Anticoagulation trends in adults aged 65 years and over with atrial fibrillation: a cohort study

Abstract

ObjectiveTo describe patterns of anticoagulation prescription and persistence for those aged ≥65 years with atrial fibrillation (AF).MethodsDescriptive cohort study using electronic general practice records of patients in England, who attended an influenza vaccination aged ≥65 years and were diagnosed with AF between 2008 and 2018. Patients were stratified by 10-year age group and year of diagnosis. Proportion anticoagulated, type of anticoagulation (direct oral anticoagulant (DOAC) or warfarin) initiated at diagnosis and persistence with anticoagulation over time are reported.Results42 290 patients (49% female), aged 65–74 (n=11 722), 75–84 (n=19 055) and 85+ (n=11 513) years at AF diagnosis are included. Prescription of anticoagulation at diagnosis increased over the time period from 55% to 86% in people aged 65–74 years, from 54% to 86% in people aged 75–84 years and from 27% to 75% in people aged 85 years and over. By 2018, 92% of patients with newly diagnosed AF were started on a DOAC. Survivor function for 5-year persistence in patients prescribed DOAC was 0.80 (95% CI 0.77 to 0.82) and for warfarin 0.71 (95% CI 0.70 to 0.72). Survivor function for any anticoagulation at 5 years was 0.79 (95% CI 0.78 to 0.81), 0.73 (95% CI 0.72 to 0.75) and 0.58 (95% CI 0.59 to 0.64) for people aged 65–74, 75–84 and 85+ years, respectively.ConclusionsRates of anticoagulation in AF in those aged ≥65 years have increased from 2008 to 2018, over which time period there has been a shift from initiating anticoagulation with warfarin to DOAC. Persistence with anticoagulation is higher in people on DOACs than on warfarin and in people aged <85 years.

The role of prognostic stratification on prescription of anticoagulants in older patients with atrial fibrillation: a multicenter, observational, prospective European study (EUROSAF)

“…It is important to note that about half of older people did not take any anticoagulant therapy at hospital discharge, confirming previous reports of a sub-optimal prescription of oral anticoagulants in older with AF [ 27 ]. The rate of older people for which anticoagulant therapy is not prescribed remains high despite evidence of increased benefit in these patients [ 28 ]. Theoretically, older patients should receive anticoagulant therapy for AF such as younger individuals, in the case of males with a CHA2DS2-VASc score ≥2 and females with a score ≥3 [ 2 ].…”

Cluster randomised controlled trial of screening for atrial fibrillation in people aged 70 years and over to reduce stroke: protocol for the pilot study for the SAFER trial

“…21 32-36 With non-Vitamin-K antagonist oral anticoagulants (NOACs; also called direct oral anticoagulants) that require substantially less monitoring, and stronger recommendations for anticoagulation in clinical guidelines, 19 31 the rates of anticoagulation are increasing, but remain suboptimal. [37][38][39] Undiagnosed AF is common and can be detected with simple and portable technology, and there are effective treatments available. 18 40-42 AF screening, therefore, fulfils many of the criteria for initiating a national systematic screening programme.…”

Cardio-Ankle Vascular Index is Associated with Prevalence and New-Appearance of Atrial Fibrillation in Japanese Urban Residents: A Retrospective Cross-Sectional and Cohort Study

“…Elderly people over the age of 65 years are at high risk of AF, and guidance from the National Institute for Health and Care Excellence recommends that elderly people with AF should be anticoagulated. 24 Additionally, since there were only 22 new-appearance of AF cases in this study, the number of confounding factors used in Cox-proportional hazards analysis was limited. From these backgrounds, two major unmodifiable factors that contribute remarkably to AF, age ≥ 65 years and gender, were used as adjusting confounders.…”