Oral anticoagulants and outcomes in adults >= 80 years with atrial fibrillation: A global federated health network analysis

Harrison, Stephanie L ORCID: 0000-0002-8846-0946, Buckley, Benjamin JR ORCID: 0000-0002-1479-8872, Ritchie, Leona A ORCID: 0000-0002-0392-1767, Proietti, Riccardo ORCID: 0000-0003-4113-7030, Underhill, Paula, Lane, Deirdre A ORCID: 0000-0002-5604-9378 and Lip, Gregory YH ORCID: 0000-0002-7566-1626 (2022) Oral anticoagulants and outcomes in adults >= 80 years with atrial fibrillation: A global federated health network analysis. JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 70 (8). pp. 2386-2392.

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Abstract

<h4>Background</h4>The objective of this study was to determine associations between use of oral anticoagulation (OAC) and stroke and bleeding-related outcomes for older people ≥80 years with atrial fibrillation (AF), and to determine trends over time in prescribing of OAC for this population.<h4>Methods</h4>A retrospective cohort study was conducted. People aged ≥80 years with AF receiving (1) no OAC; (2) warfarin; or (3) a non-vitamin-K antagonist oral anticoagulant (NOAC) between 2011 and 2019 were included. Propensity score matching was used to balance cohorts (no OAC, warfarin or a NOAC) on characteristics including age, sex, ethnicity, and co-morbidities. Cox proportional hazard models were used to derive hazard ratios (HRs) and 95% confidence intervals (CIs).<h4>Results</h4>The proportion of people aged ≥80 years receiving any OAC increased from 32.4% (n = 27,647) in 2011 to 43.6% (n = 110,412) in 2019. After propensity score matching, n = 169,067 individuals were included in the cohorts receiving no OAC or a NOAC. Compared to no OAC, participants receiving a NOAC had a lower risk of incident dementia (hazHR 0.68, 95% CI 0.65-0.71), all-cause mortality (HR 0.49, 95% CI 0.48-0.50), first-time ischaemic stroke (HR 0.87, 95% CI 0.83-0.91), and a higher risk of major bleeding (HR 1.08, 95% CI 1.05-1.11). Compared to participants receiving warfarin, participants receiving a NOAC had a lower risk of dementia (HR 0.90, 95% CI: 0.86-0.93), all-cause mortality (HR 0.74, 95% CI: 0.72-0.76), ischaemic stroke (HR 0.86, 95% CI: 0.82-0.90) and major bleeding (HR 0.88, 95% CI: 0.85-0.90). Similar results were observed when only including people with additional bleeding risk factors.<h4>Conclusions</h4>The proportion of people aged ≥80 years receiving OAC has increased since the introduction of NOACs, but remains low. Use of a NOAC was associated with improved outcomes compared to warfarin, and compared to no OAC, except for a small but statistically significant higher risk of major bleeding.

Item Type:	Article
Uncontrolled Keywords:	atrial fibrillation, older adults, oral anticoagulants
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	06 Jun 2022 14:07
Last Modified:	25 Sep 2023 14:30
DOI:	10.1111/jgs.17884
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3155955