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Clinical Summary

Factors Associated With Non-prescription of OAC in Dementia Patients With AF

Takeaway

  • This study suggests that as many as 64% of dementia patients in England do not receive oral anticoagulant (OAC) treatment in the year following atrial fibrillation (AF) diagnosis, despite having risk factors suggestive of greater thromboembolic risk.
  • Bleeding risk factors, including previous major bleeds and a history of falls, are associated with lower OAC prescribing.

Why this matters

  • Dementia is a common comorbidity in patients with AF, and guidelines recommend OAC therapy for patients with AF and dementia unless concordance cannot be ensured by the caregiver.
  • Findings warrant further studies to establish possible associations between bleeding risk factors and other potential drivers of OAC prescribing.

Study design

  • This retrospective study included 1090 dementia patients newly diagnosed with AF (aged, ≥65 years) between 2013 and 2017 using data from UK Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases.
  • Funding: Bristol-Myers Squibb-Pfizer Global Alliance.

Key results

  • Of 1090 patients, 397 (36.4%) were prescribed an OAC and 693 (63.6%) were not prescribed an OAC in the year following their diagnosis.
  • The proportion of patients who experienced thromboembolic events was high, with 97% of patients having a CHA2DS2-VASc score of >2.
  • The proportions of patients with stroke risk factors and the mean CHA2DS2-VASc score did not differ between OAC treated and untreated groups.
  • The presence of bleeding risk factors was high with only 28 (2.6%) patients not having a previous fall or a HAS-BLED bleeding risk factor.
  • Older patients (mean age, 85.72 years) were less likely to be prescribed an OAC and females were less likely to be treated than males (OR, 0.96; 95% CI, 0.94-0.98 and OR, 0.65; 95% CI, 0.50-0.83).
  • Factors associated with a lower OAC prescription included:
    • history of falls (OR, 0.76; 95% CI, 0.58-0.98);
    • previous major bleed (OR, 0.56; 95% CI, 0.43-0.73); and
    • care home residence (OR, 0.47; 95% CI, 0.30-0.74).

Limitations

  • The identification of patient characteristics was dependent on a coded record.
  • CPRD data source did not contain prescriptions issued in secondary or tertiary care.

Besford M, Graham S, Sammon C, Mehmud F, Allan V, Alikhan R, Ramagopalan S. Factors associated with non-prescription of oral anticoagulant treatment in non-valvular atrial fibrillation patients with dementia: a CPRD-HES study. Age Ageing. 2020;49(4):679-682. doi: 10.1093/ageing/afaa045. PMID: 32242616Abstract.

This clinical summary first appeared on Univadis, part of the Medscape Professional Network.

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