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

Dalgaard, Frederik

Xu, Haolin

Matsouaka, Roland A

Russo, Andrea M

Curtis, Anne B

Rasmussen, Peter Vibe

Ruwald, Martin H

Fonarow, Gregg C

Lowenstern, Angela

Hansen, Morten L

Pallisgaard, Jannik L

Alexander, Karen P

Alexander, John H

Lopes, Renato D

Granger, Christopher B

Lewis, William R

Piccini, Jonathan P

Al-Khatib, Sana M

2021-05-10T18:07:12Z

2021-05-10T18:07:12Z

2020-12

2021-05-10T18:07:10Z

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.

2047-9980

2047-9980

https://hdl.handle.net/10161/22863

eng

Ovid Technologies (Wolters Kluwer Health)

Journal of the American Heart Association

10.1161/jaha.120.017024

Humans

Atrial Fibrillation

Anticoagulants

Hospitalization

Administration, Oral

Registries

Logistic Models

Odds Ratio

Cross-Sectional Studies

Age Factors

Aged

Aged, 80 and over

Female

Male

Practice Guidelines as Topic

Practice Patterns, Physicians'

Multimorbidity

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

Journal article

Xu, Haolin|0000-0003-1069-9567

Matsouaka, Roland A|0000-0002-0271-5400

Alexander, Karen P|0000-0003-4418-1424

Alexander, John H|0000-0002-1444-2462

Lopes, Renato D|0000-0003-2999-4961

Granger, Christopher B|0000-0002-0045-3291

Piccini, Jonathan P|0000-0003-0772-2404

Al-Khatib, Sana M|0000-0002-3561-0146

e017024

23

School of Medicine

Duke Clinical Research Institute

Biostatistics & Bioinformatics

Duke

Institutes and Centers

Basic Science Departments

Medicine, Cardiology

Medicine

Clinical Science Departments

Nursing

School of Nursing

Population Health Sciences

Staff

Published

9