Real-World Clinical Characteristics and Treatment Patterns of Individuals Aged 80 and Older with Nonvalvular Atrial Fibrillation: Results from the ReAl-life Multicenter Survey Evaluating Stroke Study

Abstract

ObjectivesTo compare the clinical characteristics of and use of oral anticoagulant (OAC) therapy in individuals aged 80 and older with atrial fibrillation (AF) with those of individuals younger than 80 with AF in clinical practice. DesignObservational study. SettingThe ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey trial (NCT02344901), a national observational registry. ParticipantsTurkish adults with nonvalvular AF (NVAF). MeasurementsAge data were collected at the time of entry into the registry and the octogenarian subgroup included all patients aged 80 years. We compared background and management in octogenarian with non-octogenarian AF patients. ResultsFifty-seven cardiology units enrolled 6,273 individuals in 3months. Participants aged 80 and older (n=1,170) were more likely to be female (60.7% vs 54.7%, P<.001) and had a higher prevalence of persistant or permanent AF, comorbidities, history of cerebral vascular accident, and major bleeding. As a consequence of having more comorbidities, Congestive heart failure; Hypertension; Aged 75 and older; Diabetes Mellitus; prior stroke, transient ischemic attack, or thromboembolism; Vascular disease; Aged 65 to 74; female Sex (CHA(2)DS(2)VASc) (4.321.35 vs 3.04 +/- 1.54, P<.001) and Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile international normalized ratio, Elderly, Drugs or alcohol (HAS-BLED) (2.14 +/- 1.05 vs 1.54 +/- 1.05, P<.001) scores were higher in those aged 80 and older. The mean time in therapeutic range of individuals who were taking warfarin was lower in those aged 80 and older (45.9 +/- 27.9) than in those younger than 80 (54.7 +/- 24.9%, P<.001). Anticoagulant therapy was prescribed for 74.8% of participants younger than 80% and 63% of those aged 80 and older (P<.001). Higher CHA(2)DS(2)VASc score and lower HAS-BLED score were independent predictors of OAC prescription in participants aged 80 and older. ConclusionNearly one-fifth of individuals with NVAF in this real-world sample were aged 80 and older. Participants aged 80 and older were more likely to be female and have more comorbidities than those who were younger than 80. Those aged 80 and older with AF were less likely to receive anticoagulants than those who were younger than 80, but having more comorbidities and other individual-level characteristics may explain this difference. When they were prescribed OACs, participants aged 80 and older had poorer quality of anticoagulation than those who were younger, suggesting opportunities for improvement.