Murat Biteker1, Özcan Başaran1, Volkan Doğan1, İbrahim Altun1, Fatma Özpamuk Karadeniz2, Ahmet İlker Tekkesin3, Yasin Çakıllı4, Ceyhan Türkkan3, Mehmet Hamidi5, Vahit Demir6, Mustafa Ozan Gürsoy7, Müjgan Tek Öztürk8, Gökhan Aksan9, Sabri Seyis10, Mehmet Ballı11, Mehmet Hayri Alıcı12, Serdar Bozyel13. 1. Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey. 2. Department of Cardiology, Şanlıurfa Balıklıgöl State Hospital, Şanlıurfa, Turkey. 3. Department of Cardiology, Siyami Ersek Heart Education and Research Hospital, Istanbul, Turkey. 4. Department of Cardiology, Tuzla State Hospital, Istanbul, Turkey. 5. Department of Cardiology, Bandırma State Hospital, Bandırma, Turkey. 6. Department of Cardiology, Yozgat State Hospital, Yozgat, Turkey. 7. Department of Cardiology, Gaziemir State Hospital, Izmir, Turkey. 8. Department of Cardiology, Ankara Keçiören Education and Research Hospital, Ankara, Turkey. 9. Department of Cardiology, Şişli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey. 10. Department of Cardiology, Mersin Private Dogus Hospital, Mersin, Turkey. 11. Department of Cardiology, Mersin Toros State Hospital, Mersin, Turkey. 12. Department of Cardiology, Gaziantep be Aralık State Hospital, Gaziantep, Turkey. 13. Department of Cardiology, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey.
Abstract
OBJECTIVES: To compare the clinical characteristics of and use of oral anticoagulant (OAC) therapy in individuals aged 80 and older with atrial fibrillation (AF) with those of individuals younger than 80 with AF in clinical practice. DESIGN: Observational study. SETTING: The ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey trial (NCT02344901), a national observational registry. PARTICIPANTS: Turkish adults with nonvalvular AF (NVAF). MEASUREMENTS: Age data were collected at the time of entry into the registry and the octogenarian subgroup included all patients aged ≥ 80 years. We compared background and management in octogenarian with non-octogenarian AF patients. RESULTS: Fifty-seven cardiology units enrolled 6,273 individuals in 3 months. Participants aged 80 and older (n = 1,170) were more likely to be female (60.7% vs 54.7%, P < .001) and had a higher prevalence of persistant or permanent AF, comorbidities, history of cerebral vascular accident, and major bleeding. As a consequence of having more comorbidities, Congestive heart failure; Hypertension; Aged 75 and older; Diabetes Mellitus; prior stroke, transient ischemic attack, or thromboembolism; Vascular disease; Aged 65 to 74; female Sex (CHA2 DS2 VASc) (4.32 ± 1.35 vs 3.04 ± 1.54, P < .001) and Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile international normalized ratio, Elderly, Drugs or alcohol (HAS-BLED) (2.14 ± 1.05 vs 1.54 ± 1.05, P < .001) scores were higher in those aged 80 and older. The mean time in therapeutic range of individuals who were taking warfarin was lower in those aged 80 and older (45.9 ± 27.9) than in those younger than 80 (54.7 ± 24.9%, P < .001). Anticoagulant therapy was prescribed for 74.8% of participants younger than 80% and 63% of those aged 80 and older (P < .001). Higher CHA2 DS2 VASc score and lower HAS-BLED score were independent predictors of OAC prescription in participants aged 80 and older. CONCLUSION: Nearly one-fifth of individuals with NVAF in this real-world sample were aged 80 and older. Participants aged 80 and older were more likely to be female and have more comorbidities than those who were younger than 80. Those aged 80 and older with AF were less likely to receive anticoagulants than those who were younger than 80, but having more comorbidities and other individual-level characteristics may explain this difference. When they were prescribed OACs, participants aged 80 and older had poorer quality of anticoagulation than those who were younger, suggesting opportunities for improvement.
OBJECTIVES: To compare the clinical characteristics of and use of oral anticoagulant (OAC) therapy in individuals aged 80 and older with atrial fibrillation (AF) with those of individuals younger than 80 with AF in clinical practice. DESIGN: Observational study. SETTING: The ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey trial (NCT02344901), a national observational registry. PARTICIPANTS: Turkish adults with nonvalvular AF (NVAF). MEASUREMENTS: Age data were collected at the time of entry into the registry and the octogenarian subgroup included all patients aged ≥ 80 years. We compared background and management in octogenarian with non-octogenarian AFpatients. RESULTS: Fifty-seven cardiology units enrolled 6,273 individuals in 3 months. Participants aged 80 and older (n = 1,170) were more likely to be female (60.7% vs 54.7%, P < .001) and had a higher prevalence of persistant or permanent AF, comorbidities, history of cerebral vascular accident, and major bleeding. As a consequence of having more comorbidities, Congestive heart failure; Hypertension; Aged 75 and older; Diabetes Mellitus; prior stroke, transient ischemic attack, or thromboembolism; Vascular disease; Aged 65 to 74; female Sex (CHA2 DS2 VASc) (4.32 ± 1.35 vs 3.04 ± 1.54, P < .001) and Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile international normalized ratio, Elderly, Drugs or alcohol (HAS-BLED) (2.14 ± 1.05 vs 1.54 ± 1.05, P < .001) scores were higher in those aged 80 and older. The mean time in therapeutic range of individuals who were taking warfarin was lower in those aged 80 and older (45.9 ± 27.9) than in those younger than 80 (54.7 ± 24.9%, P < .001). Anticoagulant therapy was prescribed for 74.8% of participants younger than 80% and 63% of those aged 80 and older (P < .001). Higher CHA2 DS2 VASc score and lower HAS-BLED score were independent predictors of OAC prescription in participants aged 80 and older. CONCLUSION: Nearly one-fifth of individuals with NVAF in this real-world sample were aged 80 and older. Participants aged 80 and older were more likely to be female and have more comorbidities than those who were younger than 80. Those aged 80 and older with AF were less likely to receive anticoagulants than those who were younger than 80, but having more comorbidities and other individual-level characteristics may explain this difference. When they were prescribed OACs, participants aged 80 and older had poorer quality of anticoagulation than those who were younger, suggesting opportunities for improvement.
Authors: Jane S Saczynski; Saket R Sanghai; Catarina I Kiefe; Darleen Lessard; Francesca Marino; Molly E Waring; David Parish; Robert Helm; Felix Sogade; Robert Goldberg; Jerry Gurwitz; Weijia Wang; Tanya Mailhot; Benita Bamgbade; Bruce Barton; David D McManus Journal: J Am Geriatr Soc Date: 2019-10-01 Impact factor: 5.562
Authors: Steven A Lubitz; Shaan Khurshid; Lu-Chen Weng; Gheorghe Doros; Joseph Walker Keach; Qi Gao; Anil K Gehi; Jonathan C Hsu; Matthew R Reynolds; Mintu P Turakhia; Thomas M Maddox Journal: Am Heart J Date: 2018-03-10 Impact factor: 4.749
Authors: Cédric Villain; Sophie Liabeuf; Marie Metzger; Christian Combe; Denis Fouque; Luc Frimat; Christian Jacquelinet; Maurice Laville; Serge Briançon; Ronald L Pisoni; Nicolas Mansencal; Bénédicte Stengel; Ziad A Massy Journal: Clin Kidney J Date: 2019-06-10