World-class research. Ultimate impact.
More on impact ›

Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Cardiovasc. Med. | doi: 10.3389/fcvm.2019.00155

Geriatric conditions and prescription of vitamin K antagonists vs. direct oral anticoagulants among older patients with atrial fibrillation: SAGE-AF

 David McManus1*,  Catarina Kiefe1,  Darleen Lessard1, Molly Waring2,  David Parish3, Hamza Awad3,  Francesca Marino1, Robert Helm4, Felix Sogade3, Robert Goldberg1, Robert Hayward5, Jerry Gurwitz1, Weijia Wang1, Tanya Mailhot6, 7,  Bruce A. Barton1 and Jane Saczynski6
  • 1University of Massachusetts Medical School, United States
  • 2University of Connecticut, United States
  • 3Mercer University School of Medicine, United States
  • 4School of Medicine, Boston University, United States
  • 5Kaiser Permanente Santa Clara Medical Center, United States
  • 6Northeastern University, United States
  • 7Montreal Heart Institute, Canada


Background: Geriatric conditions are common among patients with atrial fibrillation (AF) and relate to complications of oral anticoagulation (OAC).

Objective: To examine the prevalence of geriatric conditions among older patients with AF on OAC and relate type of OAC to geriatric conditions.

Methods: Participants had a diagnosis of AF, were aged  65 years, CHA2DS2VASC  2, and had no OAC contraindications. Participants completed a 6-component geriatric assessment that included validated measures of frailty (CHS Frailty Scale), cognitive function (MoCA), social support (MOS), depressive symptoms (PHQ9), vision, and hearing. Type of OAC prescribed was documented in medical records.

Results: 86% of participants were prescribed an OAC. These participants were on average aged 75.7 (SD: 7.1) years, 49% were women, two thirds were frail or pre-frail, and 44% received a DOAC. DOAC users were younger, had lower CHA2DS2VASC and HAS-BLED scores, and were less likely to be frail. In Massachusetts, pre-frailty was associated with a significantly lower odds of DOAC vs. VKA use (OR=0.64, 95%CI 0.45, 0.91). Pre-frailty (OR=0.33, 95%CI 0.18-0.59) and social isolation (OR=0.38, 95%CI 0.14-0.99) were associated with lower odds of DOAC receipt in patients aged 75 years or older. Social isolation was associated with higher odds of DOAC use (OR=2.13, 95%CI 1.05-4.29) in patients aged 65-74 years.

Conclusions: Geriatric conditions were common and related to type of OAC prescribed, differentially by age group. Research is needed to evaluate whether a geriatric examination can be used clinically to better inform OAC decision-making in older patients with AF.

Keywords: atrial fibirillation, Anticoagualtion, Frailty, Social Isolation, Older adult

Received: 17 Jun 2019; Accepted: 11 Oct 2019.

Copyright: © 2019 McManus, Kiefe, Lessard, Waring, Parish, Awad, Marino, Helm, Sogade, Goldberg, Hayward, Gurwitz, Wang, Mailhot, Barton and Saczynski. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. David McManus, University of Massachusetts Medical School, Worcester, United States,