Use of Oral Anticoagulant Therapy in Older Adults with Atrial Fibrillation After Acute Ischemic Stroke

Objectives To explore barriers to anticoagulation in older adults with atrial fibrillation (AF) at high risk of stroke and to identify opportunities for interventions that might increase use of oral anticoagulants (OACs). Design Retrospective cohort study. Setting Two large community‐based AF cohort...

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Bibliographic Details
Published in:Journal of the American Geriatrics Society (JAGS) 2017-02, Vol.65 (2), p.241-248
Main Authors: McGrath, Emer R., Go, Alan S., Chang, Yuchiao, Borowsky, Leila H., Fang, Margaret C., Reynolds, Kristi, Singer, Daniel E.
Format: Article
Language:English
Subjects:
Accidental Falls
Administration, Oral
Age Factors
Aged
Aged, 80 and over
Anticoagulants
Anticoagulants - therapeutic use
atrial fibrillation
Atrial Fibrillation - drug therapy
Atrial Fibrillation - mortality
Cardiac arrhythmia
Cohort Studies
Comorbidity
decision‐making
Dementia
Dementia - complications
Drug Prescriptions - statistics & numerical data
Female
Humans
ischemic stroke
Male
Medical prognosis
Older people
oral anticoagulants
Patient Discharge
Prognosis
Recurrence
Retrospective Studies
Risk factors
Stroke - prevention & control
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Summary:Objectives To explore barriers to anticoagulation in older adults with atrial fibrillation (AF) at high risk of stroke and to identify opportunities for interventions that might increase use of oral anticoagulants (OACs). Design Retrospective cohort study. Setting Two large community‐based AF cohorts. Participants Individuals with ischemic stroke surviving hospitalization (N = 1,405, mean age 79). Measurements Using structured chart review, reasons for nonuse of OAC were identified, and 1‐year poststroke survival was assessed. Logistic regression was used to identify correlates of OAC nonuse. Results Median CHA2DS2‐VASc score was 5, yet 44% of participants were not prescribed an OAC at discharge. The most‐frequent (nonmutually exclusive) physician reasons for not prescribing OAC included fall risk (26.7%), poor prognosis (19.3%), bleeding history (17.1%), participant or family refusal (14.9%), older age (11.0%), and dementia (9.4%). Older age (odds ratio (OR) = 8.96, 95% confidence interval (CI) = 5.01–16.04 for aged ≥85 vs
ISSN:0002-8614
1532-5415
DOI:10.1111/jgs.14688