title: Thromboprophylaxis of elderly patients with AF in the UK: an analysis using the General Practice Research Database (GPRD) 2000-2009.
abstract: OBJECTIVE
  To assess use of thromboprophylaxis in UK general practise among patients with atrial fibrillation (AF); to investigate whether elderly patients are less likely to receive anticoagulation therapy than younger patients.
  
  
  METHODS
  Retrospective cohort study
  
  
  METHODS
  UK General Practice Research Database (GPRD)   PATIENTS:  Aged ≥60 years with a new diagnosis of AF (2000-2009).
  
  
  METHODS
  None.
  
  
  METHODS
  The main outcome measure was initiation of warfarin in the first year following diagnosis. Patients were categorised by stroke risk (CHADS(2) score) and bleeding risk (HAS-BLED score).
  
  
  RESULTS
  81 381 patients were identified (21% aged 60-69 years, 37% aged 70-79 years, 42% aged 80+ years). Patients aged 80+ years were significantly less likely to be initiated on warfarin than younger patients, adjusted for gender, practice and comorbidities; 32% of patients aged 80+ years received warfarin compared with 57% aged 60-69 years (p<0.0001), and 55% aged 70-79 years (p<0.0001). For all strata of CHADS(2)/HASBLED scores, patients aged 80+ years were significantly less likely to be treated with warfarin than younger patients. Logistic regression showed that female sex, low Basal Metabolic Index (BMI), age over 80 years, increasing HAS-BLED score and dementia were independently associated with reduced use of warfarin. Stroke/Transient Ischaemic Attack (TIA), hypertension, heart failure and left ventricular systolic dysfunction were associated with increased use. Patients with HAS-BLED>CHADS(2) were less likely to be initiated on warfarin. Higher CHADS(2) scores were associated with increased anticoagulation use.
  
  
  CONCLUSIONS
  Anticoagulation is being under-used in patients with AF aged 80+ years, even after taking into account increased bleeding risk in this age group.
authors.affiliation: Boehringer Ingelheim, Bracknell, UK.
authors.forename: Anna C E
authors.initials: AC
authors.lastname: Scowcroft
authors.forename: Sally
authors.initials: S
authors.lastname: Lee
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mant
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D058006:General Practice / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000925:Anticoagulants