TY - JOUR
T1 - Management of atrial fibrillation in older patients by morbidity burden
T2 - Insights from get with the guidelines-atrial fibrillation
AU - Dalgaard, Frederik
AU - Xu, Haolin
AU - Matsouaka, Roland A.
AU - Russo, Andrea M.
AU - Curtis, Anne B.
AU - Rasmussen, Peter Vibe
AU - Ruwald, Martin H.
AU - Fonarow, Gregg C.
AU - Lowenstern, Angela
AU - Hansen, Morten L.
AU - Pallisgaard, Jannik L.
AU - Alexander, Karen P.
AU - Alexander, John H.
AU - Lopes, Renato D.
AU - Granger, Christopher B.
AU - Lewis, William R.
AU - Piccini, Jonathan P.
AU - Al-Khatib, Sana M.
N1 - Publisher Copyright: © 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2020/12/1
Y1 - 2020/12/1
N2 - BACKGROUND: Knowledge is scarce regarding how multimorbidity is associated with therapeutic decisions regarding oral anti-coagulants (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 comor-bidities. 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 ther-apy, 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.
AB - BACKGROUND: Knowledge is scarce regarding how multimorbidity is associated with therapeutic decisions regarding oral anti-coagulants (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 comor-bidities. 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 ther-apy, 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.
UR - https://www.scopus.com/pages/publications/85097002925
UR - https://www.scopus.com/pages/publications/85097002925#tab=citedBy
U2 - 10.1161/JAHA.120.017024
DO - 10.1161/JAHA.120.017024
M3 - Article
C2 - 33241750
SN - 2047-9980
VL - 9
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 23
M1 - e017024
ER -