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Title: Impact of geriatric syndromes on anticoagulation prescription in older adults with atrial fibrillation
Authors: Li Feng Tan
Rodney Soh
Christopher Koo 
Wilson Goh
Goy Shen
Jiayi Lim 
Santhosh Seetharaman 
Reshma Merchant 
Keywords: Atrial fibrillation
older adults
geriatric syndromes
Issue Date: 12-Nov-2021
Publisher: Taylor & Francis
Citation: Li Feng Tan, Rodney Soh, Christopher Koo, Wilson Goh, Goy Shen, Jiayi Lim, Santhosh Seetharaman, Reshma Merchant (2021-11-12). Impact of geriatric syndromes on anticoagulation prescription in older adults with atrial fibrillation. Current Medical Research and Opinion 38 (03) : 339-343. ScholarBank@NUS Repository.
Abstract: Background Atrial fibrillation (AF) is common in older adults. CHA2DS2-VASC (congestive heart failure, hypertension, age ≥75 (doubled), diabetes mellitus, prior stroke or transient ischemic attack (doubled), vascular disease, age 65–74, female) and HASBLED(Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) are the most established risk stratification tools in assessing suitability for anticoagulation in AF. However, there are no established screening tools for geriatric syndromes on anticoagulation risks in older adults. Objective This study examined the association of anticoagulation prescription with geriatric syndromes. Methods Older adults 65 years and above admitted to a tertiary hospital with atrial fibrillation and CHA2DS2-VASC score ≥ 2. Data on demographics, function (modified Barthel’s Index (MBI)), cognition (mini-cog), frailty (Edmonton Frail Scale (EFS) and FRAIL), geriatric syndromes (EFS), sarcopenia (SARC-F), HASBLED and CHA2DS2-VASC were collected. Results 150 patients aged 65 and above (mean age 79.4 ± 7.1 years) with AF were recruited. 101 (67%) participants were anticoagulated, in univariate analysis comparing those who were anticoagulated with those who were not, age (OR 0.94; 95% CI 0.89−0.99), chronic kidney disease (OR 0.39; 95% CI 0.19−0.80), frailty (OR 0.77; 95% CI 0.60−0.98) and functional status by Barthel’s Index (OR 0.75; 95% CI 0.57−0.97) were significantly associated with anticoagulation prescription. In multivariate analysis, age (OR 0.93; 95% CI 0.88−0.99) and CKD (OR 0.35; 95% CI 0.16−0.76) remained significant. There was no significant difference in CHA2DS2-VASC, HASBLED, MBI or falls between the groups. Conclusions Age and CKD were significantly associated with anticoagulation prescription in patients with AF. Further studies on the impact of geriatric syndromes on anticoagulation prescription and outcomes in older adults are needed with specific guidelines for patients with geriatric syndromes and AF.
Source Title: Current Medical Research and Opinion
ISSN: 0300-7995
DOI: 10.1080/03007995.2021.2000717
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