Closeup image of older adult patient in bed being checked by doctor with stethoscope; Credit: Getty Images
Credit: Getty Images

It is uncommon for hospitalized older adults newly diagnosed with atrial fibrillation to start anticoagulation therapy. In fact, only about 25% overall begin taking these medications soon after discharge.

That’s according to new findings from investigators who urged clinicians to discuss the risks and benefits of oral anticoagulants with patients who have Afib.

The researchers identified over 38,000 Medicare fee-for-service beneficiaries, aged 65 or older, who were newly diagnosed with Afib while hospitalized in 2016. They looked for oral anticoagulant claims within seven days of discharge.

Only 1 in 4 patients began taking the drugs during this post-discharge time period. And although rates of anticoagulation were higher for patients whose main reason for acute-care admission was Afib, only 50% of those patients initiated use, investigators reported.

Patients who were frailer or who were admitted for reasons other than Afib were the least likely to initiate treatment. But higher bleeding risk scores and lower thromboembolic risk scores were also linked with decreased likelihood of anticoagulant initiation.

Initiation patterns do not appear to reflect the clinical risk, wrote Timothy S. Anderson, MD, MAS, of Harvard Medical School in Boston. 

Some patients may have had contraindications to anticoagulation, but the lower rates seen in the study population “likely reflect a missed opportunity for stroke prevention for some patients,” he and his colleagues theorized. In other cases, the choice may have been intentional based on contraindications and high near-term mortality risk, they noted.

Patients with Afib are at high risk for blood clots and thereby stroke, and older frail adults are particularly vulnerable to these outcomes. Anticoagulation drugs are used to thin the blood and prevent clotting, but the new findings track with those of other studies which have found that many older adults with Afib remain undertreated — despite the availability of new and better drugs that help prevent stroke.

The takeaway? Shared decision-making is necessary to improve oral anticoagulant prescribing in this high-risk population, the authors concluded.

The study was published in the Journal of the American Geriatrics Society.

Related articles:

Better stroke prevention needed for older, frail Afib patients, researchers contend

Falls, disability in seniors with Afib tied to lower anticoagulant use