Key result
Age 76-89 linked to ~355% higher odds of anticoagulation underutilization vs age 50-75.
Why the study?
AF substantially increases the risk of ischemic stroke and systemic embolism, particularly in elderly patients, making it critical to understand real-world patterns of anticoagulation use in this population.
Does older age (76-89 years) increase the risk of anticoagulation underutilization compared to younger age (50-75 years) in patients with nonvalvular atrial fibrillation?
Cohort (n=6,386)
No
Does older age (76-89 years) increase the risk of anticoagulation underutilization compared to younger age (50-75 years) in patients with nonvalvular atrial fibrillation?
Elderly patients (76-89 years) with nonvalvular atrial fibrillation are significantly more likely to experience anticoagulation underutilization compared to younger patients (50-75 years), highlighting the challenge of balancing stroke and bleeding risks.
Answers are grounded in this paper and cite their sources.
Suggests age-related anticoagulation gaps in nonvalvular AF; hypothesis-generating for targeted interventions in the elderly.
Background: Atrial fibrillation (AF) is associated with a substantially increased risk of ischemic stroke and systemic embolism particularly in elderly patients. Understanding real-world patterns of anticoagulation (AC) use in elderly population is critical. Methods: This is a retrospective, single-center, chart review study that included patients who had nonvalvular AF between 2021 and 2024. Patients were divided into two groups according to age: 50–75 years old and 76–89 years old. Primary endpoint was AC underutilization, which was defined by the presence of all the following conditions: 1) CHA2DS2-VASc score > 2; 2) Outcomes Registry for Better Informed Treatment (ORBIT) score ≥ 3; 3) without AC. Secondary endpoint was AC appropriateness, which is defined by the presence of all the following conditions: 1) CHA2DS2-VASc > 2; 2) ORBIT < 3; 3) with AC. Results: A total of 6,386 patients were included. Among them, 3,306 patients were 50–75 years old, and 3,080 patients were 76–89 years old. Patients in age group 76–89 had a 4.547-fold higher odds ratio (OR = 4.547; 95% confidence interval (CI), 3.827–5.403) to have AC underutilization than those in age group 50–75. Patients in age group 76–89 were 108% (OR = 2.077; 95% CI, 1.818–2.374) more likely to have AC appropriateness than those in age group 50–75. History of bleeding (OR = 10.582; 95% CI, 6.467–17.315; P < 0.001) and glomerular filtration rate (GFR) (OR = 0.985; 95% CI, 0.982–0.988; P < 0.001) were independent predictors of appropriateness. Similar, history of bleeding (OR = 2.402; 95% CI, 1.666–3.462; P < 0.001) and GFR (OR = 1.006; 95% CI, 1.001–1.010; P = 0.0185) were also independent predictors of underutilization. Conclusions: Patients in age group 76–89 were more likely to have AC underutilization than patients in age group 50–75. History of bleeding and GFR were independent predictors of appropriateness and underutilization. These findings highlight the ongoing challenge of balancing stroke prevention and bleeding risk in elderly AF patients and underscore the importance of guideline-directed, individualized AC strategies.
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Jia et al. (2026) conducted a cohort in Nonvalvular atrial fibrillation (n=6,386). Age 76-89 years vs. Age 50-75 years was evaluated on Anticoagulation underutilization (CHA2DS2-VASc > 2, ORBIT ≥ 3, without AC) (OR 4.547, 95% CI 3.827-5.403). Patients aged 76-89 years had significantly higher odds of anticoagulation underutilization compared to those aged 50-75 years (OR 4.547; 95% CI 3.827-5.403).
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