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



Ritchie, Leona A, Oke, Oluwakayode B, Harrison, Stephanie L ORCID: 0000-0002-8846-0946, Rodgers, Sarah E ORCID: 0000-0002-4483-0845, Lip, Gregory YH and Lane, Deirdre A ORCID: 0000-0002-5604-9378
(2021) Prevalence of atrial fibrillation and outcomes in older long-term care residents: a systematic review. Age and Ageing, 50 (3). 744 - 757.

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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.

Item Type: Article
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Faculty of Health and Life Sciences > Institute of Population Health
Depositing User: Symplectic Admin
Date Deposited: 10 Jun 2021 07:39
Last Modified: 01 Dec 2021 00:12
DOI: 10.1093/ageing/afaa268
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3124230

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