Geriatric conditions do not predict stroke or bleeding in long‐term care residents with atrial fibrillation

2021 ◽  
Author(s):  
Alok Kapoor ◽  
Jay Patel ◽  
Zhiyong Chen ◽  
Sybil Crawford ◽  
David McManus ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Long Term Care ◽  
Term Care ◽  
Geriatric Conditions

scholarly journals Geriatric Conditions Are Associated With Decreased Anticoagulation Use in Long‐Term Care Residents With Atrial Fibrillation

2021 ◽  
Author(s):  
Ning Zhang ◽  
Jay Patel ◽  
Zhiyong Chen ◽  
Yanhua Zhou ◽  
Sybil Crawford ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Weight Loss ◽  
Cognitive Impairment ◽  
Body Mass ◽  
Long Term Care ◽  
Term Care ◽  
Geriatric Conditions ◽  
Low Body Mass Index

Background Anticoagulation is the mainstay for stroke prevention in patients with atrial fibrillation, but concerns about bleeding inhibit its use in residents of long‐term care facilities. Risk‐profiling algorithms using comorbid disease information (eg, CHADS 2 and ATRIA [Anticoagulation and Risk Factors in Atrial Fibrillation]) have been available for years. In the long‐term care setting, however, providers and residents may place more value on geriatric conditions such as mobility impairment, activities of daily living dependency, cognitive impairment, low body mass index, weight loss, and fall history. Methods and Results Using a retrospective cohort design, we measured the association between geriatric conditions and anticoagulation use and type. After merging nursing home assessments containing information about geriatric conditions (Minimum Data Set 2015) with Medicare Part A 2014 to 2015 claims and prescription claims (Medicare Part D) 2015 to 2016, we identified 228 741 residents with atrial fibrillation and elevated stroke risk (CHA 2 DS 2 ‐VASc score ≥2) for our main analysis. Recent fall, activities of daily living dependency, moderate and severe cognitive impairment, low body mass index, and unintentional weight loss were all associated with lower anticoagulation use even after adjustment for multiple predictors of stroke and bleeding (odds ratios ranging from 0.51 to 0.91). Residents with recent fall, low body mass index, and unintentional weight loss were more likely to be using a direct oral anticoagulant, although the magnitude of this effect was smaller. Conclusions Geriatric conditions were associated with lower anticoagulation use. Preventing stroke in these residents with potential for further physical and cognitive impairment would appear to be of paramount significance, although the net benefit of anticoagulation in these individuals warrants further research.

Geriatric Conditions Predict Discontinuation of Anticoagulation in Long‐Term Care Residents With Atrial Fibrillation

2020 ◽  
Vol 68 (4) ◽  
pp. 717-724 ◽  
Author(s):  
Alok Kapoor ◽  
Gray Foley ◽  
Ning Zhang ◽  
Yanhua Zhou ◽  
Sybil Crawford ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Long Term Care ◽  
Term Care ◽  
Geriatric Conditions

Prevalence of atrial fibrillation and outcomes in older long-term care residents: a systematic review

2020 ◽  
Author(s):  
Leona A Ritchie ◽  
Oluwakayode B Oke ◽  
Stephanie L Harrison ◽  
Sarah E Rodgers ◽  
Gregory Y H Lip ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischaemic Stroke ◽  
Long Term Care ◽  
Stroke Event ◽  
Term Care ◽  
Factors Associated ◽  
Newcastle Ottawa Scale ◽  
Ischaemic Attack ◽  
Low Incidence

Abstract Background anticoagulation is integral to stroke prevention for atrial fibrillation (AF), but there is evidence of under-treatment in older people in long-term care (LTC). Objective to synthesise evidence on the prevalence and outcomes (stroke, mortality or bleeding) of AF in LTC and the factors associated with the prescription of anticoagulation. Methods studies were identified from Medline, CINAHL, PsycINFO, Scopus and Web of Science from inception to 31 October 2019. Two reviewers independently applied the selection criteria and assessed the quality of studies using the Newcastle Ottawa Scale. Results twenty-nine studies were included. Prevalence of AF was reported in 21 studies, ranging from 7 to 38%. Two studies reported on outcomes based on the prescription of anticoagulation or not; one reported a reduction in the ischaemic stroke event rate associated with anticoagulant (AC) prescription (2.84 per 100 person years, 95% confidence interval [CI]: 1.98–7.25 versus 3.95, 95% CI: 2.85–10.08) and a non-significant increase in intracranial haemorrhage rate (0.71 per 100 person years, 95% CI: 0.29–2.15 versus 0.65, 95% CI: 0.29–1.93). The second study reported a 76% lower chance of ischaemic stroke with AC prescription and a low incidence of bleeding (n = 4 events). Older age, dementia/cognitive impairment and falls/falls risk were independently associated with the non-prescription of anticoagulation. Conversely, previous stroke/transient ischaemic attack and thromboembolism were independently associated with an increased prescription of anticoagulation. Conclusion estimates of AF prevalence and factors associated with AC prescription varied extensively. Limited data on outcomes prevent the drawing of definitive conclusions. We recommend panel data collection and systems for linkage to create longitudinal cohorts to provide more robust evidence.

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