AIMS: To assess the use of antithrombotic treatment (ATT) after hospitalization with atrial fibrillation (AF) and the attributable effectiveness of ATT during follow-up. METHODS AND RESULTS: On the basis of record linkage of administrative registers, 1812 patients discharged with AF were identified and followed-up for major clinical events up to 1 year. Mean age was 79 years. After hospitalization, 56% of the patients received ATT: 29% anticoagulants, 22% antiplatelets (APs), and 5% both agents. Among patients without comorbidities, 63.0% were exposed to ATT. Several factors significantly influence the use of antithrombotic agents, including increasing age [odds ratio (OR) 0.93 (95% confidence interval (CI), 0.92-0.95)], chronic obstructive pulmonary disease [0.77 (0.59-1.00)], malignancy [0.57 (0.39-0.82)], and previous use of ATT [4.56 (3.67-5.67)]. A significantly lower mortality was observed in patients exposed to ATT [hazard ratio (HR) 0.36 (95% CI, 0.28-0.47)], both to anticoagulants [0.23 (0.15-0.35)] and to APs [0.66 (0.50-0.86)]. ATT was associated with the reduction of thrombo-embolic events [0.52 (0.25-1.07)]. Major bleeding did not contribute to increased morbidity. Subgroups analysis, propensity score (PS), and sensitivity analysis confirmed these results. CONCLUSION: Our data demonstrated that ATT was underused, also in patients without comorbidities. Exposure to ATT is associated with improved survival among elderly high-risk community patients hospitalized with AF.
AIMS: To assess the use of antithrombotic treatment (ATT) after hospitalization with atrial fibrillation (AF) and the attributable effectiveness of ATT during follow-up. METHODS AND RESULTS: On the basis of record linkage of administrative registers, 1812 patients discharged with AF were identified and followed-up for major clinical events up to 1 year. Mean age was 79 years. After hospitalization, 56% of the patients received ATT: 29% anticoagulants, 22% antiplatelets (APs), and 5% both agents. Among patients without comorbidities, 63.0% were exposed to ATT. Several factors significantly influence the use of antithrombotic agents, including increasing age [odds ratio (OR) 0.93 (95% confidence interval (CI), 0.92-0.95)], chronic obstructive pulmonary disease [0.77 (0.59-1.00)], malignancy [0.57 (0.39-0.82)], and previous use of ATT [4.56 (3.67-5.67)]. A significantly lower mortality was observed in patients exposed to ATT [hazard ratio (HR) 0.36 (95% CI, 0.28-0.47)], both to anticoagulants [0.23 (0.15-0.35)] and to APs [0.66 (0.50-0.86)]. ATT was associated with the reduction of thrombo-embolic events [0.52 (0.25-1.07)]. Major bleeding did not contribute to increased morbidity. Subgroups analysis, propensity score (PS), and sensitivity analysis confirmed these results. CONCLUSION: Our data demonstrated that ATT was underused, also in patients without comorbidities. Exposure to ATT is associated with improved survival among elderly high-risk community patients hospitalized with AF.