title: Real-World Clinical Characteristics and Treatment Patterns of Individuals Aged 80 and Older with Nonvalvular Atrial Fibrillation: Results from the ReAl-life Multicenter Survey Evaluating Stroke Study.
abstract: OBJECTIVE
  To compare the clinical characteristics of and use of oral anticoagulant (OAC) therapy in individuals aged 80 and older with atrial fibrillation (AF) with those of individuals younger than 80 with AF in clinical practice.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  The ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey trial (NCT02344901), a national observational registry.
  
  
  METHODS
  Turkish adults with nonvalvular AF (NVAF).
  
  
  METHODS
  Age data were collected at the time of entry into the registry and the octogenarian subgroup included all patients aged ≥ 80 years. We compared background and management in octogenarian with non-octogenarian AF patients.
  
  
  RESULTS
  Fifty-seven cardiology units enrolled 6,273 individuals in 3 months. Participants aged 80 and older (n = 1,170) were more likely to be female (60.7% vs 54.7%, P < .001) and had a higher prevalence of persistant or permanent AF, comorbidities, history of cerebral vascular accident, and major bleeding. As a consequence of having more comorbidities, Congestive heart failure; Hypertension; Aged 75 and older; Diabetes Mellitus; prior stroke, transient ischemic attack, or thromboembolism; Vascular disease; Aged 65 to 74; female Sex (CHA2DS2VASc) (4.32 ± 1.35 vs 3.04 ± 1.54, P < .001) and Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile international normalized ratio, Elderly, Drugs or alcohol (HAS-BLED) (2.14 ± 1.05 vs 1.54 ± 1.05, P < .001) scores were higher in those aged 80 and older. The mean time in therapeutic range of individuals who were taking warfarin was lower in those aged 80 and older (45.9 ± 27.9) than in those younger than 80 (54.7 ± 24.9%, P < .001). Anticoagulant therapy was prescribed for 74.8% of participants younger than 80% and 63% of those aged 80 and older (P < .001). Higher CHA2DS2VASc score and lower HAS-BLED score were independent predictors of OAC prescription in participants aged 80 and older.
  
  
  CONCLUSIONS
  Nearly one-fifth of individuals with NVAF in this real-world sample were aged 80 and older. Participants aged 80 and older were more likely to be female and have more comorbidities than those who were younger than 80. Those aged 80 and older with AF were less likely to receive anticoagulants than those who were younger than 80, but having more comorbidities and other individual-level characteristics may explain this difference. When they were prescribed OACs, participants aged 80 and older had poorer quality of anticoagulation than those who were younger, suggesting opportunities for improvement.
authors.affiliation: Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Biteker
authors.affiliation: Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey.
authors.forename: Özcan
authors.initials: Ö
authors.lastname: Başaran
authors.affiliation: Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey.
authors.forename: Volkan
authors.initials: V
authors.lastname: Doğan
authors.affiliation: Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey.
authors.forename: İbrahim
authors.initials: İ
authors.lastname: Altun
authors.affiliation: Department of Cardiology, Şanlıurfa Balıklıgöl State Hospital, Şanlıurfa, Turkey.
authors.forename: Fatma
authors.initials: F
authors.lastname: Özpamuk Karadeniz
authors.affiliation: Department of Cardiology, Siyami Ersek Heart Education and Research Hospital, Istanbul, Turkey.
authors.forename: Ahmet İlker
authors.initials: Aİ
authors.lastname: Tekkesin
authors.affiliation: Department of Cardiology, Tuzla State Hospital, Istanbul, Turkey.
authors.forename: Yasin
authors.initials: Y
authors.lastname: Çakıllı
authors.affiliation: Department of Cardiology, Siyami Ersek Heart Education and Research Hospital, Istanbul, Turkey.
authors.forename: Ceyhan
authors.initials: C
authors.lastname: Türkkan
authors.affiliation: Department of Cardiology, Bandırma State Hospital, Bandırma, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Hamidi
authors.affiliation: Department of Cardiology, Yozgat State Hospital, Yozgat, Turkey.
authors.forename: Vahit
authors.initials: V
authors.lastname: Demir
authors.affiliation: Department of Cardiology, Gaziemir State Hospital, Izmir, Turkey.
authors.forename: Mustafa Ozan
authors.initials: MO
authors.lastname: Gürsoy
authors.affiliation: Department of Cardiology, Ankara Keçiören Education and Research Hospital, Ankara, Turkey.
authors.forename: Müjgan
authors.initials: M
authors.lastname: Tek Öztürk
authors.affiliation: Department of Cardiology, Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey.
authors.forename: Gökhan
authors.initials: G
authors.lastname: Aksan
authors.affiliation: Department of Cardiology, Mersin Private Dogus Hospital, Mersin, Turkey.
authors.forename: Sabri
authors.initials: S
authors.lastname: Seyis
authors.affiliation: Department of Cardiology, Mersin Toros State Hospital, Mersin, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ballı
authors.affiliation: Department of Cardiology, Gaziantep be Aralık State Hospital, Gaziantep, Turkey.
authors.forename: Mehmet Hayri
authors.initials: MH
authors.lastname: Alıcı
authors.affiliation: Department of Cardiology, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey.
authors.forename: Serdar
authors.initials: S
authors.lastname: Bozyel
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control; D014421:Turkey; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: atrial fibrillation; non-valvular atrial fibrillation; octogenarians; oral anticoagulant therapy