title: Health status, geriatric syndromes and prescription of oral anticoagulant therapy in elderly medical inpatients with atrial fibrillation.
abstract: OBJECTIVE
  The aim of the present study was to investigate the prevalence of geriatric syndromes among older medical inpatients with atrial fibrillation, and their association with use of vitamin K antagonists.
  
  
  METHODS
  A retrospective study of patients aged ≥65 years discharged with a diagnosis of atrial fibrillation from the Acute Geriatric Ward was carried out. Stroke and bleeding risk were evaluated according to the CHA2DS2-VASC and HAS-BLED scores. Comorbidity, cognitive status, functional autonomy and contraindications to vitamin K antagonists were also considered.
  
  
  RESULTS
  Atrial fibrillation was documented in 1078 of 3650 patients (29.5%, mean age 83.4 ± 6.6 years, 60.3% women). Contraindications to vitamin K antagonists were documented in 24.9% of patients. Prescription of vitamin K antagonists at discharge was 37.8% and 47.9%, in the overall sample and in those without contraindications, respectively. In the overall sample, prescription of vitamin K antagonists was associated with younger age, permanent/persistent atrial fibrillation, home discharge, less comorbidity, higher hemoglobin levels, better functional independence, known atrial fibrillation at admission and lower HAS-BLED score. Among patients without contraindications to vitamin K antagonists, their use at discharge was independently associated with younger age, permanent/persistent atrial fibrillation, home discharge, higher hemoglobin levels and CHA2DS2-VASC score, better functional autonomy, and greater number of drugs.
  
  
  CONCLUSIONS
  We showed a high prevalence of atrial fibrillation among older medical inpatients, who have a poor health status and a high prevalence of geriatric syndromes. Vitamin K antagonists were prescribed in less than half of the patients; underuse was mainly accounted for by a high prevalence of comorbidities/contraindications, poor health status and limited functional autonomy. Geriatr Gerontol Int 2017; 17: 416-423.
authors.affiliation: SCDU Geriatria e Malattie Metaboliche dell'Osso, Città della Salute e della Scienza-Molinette, Torino, Italia.
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, Italia.
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, Italia.
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, Italia.
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, Italia.
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, Italia.
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, Italia.
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, Italia.
authors.forename: Simon
authors.initials: S
authors.lastname: Grosjean
authors.affiliation: SCDU Cardiologia, Città della Salute e della Scienza-Molinette, Torino, Italia.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D015331:Cohort Studies; D011307:Drug Prescriptions; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007558:Italy; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000517:prevention & control; D016019:Survival Analysis
chemical_list: D000925:Anticoagulants
keywords: atrial fibrillation; elderly; geriatric syndromes; health status; older medical inpatients