Skip to main content
SpringerLink
Log in

Determinants of Antithrombotic Treatment for Atrial Fibrillation in Octogenarians: Results of the OCTOFA Study

  • Original Research Article
  • Published:
Clinical Drug Investigation Aims and scope Submit manuscript

Abstract

Background and Objective

Atrial fibrillation, the most frequent form of arrhythmia, affects 5–15% individuals aged > 80 years. Stroke is a major risk for atrial fibrillation patients. The benefits of anticoagulant therapy clearly outweigh the risk of hemorrhage, even in the elderly. Despite the efficacy of warfarin, many eligible patients receive no prophylactic antithrombotic therapy. New generation oral anticoagulants compare favorably with vitamin K antagonists in the prevention of thromboembolic events and hemorrhage. These new agents are likely to influence the prescribing habits of anticoagulants in atrial fibrillation. The aim of this study to investigate both the frequency and the determining factors of anticoagulant prescriptions in AF patients aged ≥ 80 years and followed up by private-practice cardiologists in France.

Methods

The OCTOFA (Atrial Fibrillation in Octogenarians) Study assessed the anticoagulant prescribing habits of cardiologists in France. The volunteer cardiologists recruited all consecutive patients fulilling the inclusion criteria.

Results

Between June 2013 and September 2016, 89 cardiologists recruited 738 eligible patients: age ≥ 80 years, non-valvular atrial fibrillation, no other compelling indication for anticoagulation therapy, no recent acute coronary syndrome or stroke. Most (90.7%) patients were on oral anticoagulant therapy: vitamin K antagonist or non-vitamin K antagonist oral anticoagulants, low molecular weight heparin (1.4%), aspirin (5.7%), and no antithrombotic treatment (2.2%). Patients on vitamin K antagonists were older (p < 0.001), had lower renal function (p = 0.033), and had a more frequent history of myocardial infarction (p < 0.001), heart failure (p = 0.001), peripheral artery disease (p = 0.033), major hemorrhage (p = 0.025), and falls (p = 0.045). Four determining factors of anticoagulant prescriptions were statistically significant: high CHA2DS2-VASc score (p < 0.001), high HAS-BLED score (p < 0.001), age > 90 years (p = 0.001), and moderate/severe cognitive impairment (p = 0.002).

Conclusions

Most private-practice cardiologists prescribe anticoagulant treatment according to current guidelines in elderly atrial fibrillation patients. Non-vitamin K antagonist oral anticoagulants represent a significant proportion of prescriptions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P; ESC Scientific Document Group. ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;2016(37):2893–962.

    Google Scholar 

  2. Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, Gillum RF, Kim YH, McAnulty JH Jr, Zheng ZJ, Forouzanfar MH, Naghavi M, Mensah GA, Ezzati M, Murray CJ. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129:837–47.

    Article  PubMed  Google Scholar 

  3. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22:983–8.

    Article  PubMed  CAS  Google Scholar 

  4. Stewart S, Hart CL, Hole DJ, McMurray JJ. A population-based study of the longterm risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/ Paisley study. Am J Med. 2002;113:359–64.

    Article  PubMed  Google Scholar 

  5. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010;137:263–72.

    Article  PubMed  Google Scholar 

  6. Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel userfriendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138:1093–100.

    Article  PubMed  Google Scholar 

  7. Graham DJ, Reichman ME, Wernecke M, Zhang R, Southworth MR, Levenson M, Sheu TC, Mott K, Goulding MR, Houstoun M, MaCurdy TE, Worrall C, Kelman JA. Cardiovascular, bleeding, and mortality risks in elderly Medicare patients treated with dabigatran or warfarin for nonvalvular atrial fibrillation. Circulation. 2015;131:157–64.

    Article  PubMed  CAS  Google Scholar 

  8. Lip GY, Laroche C, Ioachim PM, Rasmussen LH, Vitali-Serdoz L, Petrescu L, Darabantiu D, Crijns HJ, Kirchhof P, Vardas P, Tavazzi L, Maggioni AP, Boriani G. Prognosis and treatment of atrial fibrillation patients by European cardiologists: one year follow-up of the EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase (EORP-AF Pilot registry). Eur Heart J. 2014;35:3365–76.

    Article  PubMed  CAS  Google Scholar 

  9. Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, Camm AJ, Weitz JI, Lewis BS, Parkhomenko A, Yamashita T, Antman EM. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383:955–62.

    Article  PubMed  CAS  Google Scholar 

  10. Marinigh R, Lip GY, Fiotti N, Giansante C, Lane DA. Age as a risk factor for stroke in atrial fibrillation patients: implications for thromboprophylaxis. J Am Coll Cardiol. 2010;56:827–37.

    Article  PubMed  Google Scholar 

  11. Gage BF, Boechler M, Doggette AL, Fortune G, Flaker GC, Rich MW, Radford MJ. Adverse outcomes and predictors of underuse of antithrombotic therapy in medicare beneficiaries with chronic atrial fibrillation. Stroke. 2000;31:822–7.

