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Oral anticoagulants and outcomes in adults ≥80 years with atrial fibrillation: A global federated health network analysis.
- Source :
-
Journal of the American Geriatrics Society . Aug2022, Vol. 70 Issue 8, p2386-2392. 7p. - Publication Year :
- 2022
-
Abstract
- Background: The objective of this study was to determine associations between use of oral anticoagulation (OAC) and stroke and bleeding‐related outcomes for older people ≥80 years with atrial fibrillation (AF), and to determine trends over time in prescribing of OAC for this population. Methods: A retrospective cohort study was conducted. People aged ≥80 years with AF receiving (1) no OAC; (2) warfarin; or (3) a non‐vitamin‐K antagonist oral anticoagulant (NOAC) between 2011 and 2019 were included. Propensity score matching was used to balance cohorts (no OAC, warfarin or a NOAC) on characteristics including age, sex, ethnicity, and co‐morbidities. Cox proportional hazard models were used to derive hazard ratios (HRs) and 95% confidence intervals (CIs). Results: The proportion of people aged ≥80 years receiving any OAC increased from 32.4% (n = 27,647) in 2011 to 43.6% (n = 110,412) in 2019. After propensity score matching, n = 169,067 individuals were included in the cohorts receiving no OAC or a NOAC. Compared to no OAC, participants receiving a NOAC had a lower risk of incident dementia (hazHR 0.68, 95% CI 0.65–0.71), all‐cause mortality (HR 0.49, 95% CI 0.48–0.50), first‐time ischaemic stroke (HR 0.87, 95% CI 0.83–0.91), and a higher risk of major bleeding (HR 1.08, 95% CI 1.05–1.11). Compared to participants receiving warfarin, participants receiving a NOAC had a lower risk of dementia (HR 0.90, 95% CI: 0.86–0.93), all‐cause mortality (HR 0.74, 95% CI: 0.72–0.76), ischaemic stroke (HR 0.86, 95% CI: 0.82–0.90) and major bleeding (HR 0.88, 95% CI: 0.85–0.90). Similar results were observed when only including people with additional bleeding risk factors. Conclusions: The proportion of people aged ≥80 years receiving OAC has increased since the introduction of NOACs, but remains low. Use of a NOAC was associated with improved outcomes compared to warfarin, and compared to no OAC, except for a small but statistically significant higher risk of major bleeding. [ABSTRACT FROM AUTHOR]
- Subjects :
- *WARFARIN
*HEMORRHAGE risk factors
*STROKE
*CONFIDENCE intervals
*ORAL drug administration
*ISCHEMIC stroke
*AGE distribution
*MORTALITY
*ATRIAL fibrillation
*ANTICOAGULANTS
*RETROSPECTIVE studies
*RISK assessment
*TREATMENT effectiveness
*SEX distribution
*COMPARATIVE studies
*MEDICAL prescriptions
*ETHNIC groups
*HEMORRHAGE
*LONGITUDINAL method
*PROPORTIONAL hazards models
*OLD age
Subjects
Details
- Language :
- English
- ISSN :
- 00028614
- Volume :
- 70
- Issue :
- 8
- Database :
- Academic Search Index
- Journal :
- Journal of the American Geriatrics Society
- Publication Type :
- Academic Journal
- Accession number :
- 158527897
- Full Text :
- https://doi.org/10.1111/jgs.17884