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Atrial fibrillation in older inpatients: are there any differences in clinical characteristics and pharmacological treatment between the frail and the non‐frail?
Author(s) -
Nguyen T. N.,
Cumming R. G.,
Hilmer S. N.
Publication year - 2016
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.12912
Subject(s) - medicine , atrial fibrillation , antithrombotic , stroke (engine) , incidence (geometry) , odds ratio , medical prescription , observational study , univariate analysis , logistic regression , prospective cohort study , multivariate analysis , mechanical engineering , physics , optics , pharmacology , engineering
Abstract Background Frailty is common in patients with atrial fibrillation and may impact on antithrombotic and anti‐arrhythmic treatment. Aim To describe differences in clinical characteristics, prescription of antithrombotic and anti‐arrhythmic medications and incidence of haemorrhage and stroke, between frail and non‐frail older inpatients. Methods Prospective observational study in patients aged ≥65 years with atrial fibrillation admitted to a teaching hospital in Sydney, Australia. Frailty was assessed using the Reported Edmonton Frail Scale, stroke risk with CHA2DS2‐VASc score and bleeding risk with HAS‐BLED score. Participants were followed after 6 months for haemorrhages and strokes. Results We recruited 302 patients (mean age 84.7 ± 7.1 years, 53.3% frail, 50% female, mean CHA2DS2‐VASc 4.61 ± 1.44, mean HAS‐BLED 2.97 ± 1.04). Frail participants were older and had more co‐morbidities and higher risk of stroke but not haemorrhage. Upon discharge, 55.7% participants were prescribed with anticoagulants (49.3% frail, 62.6% non‐frail, P = 0.02). Thirty‐three per cent received antiplatelets only and 11.1% no antithrombotics, with no difference by frailty status. For anti‐arrhythmics, 52.6% received rate‐control drugs only, 11.8% rhythm‐control drugs only and 13.5% both and 22.1% were not prescribed either, with no difference by frailty status. On univariate logistic regression, frailty decreased the likelihood of anticoagulant prescription (odds ratio (OR) 0.58, 95%CI 0.36–0.93), but this was not significant on multivariate analysis (OR 0.66, 95%CI 0.40–1.11). After 6 months, overall incidence of ischaemic stroke was 2.1%, and in patients taking anticoagulants, incidence of major/severe bleeding was 6.3%, with no significant difference between frailty groups. Conclusions Frailty status had little impact on antithrombotic prescription and no impact on anti‐arrhythmic prescription.