Frail Patients With Nonvalvular A-Fib Less Likely to Receive Anticoagulants
Frail patients with nonvalvular atrial fibrillation also less likely to receive a direct oral anticoagulant versus warfarin
MONDAY, Jan. 3, 2022 (HealthDay News) -- Frail patients with a new diagnosis of nonvalvular atrial fibrillation (NVAF) are less likely to receive an anticoagulant, according to a study published online Dec. 20 in the Canadian Journal of Cardiology.
Michela Orlandi, M.D., from the ASST Santi Paolo e Carlo in Milan, and colleagues conducted a retrospective study involving patients ages 20 years or older who were discharged from an emergency department or hospital with a new diagnosis of NVAF between April 1, 2009, and March 31, 2019. Frailty was defined using the Hospital Frailty Risk Score.
The researchers found that 22.6 percent of the 75,796 patients with a new diagnosis of NVAF were frail. Frail patients were less likely to receive any anticoagulant, even after exclusion of those with contraindications to anticoagulants (adjusted odds ratio, 0.61), even though guideline criteria for anticoagulation were more commonly met by frail versus nonfrail patients. After direct oral anticoagulants (DOACs) became available, for patients with guideline indications, anticoagulant prescribing increased more in nonfrail (from 42.4 to 68.2 percent) than frail patients (from 29.0 to 52.2 percent); frail patients were also less likely to receive a DOAC compared with warfarin (adjusted odds ratio, 0.66).
"As frail patients have higher event rates and thus stand to potentially derive greater benefit from anticoagulation than their nonfrail counterparts, we encourage clinicians to evaluate absolute risks and benefits when making prescribing decisions," a coauthor said in a statement.
One author disclosed financial ties to the pharmaceutical industry.
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