Observational Study on the Impact of Comorbidities and Frailty on Anticoagulation Therapy Compliance in Elderly Patients With Atrial Fibrillation
Objectives:This study was designed to observe the impact of frailty status and multiple comorbidities on anticoagulation therapy adherence in elderly patients(≥75 years old)with atrial fibrillation.Methods:This retrospective study enrolled 528 patients(≥75 years old)with atrial fibrillation who were admitted to the geriatric department of Peking University Third Hospital from October 2016 to October 2019.A total of 443(83.9%)elderly patients receiving anticoagulation therapy were included,with an average age of(84.72±5.39)years.Thromboembolic and bleeding risk were evaluated by CHA2DS2-VASc and HAS-BLED,ATRIA bleeding score,while the frailty index(FI)and the age-adjusted Charlson comorbidity index(ACCI)were evaluated.Those with FI≥3 and FI between 1～2 were categorized into the frailty group and pre-frailty group.Patients with ACCI≥5 were defined as elderly multiple comorbidity group(high comorbidity burden).Patients who received anticoagulation therapy after discharge were followed up for one year in the outpatient clinic to observe their medication adherence and to find the related reasons.Results:Thromboembolic risk and bleeding scoring were performed in 443 elderly patients,with CHA2DS2-VASc and HAS-BLED scores of 5.61±1.57 and 3.08±0.89,respectively,and ATRIA score was 4.13±1.90.The FI assessment showed that all enrolled patients were in a state of frailty or pre-frailty.The average ACCI was 5.73±1.51.At one year of follow-up,96(21.67%)patients discontinued anticoagulation therapy.Frailty,high comorbidity burden,and high bleeding risk according to ATRIA(ATRIA≥5)were factors affecting medication adherence,with OR values of 1.114(95%CI:1.041-1.205,P=0.003),3.201(95%CI:2.126-4.509,P=0.001),and 1.457(95%CI:1.212-2.075,P=0.024),respectively.Considering non-death endpoint,both the HAS-BLED score(HAS-BLED≥3 分,OR=1.098,95%CI:1.035-1.116,P=0.014)and warfarin(OR=1.015,95%CI:1.001-1.030,P=0.040)were influential factors of medication compliance.Conclusions:The adherence to anticoagulation therapy post-discharge in elderly patients with atrial fibrillation is significantly influenced by frailty status and high comorbidity burden.If terms of non-death endpoint,high bleeding score and use of warfarin are influential factors of medication compliance.
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