 50% of whom were men, were followed for a median duration of 42 (34 - 43) months. 56% of them had SBP less than 140 mmHg, and 21% were diagnosed as HF. All-cause mortality occurred in 39 (11%) and 31 (11%) of patients with SBP less than 140 mmHg vs. SBP more than 140 mmHg, respectively (HR 1.02, 95%CI 0.64 - 1.65). Likewise, 32 (24%) and 38 (8%) of patients with HF vs. without HF were dead, respectively (HR 3.75, 95% CI 2.33 - 6.00). Adjusted HR (95%CI) for all-cause death of each category patients was as follows; SBP less than 140 mmHg / Non-HF (Reference), SBP more than 140mmHg / Non-HF 1.41 (0.74 - 2.71), SBP less than 140 mmHg / HF 2.71 (1.40 - 5.29), SBP more than 140mmHg / HF 3.75 (1.67 - 8.09) (Figure).Conclusion:In an elderly outpatient setting, an SBP level of more than 140mmHg was likely associated with an increased risk of all-cause mortality in HF and non-HF patients but not statistically significant. On the other hand, HF was associated with increased mortality risk.