PMID- 26082176
OWN - NLM
STAT- MEDLINE
DCOM- 20160607
LR  - 20220316
IS  - 1468-2834 (Electronic)
IS  - 0002-0729 (Linking)
VI  - 44
IP  - 5
DP  - 2015 Sep
TI  - Impact of advanced age on management and prognosis in atrial fibrillation: 
      insights from a population-based study in general practice.
PG  - 874-8
LID - 10.1093/ageing/afv071 [doi]
AB  - OBJECTIVES: to examine the use of antithrombotic therapy and predictors of stroke 
      and death in very elderly (>/=85 years) atrial fibrillation (AF) patients in a 
      general practice cohort from the UK. DESIGN: retrospective, observational cohort 
      study; 12-month follow-up period. SETTING: eleven general practices serving the 
      town of Darlington, England representing a population of 105,000 patients. 
      PATIENTS: two thousand two hundred and fifty-nine patients with a history of AF, 
      561 (24.8%) aged >/=85 years. MAIN OUTCOME MEASURES: use of antithrombotic therapy 
      by age group and predictors of stroke and death. RESULTS: five hundred and 
      sixty-one (24.8%) AF patients aged >/=85 years (mean (SD) age 89 (4) years; 66% 
      female) identified with a mean CHA2DS2-VASc score of 4.6 (SD 1.4). Thirty-six per 
      cent received oral anticoagulation (OAC) compared with 57% in the 75-84 years age 
      group. Forty-nine per cent of the very elderly received antiplatelet (AP) 
      monotherapy; recorded OAC contraindications and declines were greatest among 
      those aged >/=85 years. Stroke risk was highest among the very elderly (5.2% per 
      annum), despite anticoagulation (3.9%). Multivariate analyses demonstrated an 
      increased risk of stroke with AP monotherapy (odds ratio (OR) 2.45, 95% 
      confidence intervals (CIs) 1.05-5.70) and a significant reduction in all-cause 
      mortality with OAC therapy (OR 0.59, 95% CI 0.36-0.99). CONCLUSION: the majority 
      of very elderly AF patients in general practice do not receive OAC despite their 
      higher stroke risk; almost half received AP monotherapy. AP use independently 
      increased the risk of stroke, signifying that effective stroke prevention 
      requires OAC regardless of age, except where true contraindications exist.
CI  - (c) The Author 2015. Published by Oxford University Press on behalf of the British 
      Geriatrics Society. All rights reserved. For Permissions, please email: 
      journals.permissions@oup.com.
FAU - Wolff, Andreas
AU  - Wolff A
AD  - Division of Family Practice, Chilliwack General Hospital, Chilliwack, British 
      Columbia, Canada.
FAU - Shantsila, Eduard
AU  - Shantsila E
AD  - University of Birmingham Centre for Cardiovascular Sciences, City Hospital, 
      Birmingham, UK.
FAU - Lip, Gregory Y H
AU  - Lip GY
AD  - University of Birmingham Centre for Cardiovascular Sciences, City Hospital, 
      Birmingham, UK.
FAU - Lane, Deirdre A
AU  - Lane DA
AD  - University of Birmingham Centre for Cardiovascular Sciences, City Hospital, 
      Birmingham, UK.
LA  - eng
PT  - Journal Article
DEP - 20150616
PL  - England
TA  - Age Ageing
JT  - Age and ageing
JID - 0375655
RN  - 0 (Anticoagulants)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
MH  - Administration, Oral
MH  - Age Factors
MH  - Aged, 80 and over
MH  - *Aging
MH  - Anticoagulants/administration & dosage/adverse effects/*therapeutic use
MH  - Atrial Fibrillation/diagnosis/*drug therapy/mortality
MH  - England/epidemiology
MH  - Female
MH  - Fibrinolytic Agents/administration & dosage/adverse effects/*therapeutic use
MH  - *General Practice
MH  - Humans
MH  - Male
MH  - Multivariate Analysis
MH  - Odds Ratio
MH  - Platelet Aggregation Inhibitors/administration & dosage/adverse 
      effects/*therapeutic use
MH  - Practice Patterns, Physicians'
MH  - Risk Assessment
MH  - Risk Factors
MH  - Stroke/diagnosis/mortality/*prevention & control
MH  - Time Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - age
OT  - antithrombotic therapy
OT  - atrial fibrillation
OT  - general practice
OT  - older people
OT  - stroke
EDAT- 2015/06/18 06:00
MHDA- 2016/06/09 06:00
CRDT- 2015/06/18 06:00
PHST- 2014/07/05 00:00 [received]
PHST- 2015/01/12 00:00 [accepted]
PHST- 2015/06/18 06:00 [entrez]
PHST- 2015/06/18 06:00 [pubmed]
PHST- 2016/06/09 06:00 [medline]
AID - afv071 [pii]
AID - 10.1093/ageing/afv071 [doi]
PST - ppublish
SO  - Age Ageing. 2015 Sep;44(5):874-8. doi: 10.1093/ageing/afv071. Epub 2015 Jun 16.