Should nursing home residents with atrial fibrillation be anticoagulated?

Most long-term care residents with atrial fibrillation would be at high risk for embolic stroke based on age and comorbidities according to the criteria presented here. Additionally, they are theoretically excellent candidates for adjusted-dose warfarin treatment for atrial fibrillation. They are accessible for monitoring and tend to have less dietary variability, a controlled medication list, and supervised medication administration. Balancing these features is at least a moderate risk of severe bleeding from anticoagulation based on age, comorbidities, and polypharmacy. However, studies suggest that even those long-term care residents identified as ideal candidates for anticoagulation may not receive warfarin. Those residents who do receive warfarin may not be anticoagulated within the therapeutic range much of the time. This treatment pattern may expose older adults with a high stroke risk to dying from a cardioembolic stroke or to acquiring functional deficits that make them more dependent and lower their quality of life.