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Influence of Frailty on Anticoagulant Prescription and Clinical Outcomes After 1-year Follow-Up in Hospitalised Older Patients With Atrial Fibrillation

Abstract: Frailty is an important prognostic factor in older adults with cardiovascular diseases. We aim to describe the characteristics of elderly hospitalised frail patients with non-valvular atrial fibrillation (NVAF) and to assess the influence of frailty, along with other functional and health status variables on anticoagulation prescription, 1-year all-cause mortality, and the incidence of ischemic and bleeding complications. An observational, prospective multicentre study was carried out on patients with NVAF over the age of 75, who were admitted to the Internal Medicine departments in Spain. A total of 615 patients were evaluated (mean age 85.23 ± 5.16 years, 54.3% females, 48.3% frail). Frail patients had higher CHA2DS2-VASc and HAS-BLED scores, more comorbidities and worse functional status and cognitive impairment compared to non-frail. During hospitalisation, 58 (9.4%) patients died (12.5% frail, 6.6% non-frail, p = 0.01). Among the participants discharged, 69.8% received anticoagulants, 13% anti-platelets only and 16.9% no anti-thrombotics, with no difference by frailty status. Frailty is not a predictor of anticoagulant prescription at discharge (OR 0.93, 95% CI 0.55-1.57), while functional dependency remains significantly associated (OR for severe dependency 0.44, 95% CI 0.23-0.82). After the 1-year follow-up, frail patients have a higher risk of death (HR 1.99, 95% CI 1.43-2.76). Among patients taking anticoagulants, the incidence of stroke and major bleeding is similar between frailty groups. In our study, frailty is related to worse global health status. It has no impact on antithrombotic prescription, nor is a predictor of AF complications, even though frail subjects have a higher mortality during hospitalisation and after 1-year follow-up.

Otras publicaciones de la misma revista o congreso con autores/as de la Universidad de Cantabria

 Fuente: Intern Emerg Med, 14 (1), 59-69 Jan 2019

Editorial: Springer

 Año de publicación: 2019

Nº de páginas: 11

Tipo de publicación: Artículo de Revista

 DOI: 10.1007/s11739-018-1938-3

ISSN: 1828-0447,1970-9366

Url de la publicación: https://doi.org/10.1007/s11739-018-1938-3

Autoría

GULLÓN, ALEJANDRA

FORMIGA, FRANCESC

DÍEZ MANGLANO, JESÚS

MOSTAZA, JOSÉ MARÍA

CEPEDA, JOSÉ MARÍA

POSE, ANTONIO

CASTIELLA, JESÚS

SUÁREZ FERNÁNDEZ, CARMEN

NONAVASC STUDY GROUP VASCULAR RISK GROUP OF THE SPANISH SOCIETY OF INTERNAL MEDICINE