Adoption of the SAMe-TT2R2 score in older patients with atrial fibrillation

atrial fibrillation anticoagulant SAMe-TT 2 R 2 scoreNonvitamin K oral anticoagulant (NOAC) is the preferred anticoagulant option in patients with nonvalvular atrial fibrillation (NVAF). 1 However, because of cost issues 2 , an initial vitamin K antagonist (VKA) trial would be reasonable before NOAC administration.The SAMe-TT 2 R 2 score is a tool that facilitates the identification of patients highly likely to achieve optimal anticoagulation under VKA.3e5 The aim of our prospective, observational study was to assess the level and predictors of SAMe-TT 2 R 2 adoption in a nationwide cohort of older patients with NVAF.Patients 80 years with confirmed (ECG/Holter recording) NVAF from 30 centers were recruited.The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki and was approved by the institutional review boards.All patients gave their written consent.The SAMe-TT 2 R 2 score was calculated after the addition of one point each for female sex, age <60 years, medical history (2 comorbidities), treatment (e.g., amiodarone), and two points for tobacco use and nonwhite race, respectively.Patients with an SAMe-TT 2 R 2 score <2 were deemed suitable for VKA trial, whereas 2 or <2 with a labile International Normalized Ratio (INR) as high risk for nonperformance on VKA.Labile INR was documented as repeatedly unstable INR measurements or TTR 60%.In total, 1018 patients with NVAF (mean age 85.4 years and 54.4% females) were included.Among them 419 (41.2%) had SAMe-TT 2 R 2 <2 and 599 (58.8%) had a score 2 or <2 plus labile INR (Table 1).Furthermore, 878 (86.2%) patients were treated with oral anticoagulants (OAC), while 140 (13.8%) received antiplatelets/no treatment.Among OAC-treated patients, 361 (41.1%) had SAMe-TT 2 R 2 <2, while 517 (58.9%) had a score 2 or <2 with labile INR.In consistency with the SAMe-TT 2 R 2 , the former subgroup should receive VKA, while the latter should be treated with NOACs.However, in our cohort, 293 (33.4%) patients were under VKA treatment and 585 (66.6%) patients received NOACs.In total, 52.6% received a treatment consistent with the SAMe-TT 2 R 2 score.The proportion of patients who received SAMe-TT 2 R 2 -consistent treatment was significantly lower among those considered as suitable * Active smoker: more than two cigarettes daily for at least 2 years.** Increased alcohol consumption: more than 8 drinks per week.Peer review under responsibility of Hellenic Society of Cardiology.