Frailty and oral anticoagulant prescription in adults with atrial fibrillation: A systematic review

Bul, Mary; Shaikh, Fareed Ahmed; McDonagh, Julee; Ferguson, Caleb

doi:10.1002/agm2.12214

Cited by 7 publications

(2 citation statements)

References 52 publications

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“…Therefore, physicians are reluctant to administer anticoagulation therapy to frail older patients. A recent systematic review of frailty and anticoagulation therapy demonstrated that frailty has led to a reluctance to prescribe anticoagulants 26 .…”

Section: Discussionmentioning

confidence: 99%

Observational study of frailty in older Japanese patients with non-valvular atrial fibrillation receiving anticoagulation therapy

Matsui,

Kusano,

Akao

et al. 2024

Sci Rep

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The number of patients with atrial fibrillation is increasing, and frailty prevalence increases with age, posing challenges for physicians in prescribing anticoagulants to such patients because of possible harm. The effects of frailty on anticoagulant therapy in older Japanese patients with nonvalvular atrial fibrillation (NVAF) are unclear. Herein, we prescribed rivaroxaban to Japanese patients with NVAF and monitored for a mean of 2.0 years. The primary endpoint was stroke or systemic embolism. The secondary endpoints were all-cause or cardiovascular death, composite endpoint, and major or non-major bleeding. Frailty was assessed using the Japanese long-term care insurance system. A multiple imputation technique was used for missing data. The propensity score (PS) was obtained to estimate the treatment effect of frailty and was used to create two PS-matched groups. Overall, 5717 older patients had NVAF (mean age: 73.9 years), 485 (8.5%) were classified as frail. After PS matching, background characteristics were well-balanced between the groups. Rivaroxaban dosages were 10 and 15 mg/day for approximately 80% and the remaining patients, respectively. Frailty was not associated with the primary endpoint or secondary endpoints. In conclusion, frailty does not affect the effectiveness or safety of rivaroxaban anticoagulant therapy in older Japanese patients with NVAF.Trial registration: UMIN000019135, NCT02633982.

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Section: Discussionmentioning

confidence: 99%

Observational study of frailty in older Japanese patients with non-valvular atrial fibrillation receiving anticoagulation therapy

Matsui,

Kusano,

Akao

et al. 2024

Sci Rep

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“…In daily practice, physicians will implicitly weigh multiple factors when deciding on the optimal anticoagulant treatment that is very difficult to adjust for in observational studies. 5,11 Monitoring through international normalized ratio (INR) testing allows for intervening at an early stage by titrating the VKA dose to the most optimal range, which may be beneficial in older patients living with frailty given their larger volatility in anticoagulant status. As a result, it is uncertain whether the superiority of NOACs over VKAs in patients with AF observed also holds for frail patients with AF, and the question whether these patients with AF taking VKA should be switched to an NOAC remains heavily debated.…”

Section: Joosten Et Almentioning

confidence: 99%

Safety of Switching from a Vitamin K Antagonist to a Non-Vitamin K Antagonist Oral Anticoagulant in Frail Older Patients with Atrial Fibrillation: Results of the FRAIL-AF Randomized Controlled Trial

