Harrison, SL, Buckley, BJR, Ritchie, LA, Proietti, R, Underhill, P, Lane, DA and Lip, GYH (2022) Oral anticoagulants and outcomes in adults ≥80 years with atrial fibrillation: A global federated health network analysis. Journal of the American Geriatrics Society. ISSN 0002-8614

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Abstract

Background: The objective of this study was to determine associations between use of oral anticoagulation (OAC) and stroke and bleeding-related outcomes for older people ≥80 years with atrial fibrillation (AF), and to determine trends over time in prescribing of OAC for this population. Methods: A retrospective cohort study was conducted. People aged ≥80 years with AF receiving (1) no OAC; (2) warfarin; or (3) a non-vitamin-K antagonist oral anticoagulant (NOAC) between 2011 and 2019 were included. Propensity score matching was used to balance cohorts (no OAC, warfarin or a NOAC) on characteristics including age, sex, ethnicity, and co-morbidities. Cox proportional hazard models were used to derive hazard ratios (HRs) and 95% confidence intervals (CIs). Results: The proportion of people aged ≥80 years receiving any OAC increased from 32.4% (n = 27,647) in 2011 to 43.6% (n = 110,412) in 2019. After propensity score matching, n = 169,067 individuals were included in the cohorts receiving no OAC or a NOAC. Compared to no OAC, participants receiving a NOAC had a lower risk of incident dementia (hazHR 0.68, 95% CI 0.65–0.71), all-cause mortality (HR 0.49, 95% CI 0.48–0.50), first-time ischaemic stroke (HR 0.87, 95% CI 0.83–0.91), and a higher risk of major bleeding (HR 1.08, 95% CI 1.05–1.11). Compared to participants receiving warfarin, participants receiving a NOAC had a lower risk of dementia (HR 0.90, 95% CI: 0.86–0.93), all-cause mortality (HR 0.74, 95% CI: 0.72–0.76), ischaemic stroke (HR 0.86, 95% CI: 0.82–0.90) and major bleeding (HR 0.88, 95% CI: 0.85–0.90). Similar results were observed when only including people with additional bleeding risk factors. Conclusions: The proportion of people aged ≥80 years receiving OAC has increased since the introduction of NOACs, but remains low. Use of a NOAC was associated with improved outcomes compared to warfarin, and compared to no OAC, except for a small but statistically significant higher risk of major bleeding.

Item Type:	Article
Additional Information:	This is the peer reviewed version of the following article: Harrison, SL, Buckley, BJR, Ritchie, LA, et al. Oral anticoagulants and outcomes in adults ≥80 years with atrial fibrillation: A global federated health network analysis. J Am Geriatr Soc. 2022; 1- 7. doi:10.1111/jgs.17884, which has been published in final form at https://doi.org/10.1111/jgs.17884. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.
Uncontrolled Keywords:	atrial fibrillation; older adults; oral anticoagulants; Geriatrics; 11 Medical and Health Sciences
Subjects:	R Medicine > R Medicine (General) R Medicine > RM Therapeutics. Pharmacology
Divisions:	Nursing & Allied Health Pharmacy & Biomolecular Sciences Sport & Exercise Sciences
Publisher:	Wiley
SWORD Depositor:	A Symplectic
Date Deposited:	09 Jun 2022 10:58
Last Modified:	19 May 2023 00:50
DOI or ID number:	10.1111/jgs.17884
URI:	https://researchonline.ljmu.ac.uk/id/eprint/17039

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