The role of comprehensive geriatric assessment and functional status in evaluating the patterns of antithrombotic use among older people with atrial fibrillation

• Oral anticoagulants (OACs) are underused in the elderly with atrial fibrillation (AF).
• Age, contraindication, HASBLED score, functional impairment and polypharmacy are predictors of underuse.
• OACs underuse in older patients with AF lies on a mix of clinical and geriatric variables.

Aim of the study is to investigate the use of antithrombotic drugs in older patients with atrial fibrillation (AF) at the time of hospital discharge. We enrolled 399 ≥65 years old patients with AF consecutively admitted to our acute geriatric unit from September 2012 to February 2014. Utilization of antithrombotic drugs, comorbidities, functional, mental and nutritional status were evaluated through a comprehensive geriatric assessment (CGA). A Logistic regression model was used to assess variables associated with antithrombotic use. On admission, 198 patients (49.6%) used oral anticoagulants (OAC), 125 (21.3%) antiplatelets, 32 (8%) low weight molecular heparin (LMWH) and 44 (11%) none of them. At discharge the proportion of patients on OAC increased to 55.7%. Age > 90 years (OR = 2.57, CI = 1.28–5.16, p-value = 0.008), severe functional impairment (OR = 3.38, CI = 1.63–7.01, p-value = 0.001), polypharmacy (OR = 2.07, CI = 1.1–3.86, p-value = 0.023), HAS-BLED score (OR = 1.64, CI = 1.09–2.47, p-value = 0.019) and ≥1 OAC contraindication (OR = 5.01, CI = 2.68–9.34, p-value < 0.001) were all associated with OAC underuse.In conclusion, OAC is underused in geriatric patients with AF, while antiplatelet, LMWH and no antithrombotic therapy are relatively overused. Factors associated with the decision to not prescribe OAC lie on a mix of clinical and geriatric variables, among which functional status is particularly relevant.