title: Antithrombotic treatment is strongly underused despite reducing overall mortality among high-risk elderly patients hospitalized with atrial fibrillation.
abstract: OBJECTIVE
  To assess the use of antithrombotic treatment (ATT) after hospitalization with atrial fibrillation (AF) and the attributable effectiveness of ATT during follow-up.
  
  
  RESULTS
  On the basis of record linkage of administrative registers, 1812 patients discharged with AF were identified and followed-up for major clinical events up to 1 year. Mean age was 79 years. After hospitalization, 56% of the patients received ATT: 29% anticoagulants, 22% antiplatelets (APs), and 5% both agents. Among patients without comorbidities, 63.0% were exposed to ATT. Several factors significantly influence the use of antithrombotic agents, including increasing age [odds ratio (OR) 0.93 (95% confidence interval (CI), 0.92-0.95)], chronic obstructive pulmonary disease [0.77 (0.59-1.00)], malignancy [0.57 (0.39-0.82)], and previous use of ATT [4.56 (3.67-5.67)]. A significantly lower mortality was observed in patients exposed to ATT [hazard ratio (HR) 0.36 (95% CI, 0.28-0.47)], both to anticoagulants [0.23 (0.15-0.35)] and to APs [0.66 (0.50-0.86)]. ATT was associated with the reduction of thrombo-embolic events [0.52 (0.25-1.07)]. Major bleeding did not contribute to increased morbidity. Subgroups analysis, propensity score (PS), and sensitivity analysis confirmed these results.
  
  
  CONCLUSIONS
  Our data demonstrated that ATT was underused, also in patients without comorbidities. Exposure to ATT is associated with improved survival among elderly high-risk community patients hospitalized with AF.
authors.affiliation: Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Santa Maria Imbaro, Chieti 66030, Italy. monte@negrisud.it
authors.forename: Simona
authors.initials: S
authors.lastname: Monte
authors.forename: Alejandro
authors.initials: A
authors.lastname: Macchia
authors.forename: Fabio
authors.initials: F
authors.lastname: Pellegrini
authors.forename: Marilena
authors.initials: M
authors.lastname: Romero
authors.forename: Vito
authors.initials: V
authors.lastname: Lepore
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Ettorre
authors.forename: Mario
authors.initials: M
authors.lastname: Saugo
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.forename: Gianni
authors.initials: G
authors.lastname: Tognoni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006470:Hemorrhage / Q000139:chemically induced; D006760:Hospitalization; D006801:Humans; D008297:Male; D012307:Risk Factors; D016019:Survival Analysis; D013923:Thromboembolism / Q000517:prevention & control
chemical_list: D005343:Fibrinolytic Agents