title: Atrial fibrillation in older inpatients: are there any differences in clinical characteristics and pharmacological treatment between the frail and the non-frail?
abstract: BACKGROUND
  Frailty is common in patients with atrial fibrillation and may impact on antithrombotic and anti-arrhythmic treatment.
  
  
  OBJECTIVE
  To describe differences in clinical characteristics, prescription of antithrombotic and anti-arrhythmic medications and incidence of haemorrhage and stroke, between frail and non-frail older inpatients.
  
  
  METHODS
  Prospective observational study in patients aged ≥65 years with atrial fibrillation admitted to a teaching hospital in Sydney, Australia. Frailty was assessed using the Reported Edmonton Frail Scale, stroke risk with CHA2DS2-VASc score and bleeding risk with HAS-BLED score. Participants were followed after 6 months for haemorrhages and strokes.
  
  
  RESULTS
  We recruited 302 patients (mean age 84.7 ± 7.1 years, 53.3% frail, 50% female, mean CHA2DS2-VASc 4.61 ± 1.44, mean HAS-BLED 2.97 ± 1.04). Frail participants were older and had more co-morbidities and higher risk of stroke but not haemorrhage. Upon discharge, 55.7% participants were prescribed with anticoagulants (49.3% frail, 62.6% non-frail, P = 0.02). Thirty-three per cent received antiplatelets only and 11.1% no antithrombotics, with no difference by frailty status. For anti-arrhythmics, 52.6% received rate-control drugs only, 11.8% rhythm-control drugs only and 13.5% both and 22.1% were not prescribed either, with no difference by frailty status. On univariate logistic regression, frailty decreased the likelihood of anticoagulant prescription (odds ratio (OR) 0.58, 95%CI 0.36-0.93), but this was not significant on multivariate analysis (OR 0.66, 95%CI 0.40-1.11). After 6 months, overall incidence of ischaemic stroke was 2.1%, and in patients taking anticoagulants, incidence of major/severe bleeding was 6.3%, with no significant difference between frailty groups.
  
  
  CONCLUSIONS
  Frailty status had little impact on antithrombotic prescription and no impact on anti-arrhythmic prescription.
authors.affiliation: Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital and Kolling Institute of Medical Research, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.|Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: T N
authors.initials: TN
authors.lastname: Nguyen
authors.affiliation: Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: R G
authors.initials: RG
authors.lastname: Cumming
authors.affiliation: Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital and Kolling Institute of Medical Research, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: S N
authors.initials: SN
authors.lastname: Hilmer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005500:Follow-Up Studies; D016330:Frail Elderly; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D011446:Prospective Studies; D020521:Stroke / Q000139:chemically induced; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D005343:Fibrinolytic Agents
keywords: anti-arrhythmic; anticoagulant; atrial fibrillation; bleeding; frailty; stroke