TY - JOUR
T1 - Geriatric Elements and Oral Anticoagulant Prescribing in Older Atrial Fibrillation Patients
T2 - SAGE-AF
AU - Saczynski, Jane S.
AU - Sanghai, Saket R.
AU - Kiefe, Catarina I.
AU - Lessard, Darleen
AU - Marino, Francesca
AU - Waring, Molly E.
AU - Parish, David
AU - Helm, Robert
AU - Sogade, Felix
AU - Goldberg, Robert
AU - Gurwitz, Jerry
AU - Wang, Weijia
AU - Mailhot, Tanya
AU - Bamgbade, Benita
AU - Barton, Bruce
AU - McManus, David D.
N1 - Publisher Copyright:
© 2019 The American Geriatrics Society
PY - 2020/1/1
Y1 - 2020/1/1
N2 - OBJECTIVES: Oral anticoagulants are the cornerstone of stroke prevention in high-risk patients with atrial fibrillation (AF). Geriatric elements, such as cognitive impairment and frailty, commonly occur in these patients and are often cited as reasons for not prescribing oral anticoagulants. We sought to systematically assess geriatric impairments in patients with AF and determine whether they were associated with oral anticoagulant prescribing. DESIGN: Cross-sectional analysis of baseline data from the ongoing Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF) prospective cohort study. SETTING: Multicenter study with site locations in Massachusetts and Georgia that recruited participants from cardiology, electrophysiology, and primary care clinics from 2016 to 2018. PARTICIPANTS: Participants with AF age 65 years or older, CHA2DS2-VASc (congestive heart failure; hypertension; aged ≥75 y [doubled]; diabetes mellitus; prior stroke, transient ischemic attack, or thromboembolism [doubled]; vascular disease; age 65-74; female sex) score of 2 or higher, and no oral anticoagulant contraindications (n = 1244). MEASUREMENTS: A six-component geriatric assessment included validated measures of frailty, cognitive function, social support, depressive symptoms, vision, and hearing. Oral anticoagulant use was abstracted from the medical record. RESULTS: A total of 1244 participants (mean age = 76 y; 49% female; 85% white) were enrolled; 42% were cognitively impaired, 14% frail, 53% pre-frail, 12% socially isolated, and 29% had depressive symptoms. Oral anticoagulants were prescribed to 86% of the cohort. Oral anticoagulant prescribing did not vary according to any of the geriatric elements (adjusted odds ratios [ORs] for oral anticoagulant prescribing and cognitive impairment: OR =.75; 95% confidence interval [CI] =.51-1.09; frail OR =.69; 95% CI =.35-1.36; social isolation OR =.90; 95% CI =.52-1.54; depression OR =.79; 95% CI =.49-1.27; visual impairment OR =.98; 95% CI =.65-1.48; and hearing impairment OR = 1.05; 95% CI =.71-1.54). CONCLUSION: Geriatric impairments, particularly cognitive impairment and frailty, were common in our cohort, but treatment with oral anticoagulants did not differ by impairment status. These geriatric impairments are commonly cited as reasons for not prescribing oral anticoagulants, suggesting that prescribers may either be unaware or deliberately ignoring the presence of these factors in clinical settings. J Am Geriatr Soc 68:147–154, 2019.
AB - OBJECTIVES: Oral anticoagulants are the cornerstone of stroke prevention in high-risk patients with atrial fibrillation (AF). Geriatric elements, such as cognitive impairment and frailty, commonly occur in these patients and are often cited as reasons for not prescribing oral anticoagulants. We sought to systematically assess geriatric impairments in patients with AF and determine whether they were associated with oral anticoagulant prescribing. DESIGN: Cross-sectional analysis of baseline data from the ongoing Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF) prospective cohort study. SETTING: Multicenter study with site locations in Massachusetts and Georgia that recruited participants from cardiology, electrophysiology, and primary care clinics from 2016 to 2018. PARTICIPANTS: Participants with AF age 65 years or older, CHA2DS2-VASc (congestive heart failure; hypertension; aged ≥75 y [doubled]; diabetes mellitus; prior stroke, transient ischemic attack, or thromboembolism [doubled]; vascular disease; age 65-74; female sex) score of 2 or higher, and no oral anticoagulant contraindications (n = 1244). MEASUREMENTS: A six-component geriatric assessment included validated measures of frailty, cognitive function, social support, depressive symptoms, vision, and hearing. Oral anticoagulant use was abstracted from the medical record. RESULTS: A total of 1244 participants (mean age = 76 y; 49% female; 85% white) were enrolled; 42% were cognitively impaired, 14% frail, 53% pre-frail, 12% socially isolated, and 29% had depressive symptoms. Oral anticoagulants were prescribed to 86% of the cohort. Oral anticoagulant prescribing did not vary according to any of the geriatric elements (adjusted odds ratios [ORs] for oral anticoagulant prescribing and cognitive impairment: OR =.75; 95% confidence interval [CI] =.51-1.09; frail OR =.69; 95% CI =.35-1.36; social isolation OR =.90; 95% CI =.52-1.54; depression OR =.79; 95% CI =.49-1.27; visual impairment OR =.98; 95% CI =.65-1.48; and hearing impairment OR = 1.05; 95% CI =.71-1.54). CONCLUSION: Geriatric impairments, particularly cognitive impairment and frailty, were common in our cohort, but treatment with oral anticoagulants did not differ by impairment status. These geriatric impairments are commonly cited as reasons for not prescribing oral anticoagulants, suggesting that prescribers may either be unaware or deliberately ignoring the presence of these factors in clinical settings. J Am Geriatr Soc 68:147–154, 2019.
KW - atrial fibrillation
KW - cognitive impairment
KW - frailty
KW - oral anticoagulants
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U2 - 10.1111/jgs.16178
DO - 10.1111/jgs.16178
M3 - Article
C2 - 31574165
AN - SCOPUS:85074443604
SN - 0002-8614
VL - 68
SP - 147
EP - 154
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 1
ER -