Frailty and anticoagulants in older subjects with atrial fibrillation: the EUROSAF study.
Aims Literature regarding anticoagulants in older people affected by atrial fibrillation (AF) is limited to retrospective studies, poorly considering the importance of multidimensional frailty. The main objective of this study is to evaluate in hospitalised older persons with AF the benefit/risk rat...
| Publicado en: | Age & Ageing Vol. 52; no. 11; pp. 1 - 10 |
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| Autores principales: | , , , , , , , , , |
| Formato: | Artículo |
| Publicado: |
Oxford University Press / USA
Nov2023
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=173944389&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 173944389 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00020729 AGA jtl: Age & Ageing issn: 00020729 maglogo: N pubinfo: dt: Nov2023 vid: 52 iid: 11 pid: 622 pub: Oxford University Press / USA artinfo: ui: 173944389 10.1093/ageing/afad216 ppf: 1 ppct: 9 formats: tig: atl: Frailty and anticoagulants in older subjects with atrial fibrillation: the EUROSAF study. aug: au: Pilotto, Alberto Veronese, Nicola Polidori, Maria Cristina Strandberg, Timo Topinkova, Eva Cruz-Jentoft, Alfonso J Custodero, Carlo Barbagallo, Mario Maggi, Stefania Investigators, the EUROSAF Study affil: Geriatrics Unit , Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, E.O. Galliera Hospital , Genova , Italy Department of Interdisciplinary Medicine, University of Bari "Aldo Moro" , Bari , Italy Geriatrics Unit , Department of Internal Medicine, University of Palermo , Palermo , Italy Ageing Clinical Research , Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne , Cologne , Germany University of Helsinki and Helsinki University Hospital , Helsinki Finland Center for Life Course Health Research, University of Oulu , Oulu , Finland First Faculty of Medicine, Charles University in Prague , Czech Republic Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS) , Madrid , Spain National Research Council, Neuroscience Section , Padova , Italy su: Europe Drug efficacy Hospital care of older people Disease risk factors Old age Mortality prevention Thromboembolism prevention Research Frail elderly Hemorrhagic stroke Confidence intervals Scientific observation Myocardial ischemia Ischemic stroke Gastrointestinal hemorrhage Oral drug administration Anticoagulants Atrial fibrillation Acquisition of data Geriatric assessment Severity of illness index Comparative studies Research funding Medical records Descriptive statistics Longitudinal method Vitamin K Chemical inhibitors Evaluation sug: subj: Drug efficacy Hospital care of older people Disease risk factors Old age Europe Mortality prevention Thromboembolism prevention Research Frail elderly Hemorrhagic stroke Confidence intervals Scientific observation Myocardial ischemia Ischemic stroke Gastrointestinal hemorrhage Oral drug administration Anticoagulants Atrial fibrillation Acquisition of data Geriatric assessment Severity of illness index Comparative studies Research funding Medical records Descriptive statistics Longitudinal method Vitamin K Chemical inhibitors Evaluation keyword: atrial fibrillation frailty mortality multidimensional prognostic index older people stroke atrial fibrillation frailty mortality multidimensional prognostic index older people stroke ab: Aims Literature regarding anticoagulants in older people affected by atrial fibrillation (AF) is limited to retrospective studies, poorly considering the importance of multidimensional frailty. The main objective of this study is to evaluate in hospitalised older persons with AF the benefit/risk ratio of the anticoagulant treatments, considering the severity of frailty, determined by the multidimensional prognostic index (MPI). Methods In this European, multicentre, prospective study, older hospitalised patients (≥65 years) with non-valvular AF were followed-up for 12 months. Anticoagulants' use at discharge ascertained using medical records. MPI was calculated using tools derived from comprehensive geriatric assessment, classifying participants in robust, pre-frail or frail. Mortality (primary outcome); vascular events, including ischemic heart disease or ischemic stroke, hemorrhagic stroke or gastrointestinal bleedings (secondary outcomes). Results 2,022 participants (mean age 82.9 years; females 56.6%) were included. Compared with people not taking anticoagulants (n = 823), people using vitamin K antagonists (n = 450) showed a decreased risk of mortality (hazard ratio, HR = 0.74; 95% CI: 0.59–0.93), more pronounced in patients using direct oral anticoagulants (DOACs) (n = 749) (HR = 0.46; 95% CI: 0.37–0.57). Only people taking DOACs reported a significantly lower risk of vascular events (HR = 0.55; 95% CI: 0.31–0.97). The efficacy of DOACs was present independently from frailty status. The risk of gastrointestinal bleedings and hemorrhagic stroke did not differ based on the anticoagulant treatments and by MPI values. Conclusions Anticoagulant treatment, particularly with DOACs, was associated with reduced mortality in older people, without increasing the risk of hemorrhagic events, overall suggesting the importance of treating with anticoagulants older people with AF. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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