Factors associated with non-prescription of OAC in dementia patients with AF

  • Besford M & al.
  • Age Ageing
  • 1 Jul 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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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.