Management of Atrial Fibrillation in Older Patients by Morbidity Burden: Insights From Get With The Guidelines-Atrial Fibrillation.


Background Knowledge is scarce regarding how multimorbidity is associated with therapeutic decisions regarding oral anticoagulants (OACs) in patients with atrial fibrillation. Methods and Results We conducted a cross-sectional study of hospitalized patients with atrial fibrillation using the Get With The Guidelines-Atrial Fibrillation registry from 2013 to 2019. We identified patients ≥65 years and eligible for OAC therapy. Using 16 available comorbidity categories, patients were stratified by morbidity burden. A multivariable logistic regression model was used to determine the odds of receiving OAC prescription at discharge by morbidity burden. We included 34 174 patients with a median (interquartile range) age of 76 (71-83) years, 56.6% women, and 41.9% were not anticoagulated at admission. Of these patients, 38.6% had 0 to 2 comorbidities, 50.7% had 3 to 5 comorbidities, and 10.7% had ≥6 comorbidities. The overall discharge OAC prescription was high (85.6%). The prevalence of patients with multimorbidity increased from 59.7% in 2014 to 64.3% in 2019 (P trend=0.002). Using 0 to 2 comorbidities as the reference, the adjusted odds ratio (95% CI) of OAC prescription were 0.93 (0.82, 1.05) for patients with 3 to 5 comorbidities and 0.72 (0.60, 0.86) for patients with ≥6 comorbidities. In those with ≥6 comorbidities, the most common reason for nonprescription of OACs were frequent falls/frailty (31.0%). Conclusions In a contemporary quality-of-care database of hospitalized patients with atrial fibrillation eligible for OAC therapy, multimorbidity was common. A higher morbidity burden was associated with a lower odds of OAC prescription. This highlights the need for interventions to improve adherence to guideline-recommended anticoagulation in multimorbid patients with atrial fibrillation.





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Publication Info

Dalgaard, Frederik, Haolin Xu, Roland A Matsouaka, Andrea M Russo, Anne B Curtis, Peter Vibe Rasmussen, Martin H Ruwald, Gregg C Fonarow, et al. (2020). Management of Atrial Fibrillation in Older Patients by Morbidity Burden: Insights From Get With The Guidelines-Atrial Fibrillation. Journal of the American Heart Association, 9(23). p. e017024. 10.1161/jaha.120.017024 Retrieved from

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Haolin Xu

Biostatistician, Senior

Roland Albert Matsouaka

Associate Professor of Biostatistics & Bioinformatics

Karen Patton Alexander

Professor of Medicine

My research focus is on cardiovascular disease management and outcomes in special populations, specifically older adults. Historically there has been a lack of randomized controlled data regarding treatment efficacy and outcomes in this growing population. Because of this, certain therapies may have different risk benefit profiles, which may cause physicians to alter their therapeutic interventions. My research explores evidence based treatment for older adults, including preferences and decision-making as well as frailty and aging assessments in clinical trials and registries. Diagnosis and management of stable ischemic heart disease is also an area of focus.

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