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Age and Ageing Advance Access published online on January 16, 2009
Age and Ageing, doi:10.1093/ageing/afn293
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© The Author 2009. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

The impact of frailty on the utilisation of antithrombotic therapy in older patients with atrial fibrillation

Vidya Perera1,2,3, Beata V. Bajorek3, Slade Matthews2 and Sarah N. Hilmer1,2

1 Department of Aged Care and Clinical Pharmacology, Royal North Shore Hospital, St Leonards, NSW, Australia
2 Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
3 Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia

Address correspondence to: Sarah N. Hilmer. Tel: (+612) 9926 7631; Fax: (+612) 9926 7614. Email: shilmer{at}med.usyd.edu.au

Objective: to investigate the impact of frailty on the utilisation of antithrombotics and on clinical outcomes in older people with atrial fibrillation (AF).

Design: prospective study of a cohort of 220 acute inpatients aged ≥70 years with AF, admitted to a teaching hospital in Sydney, Australia (April–July 2007), with 207 followed up over 6 months.

Results: a total of 140 patients (64%) were identified as frail using a validated tool. Frail patients were less likely to receive warfarin than non-frail on hospital admission (P = 0.002) and discharge (P < 0.001). During hospitalisation, the proportion of frail participants prescribed warfarin decreased by 10.7% and that of non-frail increased by 6.3%. Over the 6-month follow-up, 43 major or severe haemorrhages (20.8%), 20 cardioembolic strokes (9.7%) and 40 deaths (19.2%) were reported. Compared to non-frail, frail participants were significantly more likely to experience embolic stroke (RR 3.5, 95% CI 1.0–12.0, P < 0.05), had a small non-significant increase in risk of major haemorrhage (RR 1.5, 95% CI = 0.7–3.0, P = 0.29) and had greater mortality (RR 2.8, 95% CI 1.2–6.5, P = 0.01).

Conclusion: frail older inpatients with AF are significantly less likely to receive warfarin than non-frail and appear more vulnerable to adverse clinical outcomes, with and without antithrombotic therapy.

Keywords: atrial fibrillation, antithrombotic, aged, haemorrhage, stroke, death, frailty, elderly

Received 28 August 2008; accepted in revised form 18 November 2008.


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