Evidence map›Paper›PMID 25053883›Full record

ArticleClinical interventions in aging2014

Risk scores and geriatric profile: can they really help us in anticoagulation decision making among older patients suffering from atrial fibrillation?

Frédéric Maes, Olivia Dalleur, Séverine Henrard, Dominique Wouters, Christophe Scavée, Anne Spinewine, Benoit Boland

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Clinical interventions in aging, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02973984 (Evaluating the Efficacy and Risks of Anticoagulant Treatments in Multimorbid Frail Older Subjects With Atrial Fibrillation. The European Registry of Older Subjects With Atrial Fibrillation), which is not on this map. Cited by 17 papers.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02973984 unknown statusnot on this mapstarted 2016, after this paper: background citation

Evaluating the Efficacy and Risks of Anticoagulant Treatments in Multimorbid Frail Older Subjects With Atrial Fibrillation. The European Registry of Older Subjects With Atrial Fibrillation (EUROSAF)

TypeobservationalSponsorAlberto PilottoRan2016 to 2024Enrolled3,000ConditionsAtrial Fibrillation
3 · Its place in the literature

Who cites it

17 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Review
  5. Article
  6. Article
  7. Atrial fibrillation and frailty.Journal of geriatric cardiology : JGC · 2020
    Review
  8. Article
  9. Review
  10. Article
  11. Article
  12. Review
  13. Article
  14. Article
  15. Article
  16. Article
  17. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Frédéric MaesCardiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
Olivia DalleurPharmacy Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium ; Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.
Séverine HenrardInstitute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium.
Dominique WoutersPharmacy Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
Christophe ScavéeCardiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
Anne SpinewineLouvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium ; Pharmacy Department, CHU Dinant-Godinne, Université catholique de Louvain, Yvoir, Belgium.
Benoit BolandInstitute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium ; Geriatric Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesAnticoagulation for the prevention of cardio-embolism is most frequently indicated but largely underused in frail older patients with atrial fibrillation (AF). This study aimed at identifying characteristics associated with anticoagulation underuse.

methodsA cross-sectional study of consecutive geriatric patients aged ≥75 years, with AF and clear anticoagulation indication (CHADS₂ [Congestive heart failure, Hypertension, Age >75, Diabetes mellitus, and prior Stroke or transient ischemic attack] ≥2) upon hospital admission. All patients benefited from a comprehensive geriatric assessment. Their risks of stroke and bleeding were predicted using CHADS₂ and HEMORR2HAGES (Hepatic or renal disease, Ethanol abuse, Malignancy, Older (age >75 years), Reduced platelet count or function, Rebleed risk, Hypertension (uncontrolled), Anemia, Genetic factors, Excessive fall risk, and Stroke) scores, respectively.

resultsAnticoagulation underuse was observed in 384 (50%) of 773 geriatric patients with AF (median age 85 years; female 57%, cognitive disorder 33%, nursing home 20%). No geriatric characteristic was found to be associated with anticoagulation underuse. Conversely, anticoagulation underuse was markedly increased in the patients treated with aspirin (odds ratio [OR] [95% confidence interval]: 5.3 [3.8; 7.5]). Other independent predictors of anticoagulation underuse were ethanol abuse (OR: 4.0 [1.4; 13.3]) and age ≥90 years (OR: 2.0 [1.2; 3.4]). Anticoagulation underuse was not inferior in patients with a lower bleeding risk and/or a higher stroke risk and underuse was surprisingly not inferior either in the AF patients who had previously had a stroke.

conclusionHalf of this geriatric population did not receive any anticoagulation despite a clear indication, regardless of their individual bleeding or stroke risks. Aspirin use is the main characteristic associated with anticoagulation underuse.

Indexed as

Geriatric AssessmentAgedAged, 80 and overAnticoagulantsAtrial FibrillationCross-Sectional StudiesDiabetes MellitusDrug PrescriptionsEmbolismFemaleFrail ElderlyHeart FailureHemorrhageHumansHypertensionMaleAnticoagulantsPlatelet Aggregation Inhibitorsanticoagulationantiplatelet therapyatrial fibrillationgeriatric medicineunder-prescribing

Identifiers

PMID25053883
PMCPMC4105275

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Registered trials

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