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Frailty Status Affects the Decision for Long-Term Anticoagulation Therapy in Elderly Patients with Atrial Fibrillation

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Abstract

Background

Elderly patients are underrepresented in the studies concerning anticoagulation therapy (AT) in atrial fibrillation (AF), while patients’ frailty status is lacking in most of the studies.

Objective

Our objective was to evaluate AT in AF elderly patients and study the effect of patients’ frailty status on their long-term AT.

Methods

We conducted an observational prospective study that enrolled consecutive AF patients (≥ 75 years) who were hospitalized in the Department of Internal Medicine of the University Hospital of Heraklion, Crete, Greece from 1 June 2015 to 1 June 2016. We recorded the AT on admission and at discharge, all-cause mortality, and hospital readmission in a follow-up period of 1 year after hospital discharge. Frailty status was assessed by pre-established scores.

Results

One hundred and four consecutive patients (49% male; median age 87 years) were enrolled, 78 (78.8%) of whom received AT at discharge. Patients who did not receive AT at discharge had a higher HEMORR2HAGES (Hepatic or renal disease, Ethanol abuse, Malignancy, Older age, Reduced platelet count or function, Re-bleeding, Hypertension, Anemia, Genetic factors, Excessive fall risk and Stroke) score (5.5 ± 1.15 vs. 4.79 ± 1.68; p = 0.032), a lower Katz score (2.48 ± 2.23 vs. 4.08 ± 2.25; p = 0.006), and a higher Clinical Frailty Scale score (7 ± 1.95 vs. 5.57 ± 2.05; p = 0.006). Sixty-five patients (62.5%) were readmitted to a hospital during the follow-up period. In-hospital death occurred in five patients (4.8%) and 57 patients (57.6%) died within the follow-up period.

Conclusion

A high percentage of the elderly AF patients did not receive AT, even at discharge. Patients who did not receive AT at discharge had higher bleeding and frailty scores. In the 1-year follow-up period after hospital discharge, high all-cause mortality and a high number of hospital readmissions were recorded.

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Authors and Affiliations

  1. Department of Internal Medicine, University Hospital of Heraklion “PAGNI”, School of Medicine, University of Crete, Voutes, 71110, Heraklion, Crete, Greece

    Panteleimon E. Papakonstantinou, Natalia I. Asimakopoulou, John A. Papadakis, Dimitrios Leventis, Michail Panousieris, George Mentzantonakis, Ermis Hoda, Simeon Panagiotakis & Achilleas Gikas

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  1. Panteleimon E. Papakonstantinou
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  2. Natalia I. Asimakopoulou
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Correspondence to Panteleimon E. Papakonstantinou.

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No external funding was used in the preparation of this manuscript.

Conflict of interest

Panteleimon E. Papakonstantinou, Natalia I. Asimakopoulou, John A. Papadakis, Dimitrios Leventis, Michail Panousieris, George Mentzantonakis, Ermis Hoda, Simeon Panagiotakis, and Achilleas Gikas declare that they had no conflict of interest related to this article.

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Papakonstantinou, P.E., Asimakopoulou, N.I., Papadakis, J.A. et al. Frailty Status Affects the Decision for Long-Term Anticoagulation Therapy in Elderly Patients with Atrial Fibrillation. Drugs Aging 35, 897–905 (2018). https://doi.org/10.1007/s40266-018-0587-6

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  • DOI: https://doi.org/10.1007/s40266-018-0587-6

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