title: Oral anticoagulation in patients with atrial fibrillation and medical non-neoplastic disease in a terminal stage.
abstract: Many patients with non-neoplastic disease develop atrial fibrillation in advanced stages of their disease. The aim of this study is to determine the factors associated with the use of oral anticoagulants in patients with atrial fibrillation and non-neoplastic medical disease in a terminal stage, and whether their use is associated with a longer survival. Design is prospective, observational, multicentre study. Patients with atrial fibrillation and non-neoplastic disease (severe not reversible organ insufficiency) in a terminal stage were included between February 2009 and September 2010. A 6-month follow-up was carried out. We included 314 patients with a mean (SD) age of 82.6 (7.0) years. Their mean (SD) scores in CHADS2 and ATRIA scales were 3.4 (1.2) and 4.7 (2.0), respectively. Anticoagulants were prescribed to 112 (37.5 %) patients. The use of anticoagulants was associated with age (OR 0.96 95 % CI 0.93-0.99, p = 0.046) and to the Barthel index (OR 1.01 95 % CI 1.00-1.02; p = 0.034). After performing a propensity score matching analysis, 262 patients were included in the survival analysis. After 6 months, 133 (50.8 %) patients were dead. The mortality is higher among patients who are not treated with oral anticoagulants (57.1 vs. 39.4 %; p = 0.006), but it is independently associated only with the Barthel index score (HR 0.99 95 % CI 0.98-1.00; p = 0.039), delirium (HR 1.60, 95 % CI 1.08-2.36; p = 0.018), anorexia (HR 1.58 95 % CI 1.05-2.38; p = 0.027), and with the use of calcium channel blockers (HR 0.50 95 % CI 0.30-0.84; p = 0.009). In patients with atrial fibrillation and non-neoplastic disease in a terminal stage, the use of oral anticoagulants is not independently associated with a higher probability of survival.
authors: Internal Medicine Department, Hospital Royo Villanova, Duquesa Villahermosa No 163, 80 D, 50009, Saragossa, Spain. jdiez@aragon.es.|Research Group of Comorbidity and Polypathology in Aragon, Aragon Health Sciences Institute, Saragossa, Spain. jdiez@aragon.es.|Department of Medicine, Dermatology and Psychiatry, University of Zaragoza School of Medicine, Saragossa, Spain. jdiez@aragon.es.
authors: Jesús
authors: http://orcid.org/0000-0002-3132-2171
authors: J
authors: Díez-Manglano
authors: Internal Medicine Department, Complejo Hospitalario Virgen del Rocío, Seville, Spain.
authors: Máximo
authors: M
authors: Bernabeu-Wittel
authors: Internal Medicine Department, Hospital de la Vega Baja, Orihuela, Spain.
authors: José
authors: J
authors: Murcia-Zaragoza
authors: Internal Medicine Department, Hospital de la Serranía, Ronda, Spain.
authors: Belén
authors: B
authors: Escolano-Fernández
authors: Internal Medicine Department, Hospital de la Serranía, Ronda, Spain.
authors: Guadalupe
authors: G
authors: Jarava-Rol
authors: Internal Medicine Department, Complejo Hospitalario Virgen del Rocío, Seville, Spain.
authors: Carlos
authors: C
authors: Hernández-Quiles
authors: Internal Medicina Department, Hospital Virgen del Camino, Sanlúcar de Barrameda, Spain.
authors: Miguel
authors: M
authors: Oliver
authors: Internal Medicine Department, Hospital Central de la Cruz Roja Santa Adela y San José, Madrid, Spain.
authors: Susana
authors: S
authors: Sanz-Baena
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000494:pharmacology* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000209:etiology; D002121:Calcium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain; D016019:Survival Analysis; D013727:Terminal Care / Q000379:methods*
chemical_list: D000925:Anticoagulants; D002121:Calcium Channel Blockers
keywords: Atrial fibrillation; Calcium channel blockers; Oral anticoagulants; Survival; Terminal stage disease