Atrial fibrillation in older inpatients: are there any differences in clinical characteristics and pharmacological treatment between the frail and the non-frail?
Intern Med J. 2015 Sep 19;
Authors: Nguyen TN, Cumming RG, Hilmer SN
Abstract
BACKGROUND: Frailty is common in patients with atrial fibrillation (AF) and may impact on antithrombotic and antiarrhythmic treatment.
AIM: Describe differences in clinical characteristics, prescription of antithrombotic and antiarrhythmic medications and incidence of haemorrhage and stroke, between frail and non-frail older inpatients.
METHODS: Prospective observational study in patients aged ≥65 years with AF admitted to a teaching hospital in Sydney, Australia. Frailty was assessed using the Reported Edmonton Frail Scale, stroke risk with CHA2DS2-VASc score and bleeding risk with HAS-BLED score. Participants were followed after six months for haemorrhages and strokes.
RESULTS: We recruited 302 patients (mean age 84.7 ± 7.1, 53.3% frail, 50% female, mean CHA2DS2-VASc 4.61 ± 1.44, mean HAS-BLED 2.97 ± 1.04). Frail participants were older, had more comorbidities and higher risk of stroke but not haemorrhage. Upon discharge, 55.7% participants were prescribed anticoagulants (49.3% frail, 62.6% non-frail, p = 0.02). Thirty-three percent received antiplatelets only and 11.1% no antithrombotics, with no difference by frailty status. For antiarrhythmics, 52.6% received rate-control drugs only, 11.8% rhythm-control drugs only, 13.5% both and 22.1% were not prescribed either, with no difference by frailty status. On univariate logistic regression, frailty decreased the likelihood of anticoagulant prescription (OR 0.58, 95%CI 0.36-0.93), but this was not significant on multivariate analysis (OR 0.66 95%CI 0.40 - 1.11). After six months, overall incidence of ischemic stroke was 2.1% and, in patients taking anticoagulants, incidence of major/severe bleeding was 6.3%, with no significant difference between frailty groups.
CONCLUSIONS: Frailty status had little impact on antithrombotic prescription and no impact on anti-arrhythmic prescription.
PMID: 26388116 [PubMed - as supplied by publisher]