Anticoagulant therapy underuse remained frequent among 2061 elderly hospitalized AF patients between 2010 and 2023, despite a marked shift from VKAs to DOACs.
Observational (n=2,061)
Yes
Despite a shift towards DOACs, anticoagulant underuse remains frequent among elderly, multimorbid hospitalized patients with atrial fibrillation.
Background/Objectives: Atrial fibrillation (AF) is highly prevalent among older adults and is associated with increased thromboembolic risk. Although anticoagulant therapy (AC) is strongly recommended, its use in elderly and multimorbid patients remains suboptimal. This study aimed to describe long-term trends in AC prescribing patterns among hospitalized older patients with AF. Methods: We conducted a retrospective observational analysis using data from the Italian REPOSI registry, including patients aged ≥65 years hospitalized with AF between 2010 and 2023. AC at admission and discharge was analyzed, including vitamin K antagonists (VKAs), direct oral anticoagulants (DOACs), and antiplatelet agents. Temporal trends, admission-to-discharge treatment changes, and patient characteristics associated with therapy modification were assessed descriptively. Results: The study included 2061 AF patients, characterized by multimorbidity and high thromboembolic risk. A marked shift from VKAs to DOACs was observed over time. However, a substantial proportion of cases remained without AC or received only antiplatelet therapy at both admission and discharge, with untreated individuals being generally older and more clinically complex. DOAC use increased steadily but showed a slight decline at discharge after 2020. Clinical variables available in the registry only partially explained AC changes during hospitalization. Conclusions: Despite increasing adoption of DOACs, AC underuse remains frequent among elderly hospitalized patients with AF. These real-world data highlight persistent challenges in AC management in complex older adults and underscore the need for more comprehensive clinical information and data-driven tools to support individualized therapeutic decision-making.
Accordino et al. (2026) conducted an observational in Atrial fibrillation (n=2,061). Anticoagulant therapy was evaluated on Long-term trends in anticoagulant prescribing patterns at admission and discharge. Anticoagulant therapy underuse remained frequent among 2061 elderly hospitalized AF patients between 2010 and 2023, despite a marked shift from VKAs to DOACs.