ArticleAge and ageing2021
Atrial fibrillation and oral anticoagulation in older people with frailty: a nationwide primary care electronic health records cohort study.
Article in Age and ageing, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers.
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The trial behind it
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Who cites it
32 citing papers in PubMed, 63 citations in OpenAlex.
- Impact of frailty on outcomes in atrial fibrillation and HFpEF: data from the TOPCAT trial.BMC cardiovascular disorders · 2026Trial
- Clinical outcomes in patients with atrial fibrillation and frailty: insights from the ENGAGE AF-TIMI 48 trial.BMC medicine · 2020Trial
- Article
- Disparities in anticoagulation therapy for older adults with non-valvular atrial fibrillation: a comparative study of urban and suburban communities.BMC geriatrics · 2026Article
- Frailty indices based on routinely collected data: a scoping review.The Journal of frailty & aging · 2025Article
- Impact of frailty on outcomes of elderly patients with atrial fibrillation: A systematic review and meta-analysis.Pakistan journal of medical sciences · 2025Review
- Actioning atrial fibrillation identified by ambulance services in England: a qualitative exploration.BMJ open · 2024Article
- Impact of Frailty on Healthcare Outcomes after Cardioembolic Ischaemic Stroke Due to Atrial Fibrillation.International journal of environmental research and public health · 2024Article
- Atrial fibrillation: comorbidities, lifestyle, and patient factors.The Lancet regional health. Europe · 2024Review
- Frailty prevalence in older adults with atrial fibrillation: A cross-sectional study in a resource-limited setting.PloS one · 2024Article
- Hemorrhagic Coagulation Disorders and Ischemic Stroke: How to Reconcile Both?Neurology international · 2023Review
- Implications of Clinical Risk Phenotypes on the Management and Natural History of Atrial Fibrillation: A Report From the GLORIA-AF.Journal of the American Heart Association · 2023Article
- Implication of different frailty criteria in older people with atrial fibrillation: a prospective cohort study.BMC geriatrics · 2023Article
- A machine-learning based bio-psycho-social model for the prediction of non-obstructive and obstructive coronary artery disease.Clinical research in cardiology : official journal of the German Cardiac Society · 2023Article
- Atrial fibrillation and stroke prevention: 25 years of research at EP Europace journal.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Review
- Anticoagulant use in older persons at risk for falls: therapeutic dilemmas-a clinical review.European geriatric medicine · 2023Review
- 'Frailty as an adjective rather than a diagnosis'-identification of frailty in primary care: a qualitative interview study.Age and ageing · 2023Article
- Insights into the Pharmacokinetics and Pharmacodynamics of Direct Oral Anticoagulants in Older Adults with Atrial Fibrillation: A Structured Narrative Review.Clinical pharmacokinetics · 2023Review
- Frailty and subsequent adverse outcomes in older patients with atrial fibrillation treated with oral anticoagulants: The Shizuoka study.Research and practice in thrombosis and haemostasis · 2023Article
- Anticoagulation in older people with atrial fibrillation moving to care homes: a data linkage study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2023Article
Corrections and comments
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Authors and funding
7 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundAtrial fibrillation (AF) is common in older people and is associated with increased stroke risk that may be reduced by oral anticoagulation (OAC). Frailty also increases with increasing age, yet the extent of OAC prescription in older people according to extent of frailty in people with AF is insufficiently described.
methodsAn electronic health records study of 536,955 patients aged ≥65 years from ResearchOne in England (384 General Practices), over 15.4 months, last follow-up 11th April 2017. OAC prescription for AF with CHA2DS2-Vasc ≥2, adjusted (demographic and treatments) risk of all-cause mortality, and subsequent cerebrovascular disease, bleeding and falls were estimated by electronic frailty index (eFI) category of fit, mild, moderate and severe frailty.
resultsAF prevalence and mean CHA2DS2-Vasc for those with AF increased with increasing eFI category (fit 2.9%, 2.2; mild 11.2%, 3.2; moderate 22.2%, 4.0; and severe 31.5%, 5.0). For AF with CHA2DS2-Vasc ≥2, OAC prescription was higher for mild (53.2%), moderate (55.6%) and severe (53.4%) eFI categories than fit (41.7%). In those with AF and eligible for OAC, frailty was associated with increased risk of death (HR for severe frailty compared with fit 4.09, 95% confidence interval 3.43-4.89), gastrointestinal bleeding (2.17, 1.45-3.25), falls (8.03, 4.60-14.03) and, among women, stroke (3.63, 1.10-12.02).
conclusionAmong older people in England, AF and stroke risk increased with increasing degree of frailty; however, OAC prescription approximated 50%. Given competing demands of mortality, morbidity and stroke prevention, greater attention to stratified stroke prevention is needed for this group of the population.
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Registered trials
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