Prevalence of Frailty and Associations with Oral Anticoagulant Prescribing in Atrial Fibrillation

Background Frailty is often cited as a factor influencing oral anticoagulation (OAC) prescription in patients with non-valvular atrial fibrillation (NVAF). We sought to determine the prevalence of frailty and its association with OAC prescription in older veterans with NVAF. Methods We used ICD-9 co...

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Bibliographic Details
Published in:Journal of general internal medicine : JGIM 2022-03, Vol.37 (4), p.730-736
Main Authors: Sanghai, Saket R., Liu, Weisong, Wang, Weijia, Rongali, Subendhu, Orkaby, Ariela R., Saczynski, Jane S., Rose, Adam J., Kapoor, Alok, Li, Wenjun, Yu, Hong, McManus, David D.
Format: Article
Language:English
Subjects:
Administration, Oral
Aged
Anticoagulants
Anticoagulants - adverse effects
Atrial Fibrillation - complications
Atrial Fibrillation - drug therapy
Atrial Fibrillation - epidemiology
Cardiac arrhythmia
Fibrillation
Frailty
Frailty - complications
Government programs
Humans
Internal Medicine
Medicare
Medicine
Medicine & Public Health
Original Research
Prevalence
Regression analysis
Regression models
Stroke - epidemiology
Stroke - prevention & control
United States - epidemiology
Veterans
Vitamin K
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Summary:Background Frailty is often cited as a factor influencing oral anticoagulation (OAC) prescription in patients with non-valvular atrial fibrillation (NVAF). We sought to determine the prevalence of frailty and its association with OAC prescription in older veterans with NVAF. Methods We used ICD-9 codes in Veterans Affairs (VA) records and Medicare claims data to identify patients with NVAF and CHA 2 DS 2 VASC ≥2 receiving care between February 2010 and September 2015. We examined rates of OAC prescription, further stratified by direct oral anticoagulant (DOAC) or vitamin K antagonist (VKA). Participants were characterized into 3 categories: non-frail, pre-frail, and frail based on a validated 30-item EHR-derived frailty index. We examined relations between frailty and OAC receipt; and frailty and type of OAC prescribed in regression models adjusted for factors related to OAC prescription. Results Of 308,664 veterans with NVAF and a CHA 2 DS 2 VASC score ≥2, 121,839 (39%) were prescribed OAC (73% VKA). The mean age was 77.7 (9.6) years; CHA 2 DS 2 VASC and ATRIA scores were 4.6 (1.6) and 5.0 (2.9) respectively. Approximately a third (38%) were frail, another third (32%) were pre-frail, and the remainder were not frail. Veterans prescribed OAC were younger, had higher bleeding risk, and were less likely to be frail than participants not receiving OAC (all p ’s
ISSN:0884-8734
1525-1497
DOI:10.1007/s11606-021-06834-1