Geriatric Elements and Oral Anticoagulant Prescribing in Older Atrial Fibrillation Patients: SAGE-AF
Authors
Saczynski, Jane S.Sanghai, Saket
Kiefe, Catarina I.
Lessard, Darleen M.
Marino, Francesca
Goldberg, Robert J.
Gurwitz, Jerry H.
Wang, Weijia
Barton, Bruce A.
McManus, David D.
UMass Chan Affiliations
Meyers Primary Care InstituteDivision of Geriatric Medicine, Department of Medicine
Department of Population and Quantitative Health Sciences
Division of Cardiovascular Medicine, Department of Medicine
Document Type
Journal ArticlePublication Date
2019-10-01Keywords
atrial fibrillationcognitive impairment
frailty
oral anticoagulants
Cardiovascular Diseases
Geriatrics
Health Services Administration
Nervous System Diseases
Psychological Phenomena and Processes
Metadata
Show full item recordAbstract
OBJECTIVES: Oral anticoagulants are the cornerstone of stroke prevention in high-risk patients with atrial fibrillation (AF). Geriatric elements, such as cognitive impairment and frailty, commonly occur in these patients and are often cited as reasons for not prescribing oral anticoagulants. We sought to systematically assess geriatric impairments in patients with AF and determine whether they were associated with oral anticoagulant prescribing. DESIGN: Cross-sectional analysis of baseline data from the ongoing Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF) prospective cohort study. SETTING: Multicenter study with site locations in Massachusetts and Georgia that recruited participants from cardiology, electrophysiology, and primary care clinics from 2016 to 2018. PARTICIPANTS: Participants with AF age 65 years or older, CHA2 DS2 -VASc (congestive heart failure; hypertension; aged > /=75 y [doubled]; diabetes mellitus; prior stroke, transient ischemic attack, or thromboembolism [doubled]; vascular disease; age 65-74; female sex) score of 2 or higher, and no oral anticoagulant contraindications (n = 1244). MEASUREMENTS: A six-component geriatric assessment included validated measures of frailty, cognitive function, social support, depressive symptoms, vision, and hearing. Oral anticoagulant use was abstracted from the medical record. RESULTS: A total of 1244 participants (mean age = 76 y; 49% female; 85% white) were enrolled; 42% were cognitively impaired, 14% frail, 53% pre-frail, 12% socially isolated, and 29% had depressive symptoms. Oral anticoagulants were prescribed to 86% of the cohort. Oral anticoagulant prescribing did not vary according to any of the geriatric elements (adjusted odds ratios [ORs] for oral anticoagulant prescribing and cognitive impairment: OR = .75; 95% confidence interval [CI] = .51-1.09; frail OR = .69; 95% CI = .35-1.36; social isolation OR = .90; 95% CI = .52-1.54; depression OR = .79; 95% CI = .49-1.27; visual impairment OR = .98; 95% CI = .65-1.48; and hearing impairment OR = 1.05; 95% CI = .71-1.54). CONCLUSION: Geriatric impairments, particularly cognitive impairment and frailty, were common in our cohort, but treatment with oral anticoagulants did not differ by impairment status. These geriatric impairments are commonly cited as reasons for not prescribing oral anticoagulants, suggesting that prescribers may either be unaware or deliberately ignoring the presence of these factors in clinical settings.Source
J Am Geriatr Soc. 2019 Oct 1. doi: 10.1111/jgs.16178. [Epub ahead of print] Link to article on publisher's site
DOI
10.1111/jgs.16178Permanent Link to this Item
http://hdl.handle.net/20.500.14038/46838PubMed ID
31574165Notes
Full author list omitted for brevity. For the full list of authors, see article.
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10.1111/jgs.16178