Joosten,

van Doorn,

van de Ven

et al. 2023

Circulation

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Background: There is ambiguity whether frail patients with atrial fibrillation (AF) managed with vitamin K antagonists (VKAs) should be switched to a non-vitamin K oral anticoagulant (NOAC). Methods: We conducted a pragmatic, multicenter, open-label, randomized controlled superiority trial. Older AF patients living with frailty (age ≥75 years plus a Groningen Frailty Indicator (GFI) score ≥3) were randomized to switch from INR-guided VKA treatment to a NOAC or to continued VKA treatment. Patients with a glomerular filtration rate <30 mL/min/1.73 m 2 or with valvular AF were excluded. Follow-up was 12 months. The cause-specific hazard ratio (HR) was calculated for occurrence of the primary outcome which was a major or clinically relevant non-major bleeding complication, whichever came first, accounting for death as a competing risk. Analyses followed the intention-to-treat principle. Secondary outcomes included thromboembolic events. Results: Between January 2018 and June 2022, a total of 2,621 patients were screened for eligibility and 1,330 patients were randomized (mean age 83 years, median GFI 4). After randomization 6 patients in the switch to NOAC arm and 1 patient in the continue with VKA arm were excluded due to the presence of exclusion criteria, leaving 662 patients switched from a VKA to a NOAC and 661 patients continued VKAs in the intention-to-treat population. After 163 primary outcome events (101 in the switch arm, 62 in the continue arm), the trial was stopped for futility according to a prespecified futility analysis. The HR for our primary outcome was 1.69 (95% CI 1.23-2.32). The HR for thromboembolic events was 1.26 (95% CI 0.60 to 2.61). Conclusions: Switching INR-guided VKA treatment to a NOAC in frail older patients with AF was associated with more bleeding complications compared to continuing VKA treatment, without an associated reduction in thromboembolic complications.

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Triglyceride‐glucose index trajectories predict adverse cardiovascular outcomes in elderly heart failure patients with Diabetes: A retrospective cohort study

Liu,

Wang,

Luo

et al. 2024

Aging Medicine

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ObjectiveEvaluating the change trajectories of triglyceride‐glucose (TyG) index calculated after multiple tests in elderly heart failure (HF) patients may have clinical implications for predicting long‐term adverse cardiovascular events (MACEs).MethodsThis retrospective study included 1184 elderly HF (LVEF ≥50%) patients with diabetes admitted to our center between January 2015 and January 2020. Based on the multiple TyG levels detected during the exposure period with annual measurements, three distinct TyG trajectories were determined using latent mixture modeling: low‐stable group (TyG index <8.26, n = 367), medium‐stable group (TyG index 8.26–9.06, n = 613), and high‐increasing group (TyG index >9.06, n = 204). The primary endpoint was the composite outcome of MACEs.ResultsThere were significant increases in the prevalence of several cardiovascular risk factors and conditions, such as male gender, BMI, current smoker, hyperlipidemia, atrial fibrillation, old myocardial infarction, fasting glucose, triglycerides, and uric acid levels, from the Low‐Stable Group to the High‐Increasing Group (all P < 0.05). During a median follow‐up of 29 months (range, 18–46 months), 181 MACEs occurred. Kaplan–Meier analyses curve showed a significantly increased risk of MACEs in the medium‐stable and high‐increasing groups compared to the low‐stable group (HR = 2.528, 95%CI: 1.665–3.838; HR = 2.706, 95%CI: 1.722–4.255, respectively). Furthermore, the rates of heart failure‐related hospitalizations, nonfatal myocardial infarctions and non‐fatal stroke were significantly increased in the medium‐stable and high‐increasing groups. Multivariable Cox regression analyses revealed that age (HR = 1.728), current smoker (HR = 1.385), old myocardial infarction (HR = 1.593), chronic renal disease (HR = 1.682), HbA1c (HR = 1.816), NT‐proBNP (HR = 2.471), TyG trajectory (HR = 2.112) and SGLT2 inhibitors (HR = 0.841) were independently associated with the occurrence of MACEs during follow‐up (P < 0.05).ConclusionsThe TyG trajectory is strongly associated with the risk of MACEs during follow‐up in elderly patients with T2DM, suggesting that TyG trajectories may further optimize risk stratification model of cardiovascular events.

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Frailty and oral anticoagulant prescription in adults with atrial fibrillation: A systematic review

Cited by 7 publications

References 52 publications

Observational study of frailty in older Japanese patients with non-valvular atrial fibrillation receiving anticoagulation therapy

Observational study of frailty in older Japanese patients with non-valvular atrial fibrillation receiving anticoagulation therapy

Safety of Switching from a Vitamin K Antagonist to a Non-Vitamin K Antagonist Oral Anticoagulant in Frail Older Patients with Atrial Fibrillation: Results of the FRAIL-AF Randomized Controlled Trial

Triglyceride‐glucose index trajectories predict adverse cardiovascular outcomes in elderly heart failure patients with Diabetes: A retrospective cohort study

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