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Effects of oral anticoagulant therapy in older medical in-patients with atrial fibrillation: a prospective cohort observational study

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Abstract

Background

Uncertainties about efficacy and safety of oral anticoagulant therapy (OAT) among older and frail medical patients with atrial fibrillation (AF) largely contribute to under-prescription of these drugs.

Aims

In this prospective observational cohort study, we investigated mortality, and ischemic and hemorrhagic events, in hospital-discharged older patients with AF.

Methods

Stroke and bleeding risk were evaluated using CHA2DS2-VASC and HAS-BLED scores. Comorbidity, frailty, cognitive and nutritional status and functional autonomy were evaluated using standardized scales. Independent associations between clinical variables, including OAT use, and all-cause mortality, fatal and non-fatal ischemic and hemorrhagic events, were evaluated. Further clinical outcomes comparison between patients treated with OAT and those untreated was performed after adjustment for significant differences in patient baseline characteristics with propensity score matching.

Results

Of 452 patients included (mean age 81.6 years, 54.9 % women, roughly 30 % cognitively impaired and/or functionally dependent, mean CHA2DS2-VASC and HAS-BLED scores 4.6 and 2.8, respectively), 151 (33.4 %) died during a mean follow-up period of 300.5 days; ischemic and hemorrhagic stroke occurred in 4.0 and 0.4 % of patients, respectively, and major bleedings in 6.2 %.

Discussion

After multivariate analysis, OAT at discharge was associated with lower overall mortality and reduced occurrence of ischemic stroke, the first finding being confirmed in propensity score matched analysis.

Conclusions

Among older vulnerable AF patients with high post discharge death rate, OAT was associated, among other multiple factors, with reduced mortality and lower occurrence of ischemic stroke.

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Authors and Affiliations

  1. SCDU Geriatria e Malattie Metaboliche dell’Osso, Città della Salute e della Scienza-Molinette., Corso Bramante 88, 10126, Turin, Italy

    Mario Bo, Federica Li Puma, Marco Badinella Martini, Yolanda Falcone, Marina Iacovino, Enrica Grisoglio, Elena Menditto, Gianfranco Fonte, Enrico Brunetti & Giovanni Carlo Isaia

  2. SCDU Cardiologia; Città della Salute e della Scienza-Molinette., C.so Bramante 88, 10126, Turin, Italy

    Fabrizio D’Ascenzo & Fiorenzo Gaita

Authors
  1. Mario Bo
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  2. Federica Li Puma
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  3. Marco Badinella Martini
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  4. Yolanda Falcone
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  7. Elena Menditto
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  8. Gianfranco Fonte
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  9. Enrico Brunetti
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  10. Giovanni Carlo Isaia
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  11. Fabrizio D’Ascenzo
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  12. Fiorenzo Gaita
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Corresponding author

Correspondence to Yolanda Falcone.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

The study was conducted according to the principles of the Declaration of Helsinki Title 45, U.S. Code of Federal Regulations, Part 46, Protection of Human Subjects, Revised November 13, 2001, effective December 13, 2001. Signed informed consent at admission was obtained for all participants and the study was conducted according to the Recommendations Guiding Physicians in Biomedical research Involving Human Subjects.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Bo, M., Li Puma, F., Badinella Martini, M. et al. Effects of oral anticoagulant therapy in older medical in-patients with atrial fibrillation: a prospective cohort observational study. Aging Clin Exp Res 29, 491–497 (2017). https://doi.org/10.1007/s40520-016-0569-7

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  • DOI: https://doi.org/10.1007/s40520-016-0569-7

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