Barriers to Prescribing Oral Anticoagulants To Inpatients Aged 80 Years and Older With Nonvalvular Atrial Fibrillation: A Cross-Sectional Study

Background: To investigate the temporal trend of prevalence of anticoagulation treatment and explore the factors associated with under prescription of oral anti-coagulants (OACs) among inpatients aged ≥80 years with nonvalvular atrial fibrillation (NVAF). Methods: We retrospectively reviewed the medical records of inpatients with a discharge diagnosis of NVAF from a medical database. We used the Pearson chi-square or Fisher’s exact test to compare categorical variables between patients with and without OACs prescription. Logistic regression analysis was used to assess the association between risk factors and under prescription of OACs. Results: A total of 4375 patients aged ≥80 years with AF were assessed in the largest academic hospital in China from August 1, 2016, to July 31, 2020, 3165 NVAF patients were included. The prevalence of OACs use was 20.9% in 2017, 28.7% in 2018, 35.6% in 2019, and 43.9% in 2020. Of all participants with CHA2DS2-VASc≥2, 1,027 (32.4%) were prescribed OACs; 33.7% and 31.8% of patients with and without prior stroke received OACs, respectively. Age, clinical department where patients were discharged, use of antiplatelets, and history of stroke and dementia were significantly associated with not prescribing OACs. Conclusions: The prevalence of OACs use increased over the past several years. The rate of prescription of OACs was lower among NVAF patients who were older, prescribed antiplatelets, discharged from non-departmental cardiology, and suffered from comorbidities. This study found the iatrogenic factors affecting the use of OACs in the inpatients aged ≥80 years, providing clues and basis for the standardized use of OACs in the inpatients.