Geriatric Elements and Oral Anticoagulant Prescribing in Older Atrial Fibrillation Patients: SAGE-AF
Geriatric Elements and Oral Anticoagulant Prescribing in Older Atrial Fibrillation Patients: SAGE-AF
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DOI：
10.1111/jgs.16178
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发表时间：
2019-10-01
影响因子：
6.3
通讯作者：
McManus, David D.
中科院分区：
文献类型：
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作者：
Saczynski, Jane S.;Sanghai, Saket R.;McManus, David D.
目的口服抗凝药物是预防高危房颤患者卒中的基石。老年因素，如认知障碍和虚弱，通常发生在这些患者中，经常被认为是不开口服抗凝剂的原因。我们试图系统地评估房颤患者的老年损害，并确定这些损害是否与口服抗凝剂处方有关。设计对正在进行的心房颤动老年因素系统性评估(SAGE-AF)前瞻性队列研究中的基线数据进行横断面分析。设置多中心研究，地点设在马萨诸塞州和佐治亚州，从2016年到2018年从心脏病学、电生理学和初级保健诊所招募参与者。参与者年龄65岁或以上，CHA(2)DS(2)-VASc(充血性心力衰竭；高血压；老年=75岁[加倍]；糖尿病；既往中风、短暂性脑缺血发作或血栓栓塞症[加倍]；血管疾病；年龄65-74岁；女性)2分或以上，且无口服抗凝药物禁忌症(n=1244)。测量一项由六个部分组成的老年评估包括对虚弱、认知功能、社会支持、抑郁症状、视力和听力的有效测量。口服抗凝剂的使用是从病历中提取的。结果共纳入1244名受试者(平均年龄76岁；女性占49%；白人占85%)；42%的人有认知障碍，14%的人虚弱，53%的人虚弱，12%的人与世隔绝，29%的人有抑郁症状。86%的队列患者服用了口服抗凝剂。口服抗凝剂处方不会因老年因素的不同而不同(口服抗凝剂处方和认知障碍的调整优势比[OR]：OR=.75；95%可信区间[CI]=.51-1.09；虚弱OR=.69；95%CI=.35-1.36；社会隔离OR=.90；95%CI=.52-1.54；抑郁OR=.79；95%CI=.49-1.27；视力障碍OR=.98；95%CI=.65-1.48；以及听力障碍OR=1.05；95%CI=.71-1.54)。结论老年损害，特别是认知损害和虚弱，在我们的队列中很常见，但口服抗凝剂治疗并不因损害状况而异。这些老年损害通常被认为是不开口服抗凝剂的原因，这表明处方医生可能没有意识到或故意忽视这些因素在临床环境中的存在。
OBJECTIVES Oral anticoagulants are the cornerstone of stroke prevention in high-risk patients with atrial fibrillation (AF). Geriatric elements, such as cognitive impairment and frailty, commonly occur in these patients and are often cited as reasons for not prescribing oral anticoagulants. We sought to systematically assess geriatric impairments in patients with AF and determine whether they were associated with oral anticoagulant prescribing. DESIGN Cross-sectional analysis of baseline data from the ongoing Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF) prospective cohort study. SETTING Multicenter study with site locations in Massachusetts and Georgia that recruited participants from cardiology, electrophysiology, and primary care clinics from 2016 to 2018. PARTICIPANTS Participants with AF age 65 years or older, CHA(2)DS(2)-VASc (congestive heart failure; hypertension; aged >= 75 y [doubled]; diabetes mellitus; prior stroke, transient ischemic attack, or thromboembolism [doubled]; vascular disease; age 65-74; female sex) score of 2 or higher, and no oral anticoagulant contraindications (n = 1244). MEASUREMENTS A six-component geriatric assessment included validated measures of frailty, cognitive function, social support, depressive symptoms, vision, and hearing. Oral anticoagulant use was abstracted from the medical record. RESULTS A total of 1244 participants (mean age = 76 y; 49% female; 85% white) were enrolled; 42% were cognitively impaired, 14% frail, 53% pre-frail, 12% socially isolated, and 29% had depressive symptoms. Oral anticoagulants were prescribed to 86% of the cohort. Oral anticoagulant prescribing did not vary according to any of the geriatric elements (adjusted odds ratios [ORs] for oral anticoagulant prescribing and cognitive impairment: OR = .75; 95% confidence interval [CI] = .51-1.09; frail OR = .69; 95% CI = .35-1.36; social isolation OR = .90; 95% CI = .52-1.54; depression OR = .79; 95% CI = .49-1.27; visual impairment OR = .98; 95% CI = .65-1.48; and hearing impairment OR = 1.05; 95% CI = .71-1.54). CONCLUSION Geriatric impairments, particularly cognitive impairment and frailty, were common in our cohort, but treatment with oral anticoagulants did not differ by impairment status. These geriatric impairments are commonly cited as reasons for not prescribing oral anticoagulants, suggesting that prescribers may either be unaware or deliberately ignoring the presence of these factors in clinical settings.