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
Abstract
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.