title: Effects of Oral Anticoagulant Therapy in Medical Inpatients ≥65 Years With Atrial Fibrillation.
abstract: In this retrospective cohort observational study, we investigated mortality, ischemic, and hemorrhagic events in patients ≥65 years with atrial fibrillation consecutively discharged from an Acute Geriatric Ward in the period 2010 to 2013. Stroke and bleeding risk were evaluated using CHA2DS2-VASC (congestive heart failure/left ventricular dysfunction, hypertension, aged ≥75 years, diabetes mellitus, stroke/transient ischemic attack/systemic embolism, vascular disease, aged 65 to 74 years, gender category) and HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly) scores. Co-morbidity, cognitive status, and functional autonomy were evaluated using standardized scales. Independent associations among clinical variables, including use of vitamin K antagonist-based oral anticoagulant therapy (OAT), all-cause mortality, and fatal and nonfatal ischemic and hemorrhagic events, were evaluated. Further clinical outcomes comparison between patients treated with OAT and those untreated was performed after adjustment for significant differences in patient baseline characteristics with propensity score matching. Of 980 patients discharged (mean age 83 years, 60% women, roughly 30% cognitively impaired or functionally dependent, mean CHA2DS2-VASC and HAS-BLED scores 4.8 and 2.1, respectively), 505 (51.5%) died during a mean follow-up period of 571 days; ischemic and hemorrhagic stroke occurred in 82 (12.3%) and 13 patients (1.3%), respectively, and major bleedings in 43 patients (4.4%). Vitamin K antagonists' use was independently associated with reduced mortality (odds ratio 0.524) and with a nonsignificant reduction in incidence of ischemic stroke, without excess in bleeding risk. Similar findings were observed in the 2 propensity score-matched cohorts of patients. In conclusion, among vulnerable patients with atrial fibrillation ≥65 years with high post-discharge death rate, OAT was associated, among other multiple factors, with reduced mortality.
authors.affiliation: SCDU Geriatria e Malattie Metaboliche dell'Osso, Città della Salute e della Scienza-Molinette, Torino, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Bo
authors.affiliation: SCDU Geriatria e Malattie Metaboliche dell'Osso, Città della Salute e della Scienza-Molinette, Torino, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Sciarrillo
authors.affiliation: SCDU Geriatria e Malattie Metaboliche dell'Osso, Città della Salute e della Scienza-Molinette, Torino, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Li Puma
authors.affiliation: SCDU Geriatria e Malattie Metaboliche dell'Osso, Città della Salute e della Scienza-Molinette, Torino, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Badinella Martini
authors.affiliation: SCDU Geriatria e Malattie Metaboliche dell'Osso, Città della Salute e della Scienza-Molinette, Torino, Italy. Electronic address: yolanda.falcone@yahoo.it.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Falcone
authors.affiliation: SCDU Geriatria e Malattie Metaboliche dell'Osso, Città della Salute e della Scienza-Molinette, Torino, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Iacovino
authors.affiliation: SCDU Geriatria e Malattie Metaboliche dell'Osso, Città della Salute e della Scienza-Molinette, Torino, Italy.
authors.forename: Enrica
authors.initials: E
authors.lastname: Grisoglio
authors.affiliation: SCDU Geriatria e Malattie Metaboliche dell'Osso, Città della Salute e della Scienza-Molinette, Torino, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Menditto
authors.affiliation: SCDU Geriatria e Malattie Metaboliche dell'Osso, Città della Salute e della Scienza-Molinette, Torino, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Fonte
authors.affiliation: SCDU Geriatria e Malattie Metaboliche dell'Osso, Città della Salute e della Scienza-Molinette, Torino, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Brunetti
authors.affiliation: SCDU Geriatria e Malattie Metaboliche dell'Osso, Città della Salute e della Scienza-Molinette, Torino, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Maggiani
authors.affiliation: SCDU Geriatria e Malattie Metaboliche dell'Osso, Città della Salute e della Scienza-Molinette, Torino, Italy.
authors.forename: Giovanni Carlo
authors.initials: GC
authors.lastname: Isaia
authors.affiliation: SCDU Cardiologia, Città della Salute e della Scienza-Molinette, Torino, Italy.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000401:mortality; D002545:Brain Ischemia / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007297:Inpatients; D007558:Italy / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
chemical_list: D000925:Anticoagulants