TY - JOUR

T1 - Management of Atrial Fibrillation in Older Patients by Morbidity Burden

T2 - Insights From Get With The Guidelines-Atrial Fibrillation

AU - Dalgaard, Frederik

AU - Xu, Haolin

AU - Matsouaka, Roland A

AU - Russo, Andrea M

AU - Curtis, Anne B

AU - Rasmussen, Peter Vibe

AU - Ruwald, Martin H

AU - Fonarow, Gregg C

AU - Lowenstern, Angela

AU - Hansen, Morten L

AU - Pallisgaard, Jannik L

AU - Alexander, Karen P

AU - Alexander, John H

AU - Lopes, Renato D

AU - Granger, Christopher B

AU - Lewis, William R

AU - Piccini, Jonathan P

AU - Al-Khatib, Sana M

PY - 2020

Y1 - 2020

N2 - Background Knowledge is scarce regarding how multimorbidity is associated with therapeutic decisions regarding oral anticoagulants (OACs) in patients with atrial fibrillation. Methods and Results We conducted a cross-sectional study of hospitalized patients with atrial fibrillation using the Get With The Guidelines-Atrial Fibrillation registry from 2013 to 2019. We identified patients ≥65 years and eligible for OAC therapy. Using 16 available comorbidity categories, patients were stratified by morbidity burden. A multivariable logistic regression model was used to determine the odds of receiving OAC prescription at discharge by morbidity burden. We included 34 174 patients with a median (interquartile range) age of 76 (71-83) years, 56.6% women, and 41.9% were not anticoagulated at admission. Of these patients, 38.6% had 0 to 2 comorbidities, 50.7% had 3 to 5 comorbidities, and 10.7% had ≥6 comorbidities. The overall discharge OAC prescription was high (85.6%). The prevalence of patients with multimorbidity increased from 59.7% in 2014 to 64.3% in 2019 (P trend=0.002). Using 0 to 2 comorbidities as the reference, the adjusted odds ratio (95% CI) of OAC prescription were 0.93 (0.82, 1.05) for patients with 3 to 5 comorbidities and 0.72 (0.60, 0.86) for patients with ≥6 comorbidities. In those with ≥6 comorbidities, the most common reason for nonprescription of OACs were frequent falls/frailty (31.0%). Conclusions In a contemporary quality-of-care database of hospitalized patients with atrial fibrillation eligible for OAC therapy, multimorbidity was common. A higher morbidity burden was associated with a lower odds of OAC prescription. This highlights the need for interventions to improve adherence to guideline-recommended anticoagulation in multimorbid patients with atrial fibrillation.

AB - Background Knowledge is scarce regarding how multimorbidity is associated with therapeutic decisions regarding oral anticoagulants (OACs) in patients with atrial fibrillation. Methods and Results We conducted a cross-sectional study of hospitalized patients with atrial fibrillation using the Get With The Guidelines-Atrial Fibrillation registry from 2013 to 2019. We identified patients ≥65 years and eligible for OAC therapy. Using 16 available comorbidity categories, patients were stratified by morbidity burden. A multivariable logistic regression model was used to determine the odds of receiving OAC prescription at discharge by morbidity burden. We included 34 174 patients with a median (interquartile range) age of 76 (71-83) years, 56.6% women, and 41.9% were not anticoagulated at admission. Of these patients, 38.6% had 0 to 2 comorbidities, 50.7% had 3 to 5 comorbidities, and 10.7% had ≥6 comorbidities. The overall discharge OAC prescription was high (85.6%). The prevalence of patients with multimorbidity increased from 59.7% in 2014 to 64.3% in 2019 (P trend=0.002). Using 0 to 2 comorbidities as the reference, the adjusted odds ratio (95% CI) of OAC prescription were 0.93 (0.82, 1.05) for patients with 3 to 5 comorbidities and 0.72 (0.60, 0.86) for patients with ≥6 comorbidities. In those with ≥6 comorbidities, the most common reason for nonprescription of OACs were frequent falls/frailty (31.0%). Conclusions In a contemporary quality-of-care database of hospitalized patients with atrial fibrillation eligible for OAC therapy, multimorbidity was common. A higher morbidity burden was associated with a lower odds of OAC prescription. This highlights the need for interventions to improve adherence to guideline-recommended anticoagulation in multimorbid patients with atrial fibrillation.

KW - Administration, Oral

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Anticoagulants/therapeutic use

KW - Atrial Fibrillation/complications

KW - Cross-Sectional Studies

KW - Female

KW - Hospitalization

KW - Humans

KW - Logistic Models

KW - Male

KW - Multimorbidity

KW - Odds Ratio

KW - Practice Guidelines as Topic

KW - Practice Patterns, Physicians'

KW - Registries

U2 - 10.1161/JAHA.120.017024

DO - 10.1161/JAHA.120.017024

M3 - Journal article

C2 - 33241750

VL - 9

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 23

M1 - e017024

ER -