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Underuse of Anticoagulation in Older Patients with Atrial Fibrillation and CHADS2 Score ≥ 2: Are We Doing Better Since the Marketing of Direct Oral Anticoagulants?

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Abstract

Objective

Our objectives were to (1) describe the evolution of the underuse of anticoagulants in older people with atrial fibrillation (AF) and a CHADS2 score ≥ 2 since direct oral anticoagulants (DOACs) were introduced to the market and (2) describe factors associated with this underuse.

Methods

We conducted a retrospective cross-sectional study including geriatric patients admitted during the pre-DOAC (2008–2011) and post-DOAC (2013–2015) periods in an academic hospital in Belgium. Five inclusion criteria were met: age ≥ 75 years, diagnosis of AF, indication for anticoagulation (CHADS2 score ≥ 2), risk of functional decline (Identification of Seniors At Risk [ISAR] score ≥ 2), and comprehensive geriatric assessment. The use of anticoagulants and antiplatelets at home before admission was recorded. Risks of stroke and bleeding were calculated using CHADS2 and HEMORR2HAGES scores, respectively. Three different logistic regression models were performed to describe the evolution of and factors associated with the underuse of anticoagulants after DOAC marketing.

Results

Anticoagulant underuse, present in 209 of 614 (34%) geriatric patients with AF, was lower in patients with a history of stroke (28.5%) or congestive heart failure (26.9%) but higher in those receiving antiplatelets (56.2%) and in older individuals. Anticoagulant underuse decreased significantly from the pre-DOAC (37.3%) to the post-DOAC (29.7%) era, as shown by two analyses using propensity scores.

Conclusion

In older patients with AF, anticoagulant underuse was mainly associated with antiplatelet use. Anticoagulant underuse and antiplatelet use have both decreased since DOAC marketing. Underuse of anticoagulants was still a concern for three in ten geriatric patients with AF at high risk of stroke (CHADS2 score ≥ 2).

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Author information

Authors and Affiliations

  1. Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium

    Séverine Henrard, Sophie Marien & Olivia Dalleur

  2. Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium

    Séverine Henrard, Sophie Marien & Benoit Boland

  3. Geriatric Medicine, Cliniques universitaires Saint-Luc, Brussels, Belgium

    Sophie Marien & Benoit Boland

  4. Pharmacy, Cliniques universitaires Saint-Luc, Brussels, Belgium

    Caroline Vandenabeele & Olivia Dalleur

Authors
  1. Séverine Henrard
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  2. Caroline Vandenabeele
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  4. Benoit Boland
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  5. Olivia Dalleur
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Corresponding author

Correspondence to Séverine Henrard.

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Ethical approval

This retrospective study was approved by the local Ethics Committee (Commission d’Ethique Hospitalo-Facultaire, Cliniques universitaires Saint-Luc, Brussels, Belgium; B403201111806).

Funding

No sources of funding were used to conduct this study or prepare this manuscript.

Conflict of interest

Séverine Henrard, Caroline Vandenabeele, Sophie Marien, Benoit Boland, and Olivia Dalleur have no conflicts of interest.

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Henrard, S., Vandenabeele, C., Marien, S. et al. Underuse of Anticoagulation in Older Patients with Atrial Fibrillation and CHADS2 Score ≥ 2: Are We Doing Better Since the Marketing of Direct Oral Anticoagulants?. Drugs Aging 34, 841–850 (2017). https://doi.org/10.1007/s40266-017-0493-3

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  • DOI: https://doi.org/10.1007/s40266-017-0493-3

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