Discharge without oral anticoagulants occurred in 44% of older adults with atrial fibrillation after ischemic stroke and was associated with higher 1-year mortality (42.5% vs 19.1%; P<0.001).
Cohort (n=1,405)
Sí
What are the barriers to oral anticoagulant use and its association with 1-year survival in older adults with atrial fibrillation after acute ischemic stroke?
Despite high stroke risk, over 40% of older AF patients surviving ischemic stroke are not discharged on OACs, largely due to fall risk and frailty, and these patients face very high 1-year mortality.
Tasa de eventos absoluta: 19.1% vs 42.5%
valor p: p=< .001
Objectives To explore barriers to anticoagulation in older adults with atrial fibrillation ( AF ) at high risk of stroke and to identify opportunities for interventions that might increase use of oral anticoagulants ( OAC s). Design Retrospective cohort study. Setting Two large community‐based AF cohorts. Participants Individuals with ischemic stroke surviving hospitalization (N = 1,405, mean age 79). Measurements Using structured chart review, reasons for nonuse of OAC were identified, and 1‐year poststroke survival was assessed. Logistic regression was used to identify correlates of OAC nonuse. Results Median CHA 2 DS 2 ‐ VAS c score was 5, yet 44% of participants were not prescribed an OAC at discharge. The most‐frequent (nonmutually exclusive) physician reasons for not prescribing OAC included fall risk (26.7%), poor prognosis (19.3%), bleeding history (17.1%), participant or family refusal (14.9%), older age (11.0%), and dementia (9.4%). Older age (odds ratio ( OR ) = 8.96, 95% confidence interval ( CI ) = 5.01–16.04 for aged ≥85 vs <65) and disability ( OR = 12.58, 95% CI = 5.82–27.21 for severe vs no deficit) were the most‐important independent predictors of nonuse of OAC s. By 1 year, 42.5% of those not receiving an OAC at discharge had died, versus 19.1% of those receiving an OAC ( P < .001), far higher than recurrent stroke rates. Conclusion Despite very high stroke risk, more than 40% of participants were not discharged with an OAC . Dominant reasons included fall risk, poor prognosis, older age, and dementia. These individuals’ high 1‐year mortality rate confirmed their high level of comorbidity. To improve anticoagulation decisions and outcomes in this population, future research should focus on strategies to mitigate fall risk, improve assessment of risks and benefits of anticoagulation in individuals with AF , and determine whether newer anticoagulants are safer in complex elderly and frail individuals.
McGrath et al. (Fri,) conducted a cohort in Atrial Fibrillation After Acute Ischemic Stroke (n=1,405). Oral anticoagulants (OACs) vs. No OAC was evaluated on 1-year mortality (p=< .001). Discharge without oral anticoagulants occurred in 44% of older adults with atrial fibrillation after ischemic stroke and was associated with higher 1-year mortality (42.5% vs 19.1%; P<0.001).
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