    Article  PubMed  CAS  Google Scholar 

  12. Cohen N, Almoznino-Sarafian D, Alon I, Gorelik O, Koopfer M, Chachashvily S, Shteinshnaider M, Litvinjuk V, Modai D. Warfarin for stroke prevention still underused in atrial fibrillation: patterns of omission. Stroke. 2000;31:1217–22.

    Article  PubMed  CAS  Google Scholar 

  13. Man-Son-Hing M, Laupacis A. Anticoagulant-related bleeding in older persons with atrial fibrillation: physicians’ fears often unfounded. Arch Intern Med. 2003;163:1580–6.

    Article  PubMed  Google Scholar 

  14. Jacobs LG, Billett HH, Freeman K, Dinglas C, Jumaquio L. Anticoagulation for stroke prevention in elderly patients with atrial fibrillation, including those with falls and/or early-stage dementia: a single-center, retrospective, observational study. Am J Geriatr Pharmacother. 2009;7:159–66.

    Article  PubMed  Google Scholar 

  15. Formiga F, Fort I, Reig L, Robles MJ, Espinosa MC, Rodriguez D. Atrial fibrillation in elderly patients with dementia. Gerontology. 2009;55:202–4.

    Article  PubMed  Google Scholar 

  16. Olesen JB, Sorensen R, Hansen ML, Lamberts M, Weeke P, Mikkelsen AP, Køber L, Gislason GH, Torp-Pedersen C, Fosbøl EL. Non-vitamin K antagonist oral anticoagulation agents in anticoagulant naive atrial fibrillation patients: Danish nationwide descriptive data 2011–2013. Europace. 2015;17:187–93.

    Article  PubMed  Google Scholar 

  17. Feeney JM, Santone E, DiFiori M, Kis L, Jayaraman V, Montgomery SC. Compared to warfarin, direct oral anticoagulants are associated with lower mortality in patients with blunt traumatic intracranial hemorrhage: a TQIP study. J Trauma Acute Care Surg. 2016;81(5):843–8.

    Article  PubMed  CAS  Google Scholar 

  18. Connolly S, Pogue J, Hart R, Pfeffer M, Hohnloser S, Chrolavicius S, Pfeffer M, Hohnloser S, Yusuf S, ACTIVE Writing Group of the ACTIVE Investigators. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet. 2006;367:1903–12.

    Article  PubMed  CAS  Google Scholar 

  19. Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, Camm AJ, Weitz JI, Lewis BS, Parkhomenko A, Yamashita T, Antman EM. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383:955–62.

    Article  PubMed  CAS  Google Scholar 

  20. Richiardi L, Pizzi C, Pearce N. Representativeness. Int J Epidemiol. 2014;43:632–3.

    Article  PubMed  Google Scholar 

  21. Fourrier-Réglat A, Droz-Perroteau C, Bénichou J, Depont F, Amouretti M, Bégaud B, Moride Y, Blin P, CADEUS Team. Moore N (2008) Impact of prescriber nonresponse on patient representativeness. Epidemiology. 2008;19:186–90.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the private-practice cardiologists and the patients who agreed to take part in the OCTOFA study. Special thanks go to Fabrice Sberro (Altimed) and Jean-Charles Kerihuel (Vertical) for technical assistance. The authors are also indebted to Moyra Barbier for editorial assistance.

Author information

Authors and Affiliations

  1. Assistance Publique-Hôpitaux de Paris, Unité HTA, Prévention et Thérapeutique Cardiovasculaires, Centre de Diagnostic et de Thérapeutique, Hôtel-Dieu University Hospital, Université Paris Descartes, Place du Parvis Notre-Dame, 75004, Paris, France

    Jacques Blacher

  2. AP-HP, Cardiology Department, Avicenne University Hospital, Paris 13 University, Bobigny, France

    Emmanuel Sorbets

  3. Collège National des Cardiologues Français (CNCF), Paris, France

    Dominique Guedj Meynier, Jean-Pierre Huberman, Jacques Gauthier, Serge Cohen & Olivier Hoffman

Authors
  1. Jacques Blacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emmanuel Sorbets
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dominique Guedj Meynier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jean-Pierre Huberman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jacques Gauthier
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Serge Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Olivier Hoffman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jacques Blacher.

Ethics declarations

Conflict of interest

All authors have no conflict of interest to declare.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The CNCF (Collège National des Cardiologues Français) supported all expenses of the OCTOFA study.

Ethical approval

Both the program and the study received approval from the appropriate ethics and administrative committees.

Informed consent

All participants provided written informed consent.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Blacher, J., Sorbets, E., Guedj Meynier, D. et al. Determinants of Antithrombotic Treatment for Atrial Fibrillation in Octogenarians: Results of the OCTOFA Study. Clin Drug Investig 39, 891–898 (2019). https://doi.org/10.1007/s40261-019-00809-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40261-019-00809-1

Search

Navigation