Oral anticoagulant use in octogenarian European patients with atrial fibrillation: A subanalysis of PREFER in AF

Background: Few studies describe oral anticoagulant (OAC) prescription practices in very elderly patients with atrial fibrillation (AF).
Methods: In this sub-analysis of the PREFER in AF study, performed in 2012, patients were stratified according to age (< 80 [n = 5565] and ≥ 80 years [n = 1660]) and OAC treatment. Factors associated with OAC prescription were analyzed in a multivariate logistic regression model with backward elimination of variables least associated with OAC use.
Results: Patients ≥ 80 years presented with permanent AF more often (p < 0.0001) and reported fatigue and dyspnea more frequently (p < 0.0001) and palpitations less frequently (p < 0.0001) than patients < 80 years. Hypertension, stroke, heart failure, coronary heart disease, peripheral arterial disease, cancer, chronic kidney disease, and prior major bleeding were significantly more frequent in ≥ 80 years. Most patients were treated with OACs in both age groups. The overall use of vitamin K antagonists was similar in both groups (78.2% vs.78.2% p = 0.98), while the use of non-vitamin K antagonist OACs was lower in the ≥ 80 years old group than in the < 80 years group (4.5% vs. 6.6% p = 0.001). Among patients ≥ 80 years, prior stroke and heart failure were significantly associated with OAC use, whereas higher age, prior bleeding, paroxysmal AF, chronic hepatic disease, and difficulties with self-care were associated with no OAC use.
Conclusions: The current use of OAC in European AF patients was satisfactorily high in octogenarians, suggesting reasonable implementation of current guidelines. Interestingly, patients with poor quality of life were less often anticoagulated. This may warrant further studies.