title: The impact of frailty on the utilisation of antithrombotic therapy in older patients with atrial fibrillation.
abstract: OBJECTIVE
  to investigate the impact of frailty on the utilisation of antithrombotics and on clinical outcomes in older people with atrial fibrillation (AF).
  
  
  METHODS
  prospective study of a cohort of 220 acute inpatients aged > or =70 years with AF, admitted to a teaching hospital in Sydney, Australia (April-July 2007), with 207 followed up over 6 months.
  
  
  RESULTS
  a total of 140 patients (64%) were identified as frail using a validated tool. Frail patients were less likely to receive warfarin than non-frail on hospital admission (P = 0.002) and discharge (P < 0.001). During hospitalisation, the proportion of frail participants prescribed warfarin decreased by 10.7% and that of non-frail increased by 6.3%. Over the 6-month follow-up, 43 major or severe haemorrhages (20.8%), 20 cardioembolic strokes (9.7%) and 40 deaths (19.2%) were reported. Compared to non-frail, frail participants were significantly more likely to experience embolic stroke (RR 3.5, 95% CI 1.0-12.0, P < 0.05), had a small non-significant increase in risk of major haemorrhage (RR 1.5, 95% CI = 0.7-3.0, P = 0.29) and had greater mortality (RR 2.8, 95% CI 1.2-6.5, P = 0.01).
  
  
  CONCLUSIONS
  frail older inpatients with AF are significantly less likely to receive warfarin than non-frail and appear more vulnerable to adverse clinical outcomes, with and without antithrombotic therapy.
authors.affiliation: Department of Aged Care and Clinical Pharmacology, Royal North Shore Hospital, St Leonards, NSW, Australia.
authors.forename: Vidya
authors.initials: V
authors.lastname: Perera
authors.forename: Beata V
authors.initials: BV
authors.lastname: Bajorek
authors.forename: Slade
authors.initials: S
authors.lastname: Matthews
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Hilmer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000401:mortality*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006470:Hemorrhage / Q000401:mortality; D006801:Humans; D020766:Intracranial Embolism / Q000401:mortality; D016015:Logistic Models; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000401:mortality; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D014859:Warfarin