EUROSAF – The European prospective observational study of the efficacy and safety of anticoagulants treatment in geriatric patients with atrial fibrillation. Pilot results of anticoagulants treatment in frail seniors in the Czech Republic
Authors:
Eva Topinková 1; Helena Michálková 1; Simona Vráblová 1; Hana Matějovská Kubešová 2; Jiří Nakládal 2; Ondřej Výškaj 2
Authors place of work:
Geriatrická klinika 1. LF UK a VFN Praha
1; Klinika interní, geriatrie a praktického lékařství LF MU a FN Brno
2
Published in the journal:
Geriatrie a Gerontologie 2022, 11, č. 1: 36-41
Category:
Original Article
Summary
Patients with atrial fibrillation with higher risk of stroke and thromboembolic complications benefit from anticoagulants treatment. However, there is not enough evidence if such benefit is present in geriatric patients aged 80 years and over with concomitant morbidity, functional limitations in selfcare, with geriatric syndromes and frailty. The aim of the EURopean study of Older Subjects with Atrial Fibrillation (EUROSAF) currently running in 12 European countries is to analyse efficacy of anticoagulants on overall mortality and safety.
In this paper we present baseline demographic and clinical characteristics of patients with documented nonvalvular atrial fibrillation discharged from two geriatric centres in CR (N = 383). Further, we analyse the prescription of anticoagulants stratified by geriatric frailty level. The mean age of the sample was 82,3 (± 5,9) years, 83 % was 75 years and older. We confirmed high degree of comorbidities (CIRS score 1.7 ± 0.30), limitations in ADL activities, cognitive impairments, risk of malnutrition and falls. We wound both high risk in CHA2DS2-VASc (mean score 5.06 ± 1.19) as well as HAS-BLED (2.84±0.87). In our sample a half of patients did not receive anticoagulant medication. Novel direct oral antikoagulants DOAC were prescribed only in 13 % of patients. Higher mortality risk/frailty was reflected in lower anticoagulants prescription (in the group with the highest mortality risk MPI-III only 17.6 % received OAK compared to 41.3 % in the group with lowest mortality risk MPI-I, p < 0.05). The most frequent reasons for non-prescribing were in decreasing order: high risk of falls, non- -compliance, treatment refusal and past bleeding. Further studies are needed which would include the oldest old (80+), frail, clinically complex seniors to justify the underprescribing of anticoagulants or confirm their benefit in this high-risk population.
Keywords:
Anticoagulants – frailty – EUROSAF – older patients – comprehensive geriatric assessment – multidimensional prognostic index – MPI
Zdroje
1. Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S. Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol 2014; 6: 213–220.
2. Zathar Z, Karunatilleke A, Fawzy AM, et al. Atrial fibrillation in older people: concepts and controversies. Front Med 2019.
3. Krijthe BP, Kunst A, Benjamin EJ, et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J 2013; 34(35): 2746–2751.
4. Nehaj F, Sokol J, Kubašková M, et al. Porovnanie skórovacích systémov na stanovenie rizika krvácania a tromboembolizmu u pacientov s fibriláciou predsiení a hemoragický šok u pacienta na triple terapii. Int med prax 2019; 21(2): 100–104.
5. Polidori MC, Alves M, Bahat G, et al. Special Interest Group “Cardiovascular Diseases” of the EuGMS. Atrial fibrillation: a geriatric perspective on the 2020 ESC guidelines. Eur Geriatr Med 2021 Nov 2: 1–14.
6. Alonso A, Arenas-de-Larriva AP. Atrial fibrillation, cognitive decline and dementia. Eur Cardiol 2016; 11: 49–53.
7. Magnani JW, Wang N, Benjamin EJ, et al. Atrial fibrillation and declining physical performance in older adults: the health, aging, and body composition study. Circ Arrhythm Electrophysiol 2016; 9: e003525.
8. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC). Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42(5): 373–498.
9. Maes F, Dalleur O, Henrard S, et al. Risk scores and geriatric profile: can they really help us in anticoagulation decision making among older patients suffering from atrial fibrillation? Clin Interv Aging 2014; 9: 1091–1099.
10. Bo M, Marchionni N. Practical use of direct oral anticoagulants (DOACs) in the older person with atrial fibrillation. Eur J Intern Med. 2020; 71: 32–38.
11. Topinková E. Geriatrie pro praxi. Praha: Galén 2005.
12. Weber P. Geriatrické syndromy a syndrom frailty – zlatý grál geriatrické medicíny. Vnitř Lék 2011; 57(11).
13. Cruz-Jentoft AJ, Daragjati J, Fratiglioni L, et al. Using the Multidimensional Prognostic Index (MPI) to improve cost-effectiveness of interventions in multimorbid frail older persons: results and final recommendations from the MPI_ AGE European Project. Aging Clin Exp Res 2020; 32(5): 861–868.
14. Pilotto A, Sancarlo D, Daragjati J, Panza F. Perspective: the challenge of clinical decision-making for drug treatment in older people. The role of multidimensional assessment and prognosis. Front Med 2015; 1: 61.
15. Pilotto A, Gallina P, Copetti M, et al. Warfarin treatment and all-cause mortality in community- dwelling older adults with atrial fibrillation: a retrospective observational study. J Am Geriatr Soc 2016; 64(7): 1416–1424.
16. Veronese N, Argusti A, Canepa E, et al. Evaluating the effectiveness and risks of oral anticoagulant treatments in multimorbid frail older subjects with atrial fibrillation using the multidimensional prognostic index: the EURopean study of older subjects with atrial fibrillation—EUROSAF. Eur Geriatr Med 2018; 9: 149–154.
17. Pilotto A, Ferrucci L, Franceschi M, et al. Development and validation of a multidimensional prognostic index for one-year mortality from comprehensive geriatric assessment in hospitalized older patients. Rejuvenation research 2008; 11(1): 151–161.
18. Táborský M, Fiala M, Heinc M, Býma S. Fibrilace síní. Doporučené diagnostické a terapeutické postupy pro všeobecné praktické lékaře, novelizace 2021. CDP-PL Praha.
19. Karetová D, Bultas J. Antikoagulační léčba u seniorů. Vnitř Lék 2018; 64(11): 1011–1020.
20. Špác J, Kianička B. Nové postupy v antikoagulační léčbě u seniorů s fibrilací síní. Kardiol Rev Int Med 2012; 14(1): 22–26.
21. Monte S, Macchia A, Pellegrini F, et al. Antithrombotic treatment is strongly underused despite reducing overall mortality among high-risk elderly patients hospitalized with atrial fibrillation. Eur Heart J 2006; 27: 2217–2223.
22. Sardar P, Chatterjee S, Chaudhari S, Lip GY. New oral anticoagulants in elderly adults: evidence from a meta-analysis of randomized trials. J Am Geriatr Soc 2014; 62(5): 857–864.
23. Karamichalakis N, Letsas KP, Vlachos K, et al. Managing atrial fibrillation in the very elderly patient: challenges and solutions. Vasc Health Risk Manag 2015; 11: 555–562.
24. Ng KH, Hart RG, Eikelboom JW. Anticoagulation in patients aged ≥ 75 years with atrial fibrillation: role of novel oral anticoagulants. Cardiol Ther 2013; 2(2): 135– 149.
25. Lefebvre MC, St-Onge M, Glazer-Cavanagh M, et al The effect of bleeding risk and frailty status on anticoagulation patterns in octogenarians with atrial fibrillation: The FRAIL-AF Study. Can J Cardiol 2016; 32(2): 169–176.
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Geriatrics General practitioner for adults Orthopaedic prostheticsČlánok vyšiel v časopise
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