title: Clinical Characteristics and Outcomes in Extreme Elderly (Age ≥ 85 Years) Japanese Patients With Atrial Fibrillation: The Fushimi AF Registry.
abstract: BACKGROUND
  Atrial fibrillation (AF) is increasingly prevalent with age, and increasing age is an independent risk factor for ischemic stroke. Oral anticoagulant (OAC) therapy use in the extreme elderly (aged ≥ 85 years) is challenging.
  
  
  METHODS
  The Fushimi AF Registry is a community-based prospective study of Japanese patients with AF (79 participating medical institutions in Fushimi-ku, Kyoto, Japan). Patient enrollment started in March 2011, and follow-up data were available for 3,304 patients as of July 2014. We compared clinical characteristics and outcomes between the extreme elderly group (n = 479 [14.5%]) and other age-groups.
  
  
  RESULTS
  The extreme elderly group had a higher prevalence of major comorbidities and risk scores for stroke but received fewer OACs. After a mean follow-up of 2.0 years, end points in the extreme elderly group were as follows: all-cause death, 17.6; stroke/systemic embolism, 5.1; and major bleeding, 2.0 per 100 person-years. Extreme age was associated with a higher incidence of combined stroke/systemic embolism and all-cause death (hazard ratio [HR], 3.20; 95% CI, 2.66-3.84; P < .01) and higher incidences of stroke/systemic embolism (HR, 2.57; 95% CI, 1.77-3.65; P < .01) and mortality (HR, 3.48; 95% CI, 2.84-4.25; P < .01) compared with other patients (aged ≤ 84 years). The incidence of major bleeding was not significantly different (HR, 1.40; 95% CI, 0.78-2.36; P = .25).
  
  
  CONCLUSIONS
  In the present community-based prospective cohort, Japanese extreme elderly patients with AF had a higher incidence of stroke but similar major bleeding risks compared with the younger AF population.
  
  
  BACKGROUND
  UMIN Clinical Trials Registry; No.: UMIN000005834; URL: http://www.umin.ac.jp/ctr/index.htm.
authors.affiliation: Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Yugo
authors.initials: Y
authors.lastname: Yamashita
authors.affiliation: Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hamatani
authors.affiliation: Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Esato
authors.affiliation: Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan.
authors.forename: Yeong-Hwa
authors.initials: YH
authors.lastname: Chun
authors.affiliation: Tsuji Clinic, Kyoto, Japan.
authors.forename: Hikari
authors.initials: H
authors.lastname: Tsuji
authors.affiliation: Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Wada
authors.affiliation: Division of Translational Research, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Hasegawa
authors.affiliation: Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Abe
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, England; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Gregory Y H
authors.initials: GYH
authors.lastname: Lip
authors.affiliation: Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. Electronic address: akao@kuhp.kyoto-u.ac.jp.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Akao
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000453:epidemiology*; D004617:Embolism / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*
keywords: atrial fibrillation; cardiology; stroke