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Atrial fibrillation and oral anticoagulation in older people with frailty: a nationwide primary care electronic health records cohort study

Lookup NU author(s): Dr Chris WilkinsonORCiD, Mohammad Yadegarfar

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This is the authors' accepted manuscript of an article that has been published in its final definitive form by Oxford University Press, 2021.

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Abstract

Background Atrial fibrillation (AF) is common in older people and is associated with increased stroke risk, which may be reduced by oral anticoagulation (OAC). Frailty also increases with increasing age, yet the extent of OAC prescription in older people according to extent of frailty in people with AF is insufficiently described. Methods An electronic health records study of 536,955 patients aged ≥65 years from ResearchOne in England (384 General Practices), over 15.4 months, last follow-up 11^th April, 2017. OAC prescription for AF with CHA₂DS₂-Vasc ≥2, adjusted (demographic and treatments) risk of all-cause mortality, and subsequent cerebrovascular disease, bleeding and falls were estimated by electronic frailty index (eFI) category of fit, mild, moderate and severe frailty. Results AF prevalence and mean CHA₂DS₂-Vasc for those with AF increased with increasing eFI category (fit 2.9%, 2.2; mild 11.2%, 3.2; moderate 22.2%, 4.0; severe 31.5%, 5.0). For AF with CHA₂DS₂-Vasc ≥2, OAC prescription was higher for mild (53.2%), moderate (55.6%) and severe (53.4%) eFI categories than fit (41.7%). In those with AF and eligible for OAC, frailty was associated with increased risk of death (HR for severe frailty compared with fit 4.09, 95% CI 3.43-4.89), gastrointestinal bleeding (2.17, 1.45-3.25), falls (8.03, 4.60-14.03) and, among women, stroke (3.63, 1.10-12.02).Conclusion Among older people in England, AF and stroke risk increased with increasing degree of frailty, however, OAC prescription approximated 50%. Given competing demands of mortality, morbidity and stroke prevention, greater attention to stratified stroke prevention is needed for this group of the population.

Publication metadata

Author(s): Wilkinson C, Clegg A, Todd O, Rockwood K, Yadegarfar ME, Gale CP, Hall M

Publication type: Article

Publication status: Published

Journal: Age and Ageing

Year: 2021

Volume: 50

Issue: 3

Pages: 772-779

Print publication date: 01/05/2021

Online publication date: 16/12/2020

Acceptance date: 04/11/2020

Date deposited: 11/11/2020

ISSN (print): 0002-0729

ISSN (electronic): 1468-2834

Publisher: Oxford University Press

URL: https://doi.org/10.1093/ageing/afaa265

DOI: 10.1093/ageing/afaa265

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