title: Impact of advanced age on management and prognosis in atrial fibrillation: insights from a population-based study in general practice.
abstract: OBJECTIVE
  to examine the use of antithrombotic therapy and predictors of stroke and death in very elderly (≥85 years) atrial fibrillation (AF) patients in a general practice cohort from the UK.
  
  
  METHODS
  retrospective, observational cohort study; 12-month follow-up period.
  
  
  METHODS
  eleven general practices serving the town of Darlington, England representing a population of 105,000 patients.
  
  
  METHODS
  two thousand two hundred and fifty-nine patients with a history of AF, 561 (24.8%) aged ≥85 years.
  
  
  METHODS
  use of antithrombotic therapy by age group and predictors of stroke and death.
  
  
  RESULTS
  five hundred and sixty-one (24.8%) AF patients aged ≥85 years (mean (SD) age 89 (4) years; 66% female) identified with a mean CHA2DS2-VASc score of 4.6 (SD 1.4). Thirty-six per cent received oral anticoagulation (OAC) compared with 57% in the 75-84 years age group. Forty-nine per cent of the very elderly received antiplatelet (AP) monotherapy; recorded OAC contraindications and declines were greatest among those aged ≥85 years. Stroke risk was highest among the very elderly (5.2% per annum), despite anticoagulation (3.9%). Multivariate analyses demonstrated an increased risk of stroke with AP monotherapy (odds ratio (OR) 2.45, 95% confidence intervals (CIs) 1.05-5.70) and a significant reduction in all-cause mortality with OAC therapy (OR 0.59, 95% CI 0.36-0.99).
  
  
  CONCLUSIONS
  the majority of very elderly AF patients in general practice do not receive OAC despite their higher stroke risk; almost half received AP monotherapy. AP use independently increased the risk of stroke, signifying that effective stroke prevention requires OAC regardless of age, except where true contraindications exist.
authors.affiliation: Division of Family Practice, Chilliwack General Hospital, Chilliwack, British Columbia, Canada.
authors.forename: Andreas
authors.initials: A
authors.lastname: Wolff
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
authors.forename: Eduard
authors.initials: E
authors.lastname: Shantsila
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
authors.forename: Deirdre A
authors.initials: DA
authors.lastname: Lane
mesh_terms: D000284:Administration, Oral; D000367:Age Factors; D000369:Aged, 80 and over; D000375:Aging; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D004739:England / Q000453:epidemiology; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D058006:General Practice; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors
keywords: age; antithrombotic therapy; atrial fibrillation; general practice; older people; stroke