The Effect of Bleeding Risk and Frailty Status on Anticoagulation Patterns in Octogenarians With Atrial Fibrillation: The FRAIL-AF Study

• Published in: Canadian journal of cardiology 2016-02, Vol.32 (2), p.169-176
• Main Authors: Lefebvre, Marie-Claude D., PharmD, MSc, St-Onge, Maude, PharmD, MSc, Glazer-Cavanagh, Maude, PharmD, MSc, Bell, Laurence, PharmD, Kha Nguyen, John Nam, BPharm, MSc, Viet-Quoc Nguyen, Patrick, BPharm, MSc, EMBA, Tannenbaum, Cara, MD, MSc
• Format: Article
• Language: English
• Subjects: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants - administration & dosage; Atrial Fibrillation - blood; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Blood Coagulation; Cardiovascular; Cross-Sectional Studies; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Frail Elderly; Hemorrhage - blood; Hemorrhage - chemically induced; Hemorrhage - epidemiology; Humans; Incidence; Male; Quebec - epidemiology; Retrospective Studies; Risk Assessment - methods; Risk Factors; Thromboembolism - etiology; Thromboembolism - prevention & control; Warfarin - administration & dosage
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2015.05.012

Abstract Background Older adults are at increased risk of atrial fibrillation (AF), its thromboembolic complications, and bleeding. A significant percentage of octogenarians do not receive anticoagulation therapy. The objective of this study was to investigate the effect of thromboembolic risk, bleeding risk, and frailty on the anticoagulation status of octogenarians hospitalized with AF. Methods A cross-sectional study was conducted in 682 hospitalized patients aged 80 years and older with AF or atrial flutter in Montreal, Québec. Consumption of warfarin or a new oral anticoagulant was documented. Medical record data were used to determine each patient's frailty status using the Clinical Frailty Scale (CFS) and to evaluate the risk of stroke (CHADS2 [ C ongestive Heart Failure, H ypertension, A ge, D iabetes, S troke/Transient Ischemic Attack]) and bleeding (HAS-BLED [ H ypertension, A bnormal renal/liver function, S troke, B leeding history or predisposition, L abile international normalized ratio, E lderly (> 65 years) D rugs/alcohol concomitantly]). Univariable and multivariable logistic regression analyses were used to examine the effect of frailty status and the risk of stroke and bleeding on the probability of receiving anticoagulation therapy. Results Seventy percent of octogenarians with AF received anticoagulation therapy (n = 475). A high risk of stroke (CHADS2  = 3 compared with CHADS2  = 1, odds ratio [OR], 3.58; 95% confidence interval [CI], 1.09-11.77), and the absence of severe frailty (CFS < 7; OR, 3.41; 95% CI, 1.84-6.33) were independently associated with anticoagulant use in multivariable analyses. A high risk of bleeding (HAS-BLED score ≥ 3; OR, 0.33; 95% CI, 0.12-0.86) was associated with the absence of anticoagulation. Conclusions Our study suggests a higher prevalence of appropriate anticoagulation among octogenarians with AF than reported in previous studies. Further work is needed to develop and disseminate tools to optimize the use of anticoagulants in this high-risk population.