The impact of frailty on the utilisation of antithrombotic therapy in older patients with atrial fibrillation.
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.
Perera
Vidya
V
Department of Aged Care and Clinical Pharmacology, Royal North Shore Hospital, St Leonards, NSW, Australia.
Bajorek
Beata V
BV
Matthews
Slade
S
Hilmer
Sarah N
SN
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*
D005343:Fibrinolytic Agents; D014859:Warfarin