Key result
Elderly patients (≥80 years) with non-valvular atrial fibrillation were less likely to receive oral anticoagulants than younger patients (64.4% vs 75.3%; OR 0.91; 95% CI 0.86-0.97; P=0.003).
Why the study?
AF is common in the elderly but often suboptimally treated, with limited data on stroke prevention strategies in this population, particularly in the Balkan region.
Are elderly patients (≥80 years) with non-valvular atrial fibrillation less likely to receive oral anticoagulant therapy compared to younger patients?
Cross-Sectional (n=2,671)
Yes
Are elderly patients (≥80 years) with non-valvular atrial fibrillation less likely to receive oral anticoagulant therapy compared to younger patients?
Odds Ratio: 0.91 (95% CI 0.86–0.97)
Absolute Event Rate: 64.4% vs 75.3%
p-value: p=0.003
Elderly patients with non-valvular atrial fibrillation in the Balkan region are significantly undertreated with oral anticoagulants despite having a higher stroke risk profile.
May indicate OAC undertreatment in elderly AF patients despite higher stroke risk; observational data leave open need for prospective confirmation.
Background Atrial fibrillation (AF) is common amongst the elderly, but this group tends to be suboptimally treated. Limited data are available on the stroke prevention strategies in the elderly, especially in the Balkan region. Aim We investigated the use of oral anticoagulant therapy (OAC) amongst elderly AF patients in clinical practice in the Balkan region. Method A 12‐week prospective snapshot survey (2014‐2015) of consecutive non‐valvular AF patients was conducted in Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Montenegro, Romania and Serbia. Data were collected via an electronic case report form. Results Of 2671 patients, 418 (15.6%) were ≥80 years old. Overall, OAC was used in 1965 patients (73.6%). Compared with younger patients, the elderly (age ≥ 80) had a higher mean CHA 2 DS 2 ‐VASc score (3.22 ± 1.71 vs 4.89 ± 1.35, P < .001) and more often a HAS‐BLED score of ≥3 (n = 198 [47.0%] vs n = 625 [27.3%], P < .001), but were less likely to receive OAC (n = 269 [64.4%] vs n = 1696 [75.3%], odds ratio [OR] 0.91; 95%CI 0.86‐0.97, P = .003). There was no significant association between OAC use and mean CHA 2 DS 2 ‐VASc (OR 0.86; 95%CI 0.75‐1.00, P = .053) or HAS‐BLED score (OR 1.21; 95%CI 0.81‐1.81, P = .349) in the elderly. Conclusion In the BALKAN‐AF Survey, elderly AF patients were less likely to receive the guideline‐adherent treatment despite their less favourable risk profile. Since OAC nonuse among the elderly was not associated with increased HAS‐BLED score, factors other than patients’ risk profile could influence the implementation of guideline‐adherent treatment for thromboprophylaxis in the elderly AF patients.
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Potpara et al. (2020) conducted a cross-sectional in non-valvular atrial fibrillation (n=2,671). Age ≥ 80 years vs. Age < 80 years was evaluated on Use of oral anticoagulant therapy (OAC) (OR 0.91, 95% CI 0.86-0.97, p=0.003). Elderly patients (≥80 years) with non-valvular atrial fibrillation were less likely to receive oral anticoagulants than younger patients (64.4% vs 75.3%; OR 0.91; 95% CI 0.86-0.97; P=0.003).
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