title: Oral anticoagulant use in octogenarian European patients with atrial fibrillation: A subanalysis of PREFER in AF.
abstract: BACKGROUND
  Few studies describe oral anticoagulant (OAC) prescription practices in very elderly patients with atrial fibrillation (AF).
  
  
  METHODS
  In this sub-analysis of the PREFER in AF study, performed in 2012, patients were stratified according to age (<80 [n=5565] and ≥80years [n=1660]) and OAC treatment. Factors associated with OAC prescription were analyzed in a multivariate logistic regression model with backward elimination of variables least associated with OAC use.
  
  
  RESULTS
  Patients ≥80years presented with permanent AF more often (p<0.0001) and reported fatigue and dyspnea more frequently (p<0.0001) and palpitations less frequently (p<0.0001) than patients <80years. Hypertension, stroke, heart failure, coronary heart disease, peripheral arterial disease, cancer, chronic kidney disease, and prior major bleeding were significantly more frequent in ≥80years. Most patients were treated with OACs in both age groups. The overall use of vitamin K antagonists was similar in both groups (78.2% vs.78.2% p=0.98), while the use of non-vitamin K antagonist OACs was lower in the ≥80years old group than in the <80years group (4.5% vs. 6.6% p=0.001). Among patients ≥80years, prior stroke and heart failure were significantly associated with OAC use, whereas higher age, prior bleeding, paroxysmal AF, chronic hepatic disease, and difficulties with self-care were associated with no OAC use.
  
  
  CONCLUSIONS
  The current use of OAC in European AF patients was satisfactorily high in octogenarians, suggesting reasonable implementation of current guidelines. Interestingly, patients with poor quality of life were less often anticoagulated. This may warrant further studies.
authors.affiliation: APHP, Hôpital Broca, 54-56 Pascal, 75013 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Equipe d'Accueil 4468, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Hanon
authors.affiliation: APHP, Hôpital Broca, 54-56 Pascal, 75013 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Equipe d'Accueil 4468, Paris, France.
authors.forename: Jean-Sébastien
authors.initials: JS
authors.lastname: Vidal
authors.affiliation: Georges Pompidou Hospital, René Descartes University, Paris, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Le Heuzey
authors.affiliation: Institute of Cardiovascular Sciences, University of Birmingham and SWBH and UHB NHS Trusts, Birmingham, UK; Department of Cardiovascular Medicine, Hospital of the University of Münster, Münster, Germany; AFNET, Münster, Germany.
authors.forename: Paulus
authors.initials: P
authors.lastname: Kirchhof
authors.affiliation: Institute of Cardiology, Center of Excellence on Aging, G. d'Annunzio University, Chieti-Pescara, Italy; Ospedale SS. Annunziata, Chieti, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: De Caterina
authors.affiliation: Daiichi Sankyo Europe GmbH, Munich, Germany.
authors.forename: Josef
authors.initials: J
authors.lastname: Schmitt
authors.affiliation: Daiichi Sankyo Europe GmbH, Munich, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Laeis
authors.affiliation: Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy; University of Milan, Milan, Italy.
authors.forename: Pier Mannuccio
authors.initials: PM
authors.lastname: Mannucci
authors.affiliation: University of Milan, Milan, Italy; Geriatric Unit, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy.
authors.forename: Maura
authors.initials: M
authors.lastname: Marcucci
mesh_terms: D000284:Administration, Oral; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012042:Registries; D012307:Risk Factors; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: Atrial fibrillation; Elderly: Oral anticoagulants: Multivariate analysis