Characteristics of warfarin under-prescription in older adults with atrial fibrillation

Background: The prevalence of atrial fibrillation (AF) and atrial flutter (AFl) increases with age. Under-prescription of anticoagulants in older adults can lead to increased morbidity and mortality. We analyzed warfarin prescription patterns in older adults. Methods: In this observational single-ce...

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Autores principales:	Sana Rashid, Maciej Tysarowski, Jorge Naranjo, Atharva Dhole, Luka Petrovic, Emad F. Aziz
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Anticoagulants Arrythmia Atrial fibrillation Atrial flutter Elderly Warfarin Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/e90cff6fe26f4c3884081eedeb0cbd20
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spelling	oai:doaj.org-article:e90cff6fe26f4c3884081eedeb0cbd202021-11-12T04:42:08ZCharacteristics of warfarin under-prescription in older adults with atrial fibrillation2352-906710.1016/j.ijcha.2021.100914https://doaj.org/article/e90cff6fe26f4c3884081eedeb0cbd202021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2352906721002025https://doaj.org/toc/2352-9067Background: The prevalence of atrial fibrillation (AF) and atrial flutter (AFl) increases with age. Under-prescription of anticoagulants in older adults can lead to increased morbidity and mortality. We analyzed warfarin prescription patterns in older adults. Methods: In this observational single-center study, we analyzed 2179 consecutive patients with admission diagnosis of AF or AFl. Patients were divided into “older” (≥ 75 years old) and “younger” (<75 years old) groups. Prescription patterns of warfarin were analyzed. Patients discharged from the hospital on a non-warfarin anticoagulation were excluded. Results: Of the 1988 patients analyzed, 46.9% were ≥75 years old, of which 50.8% were prescribed warfarin. There was no association between mean CHA2DS2-VASc score and warfarin prescription on discharge (OR = 1.06 (95% CI 0.93–1.21), p = 0.388) in the older group. After adjusting for hypertension, renal function, and Black race, warfarin prescription in older adults was independently associated with lower aspirin prescription rates (OR = 0.57 (95% CI 0.43–0.75), p < 0.001), lower body mass index (OR = 1.03 (95% CI 1.01–1.06), p = 0.018), and lower hemoglobin levels (OR = 1.11 (95% CI 1.04–1.19), p = 0.002). Conclusions: In our study, older adults (≥75 years old) with AF and AFl tended to have lower rates of warfarin prescription despite higher CHA2DS2-VASc score and higher risk of thromboembolic events. Anemia, lower body weight, and aspirin use were characteristics associated with warfarin under-prescription.Sana RashidMaciej TysarowskiJorge NaranjoAtharva DholeLuka PetrovicEmad F. AzizElsevierarticleAnticoagulantsArrythmiaAtrial fibrillationAtrial flutterElderlyWarfarinDiseases of the circulatory (Cardiovascular) systemRC666-701ENInternational Journal of Cardiology: Heart & Vasculature, Vol 37, Iss , Pp 100914- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Anticoagulants Arrythmia Atrial fibrillation Atrial flutter Elderly Warfarin Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Anticoagulants Arrythmia Atrial fibrillation Atrial flutter Elderly Warfarin Diseases of the circulatory (Cardiovascular) system RC666-701 Sana Rashid Maciej Tysarowski Jorge Naranjo Atharva Dhole Luka Petrovic Emad F. Aziz Characteristics of warfarin under-prescription in older adults with atrial fibrillation
description	Background: The prevalence of atrial fibrillation (AF) and atrial flutter (AFl) increases with age. Under-prescription of anticoagulants in older adults can lead to increased morbidity and mortality. We analyzed warfarin prescription patterns in older adults. Methods: In this observational single-center study, we analyzed 2179 consecutive patients with admission diagnosis of AF or AFl. Patients were divided into “older” (≥ 75 years old) and “younger” (<75 years old) groups. Prescription patterns of warfarin were analyzed. Patients discharged from the hospital on a non-warfarin anticoagulation were excluded. Results: Of the 1988 patients analyzed, 46.9% were ≥75 years old, of which 50.8% were prescribed warfarin. There was no association between mean CHA2DS2-VASc score and warfarin prescription on discharge (OR = 1.06 (95% CI 0.93–1.21), p = 0.388) in the older group. After adjusting for hypertension, renal function, and Black race, warfarin prescription in older adults was independently associated with lower aspirin prescription rates (OR = 0.57 (95% CI 0.43–0.75), p < 0.001), lower body mass index (OR = 1.03 (95% CI 1.01–1.06), p = 0.018), and lower hemoglobin levels (OR = 1.11 (95% CI 1.04–1.19), p = 0.002). Conclusions: In our study, older adults (≥75 years old) with AF and AFl tended to have lower rates of warfarin prescription despite higher CHA2DS2-VASc score and higher risk of thromboembolic events. Anemia, lower body weight, and aspirin use were characteristics associated with warfarin under-prescription.
format	article
author	Sana Rashid Maciej Tysarowski Jorge Naranjo Atharva Dhole Luka Petrovic Emad F. Aziz
author_facet	Sana Rashid Maciej Tysarowski Jorge Naranjo Atharva Dhole Luka Petrovic Emad F. Aziz
author_sort	Sana Rashid
title	Characteristics of warfarin under-prescription in older adults with atrial fibrillation
title_short	Characteristics of warfarin under-prescription in older adults with atrial fibrillation
title_full	Characteristics of warfarin under-prescription in older adults with atrial fibrillation
title_fullStr	Characteristics of warfarin under-prescription in older adults with atrial fibrillation
title_full_unstemmed	Characteristics of warfarin under-prescription in older adults with atrial fibrillation
title_sort	characteristics of warfarin under-prescription in older adults with atrial fibrillation
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/e90cff6fe26f4c3884081eedeb0cbd20
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Characteristics of warfarin under-prescription in older adults with atrial fibrillation

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