Saket R Sanghai1, Weisong Liu2, Weijia Wang3, Subendhu Rongali4, Ariela R Orkaby5,6, Jane S Saczynski3,7, Adam J Rose8, Alok Kapoor9, Wenjun Li9, Hong Yu9,10,11, David D McManus2,3. 1. Division of Cardiac Electrophysiology, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA. sanghaisaket@gmail.com. 2. Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA. 3. Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA. 4. University of Massachusetts, Amherst, MA, USA. 5. New England GRECC, VA Boston Health Care System, Boston, MA, USA. 6. Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA. 7. Department of Pharmacy and Health System Sciences, Northeastern University, Boston, MA, USA. 8. Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA. 9. Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA. 10. University of Massachusetts, Lowell, MA, USA. 11. Edith Nourse Rogers Memorial VA Medical Center, Bedford, MA, USA.
Abstract
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 CHA2DS2VASC ≥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 CHA2DS2VASC score ≥2, 121,839 (39%) were prescribed OAC (73% VKA). The mean age was 77.7 (9.6) years; CHA2DS2VASC 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<0.001). After adjustment for factors associated with OAC use, pre-frail (OR: 0.89, 95% CI: 0.87-0.91) and frail (OR: 0.66, 95% CI: 0.64-0.68) veterans were significantly less likely to be prescribed OAC than non-frail veterans. Of those prescribed OAC, pre-frail (OR:1.27, 95% CI: 1.22-1.31) and frail (OR: 1.75, 95% CI: 1.67-1.83) veterans were significantly more likely than non-frail veterans to be prescribed a DOAC than a VKA. CONCLUSIONS: There are high rates of frailty among older veterans with NVAF. Frailty using an EHR-derived index is associated with decreased OAC prescription.
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 CHA2DS2VASC ≥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 CHA2DS2VASC score ≥2, 121,839 (39%) were prescribed OAC (73% VKA). The mean age was 77.7 (9.6) years; CHA2DS2VASC 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<0.001). After adjustment for factors associated with OAC use, pre-frail (OR: 0.89, 95% CI: 0.87-0.91) and frail (OR: 0.66, 95% CI: 0.64-0.68) veterans were significantly less likely to be prescribed OAC than non-frail veterans. Of those prescribed OAC, pre-frail (OR:1.27, 95% CI: 1.22-1.31) and frail (OR: 1.75, 95% CI: 1.67-1.83) veterans were significantly more likely than non-frail veterans to be prescribed a DOAC than a VKA. CONCLUSIONS: There are high rates of frailty among older veterans with NVAF. Frailty using an EHR-derived index is associated with decreased OAC prescription.
Authors: Karen P Alexander; Marc A Brouwer; Hillary Mulder; Dragos Vinereanu; Renato D Lopes; Marco Proietti; Sana M Al-Khatib; Ziad Hijazi; Sigrun Halvorsen; Elaine M Hylek; Freek W A Verheugt; John H Alexander; Lars Wallentin; Christopher B Granger Journal: Am Heart J Date: 2018-11-22 Impact factor: 4.749
Authors: Ariela R Orkaby; Kathryn L Lunetta; Fangui J Sun; Jane A Driver; Emelia J Benjamin; Naomi M Hamburg; Gary F Mitchell; Ramachandran S Vasan; Joanne M Murabito Journal: J Gerontol A Biol Sci Med Sci Date: 2019-02-15 Impact factor: 6.053
Authors: Alfredo J Selim; Dan R Berlowitz; Graeme Fincke; Zhongxiao Cong; William Rogers; Samuel C Haffer; Xinhua S Ren; Austin Lee; Shirley X Qian; Donald R Miller; Avron Spiro; Bernardo J Selim; Lewis E Kazis Journal: J Am Geriatr Soc Date: 2004-08 Impact factor: 5.562
Authors: Raghavendra Charan P Makam; David C Hoaglin; David D McManus; Victoria Wang; Joel M Gore; Frederick A Spencer; Richeek Pradhan; Hoang Tran; Hong Yu; Robert J Goldberg Journal: PLoS One Date: 2018-05-24 Impact factor: 3.240
Authors: Alberto Pilotto; Nicola Veronese; Maria Cristina Polidori; Timo Strandberg; Eva Topinkova; Alfonso J Cruz-Jentoft; Carlo Custodero; Stefania Maggi Journal: Ann Med Date: 2022-12 Impact factor: 5.348