AF and Oral Anticoagulant Prescription Rates in Older People With Frailty

Sarfaroj Khan 


December 29, 2020


  • Frailty was common in older patients with atrial fibrillation (AF) and associated with an increased risk of mortality, falls and gastrointestinal bleeding (GI).

  • Oral anticoagulant (OAC) was prescribed in approximately 50% of patients with an elevated stroke risk and AF, and OAC prescription was more common in patients with frailty than those without.

Why this matters

  • Despite an increasing prevalence of both AF and frailty, comprehensive community-based data on the disease burden, OAC prescription rates and clinical outcomes are lacking for older people with AF and frailty.

Study design

  • This population-based study included 536,955 patients (age, ≥65 years) from ResearchOne database in England.

  • OAC prescription for AF with CHA2DS2-Vasc ≥2, risk of mortality and subsequent cerebrovascular disease, bleeding and falls were estimated by electronic frailty index category (fit, mild, moderate and severe frailty).

  • Funding: None disclosed.

Key results

  • The prevalence of AF in older patients was 11.39% (n=61,177).

  • Frailty was more common in patients with AF (89.5%) vs those without (55.4%).

  • OAC was prescribed in 53.1% (n=30,916) of patients with AF and a CHA2DS2-VASc score of ≥2.

  • OAC was more commonly prescribed in patients with frailty (adjusted OR [95% CI] compared with fit, mild: 1.84 [1.72-1.96]; moderate: 2.34 [1.18-2.50]; and severe: 2.51 [2.33-2.71]).

  • In patients with AF and eligible for OAC, frailty was associated with an increased risk of (HR for severe frailty vs fit; 95% CI):

    • mortality (4.09; 3.43-4.89);

    • GI bleeding (2.17; 1.45-3.25); and

    • falls (8.03; 4.60-14.03).

  • Women, but not men, had an increased stroke risk associated with increased levels of frailty (HR for severe frailty vs fit, 3.63; 95% CI, 1.10-12.02).


  • Risk of bias.


Wilkinson C, Clegg A, Todd O, Rockwood K, Yadegarfar ME, Gale CP, Hall M. Atrial fibrillation and oral anticoagulation in older people with frailty: a nationwide primary care electronic health records cohort study. Age Ageing. 2020 Dec 16 [Epub ahead of print]. doi: 10.1093/ageing/afaa265. PMID: 33320932 View abstract

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


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