Annals of Long-Term Care: Clinical Care and Aging. 2016;24(6):37.
Researchers from the University of Cincinnati (UC) College of Medicine claim that female atrial fibrillation (AF) patients are less likely than their male counterparts to receive blood thinning therapies to prevent stroke. They also found that aspirin should not be a substitute for oral anticoagulant therapy (OAT) in older adults. The findings were published online in the Journal of the American Geriatrics Society (2016;64(5):1054-1060).
The study design was a retrospective cohort study of adults aged 28 to 93 with nonvalvular AF (N = 1585) seen between March 2013 and February 2014 in primary care practices of an academic health care system. Treatment recommendations were made using a computerized AF decision support tool [Atrial Fibrillation Decision Support Tool (AFDST)] based on projections of quality-adjusted life expectancy calculated using a decision analytical model that integrates individual-specific risk factors for stroke and hemorrhage. Based on this information, the tool makes suggestions for the best treatment to prevent AF-related stroke.
Mark Eckman, MD, professor of clinical medicine and lead study investigator, said the objective of the study was to assess the appropriateness of OAT in women and elderly adults, looking for patterns of undertreatment or unnecessary treatment. Undertreatment of patients with AF is a national problem and the AFDST is designed to get more tristate AF patients using anticoagulants when appropriate, says Dr Eckman. The AFDST supports clinician decision-making by suggesting when blood thinning therapy is warranted.
According to the results, treatment was discordant from AFDST-recommended treatment in 45% (326/725) of women and 39% (338/860) of men (P = .02). Dr Eckman said, “The irony is that women have a higher risk of AF-related stroke, controlling for other risk factors such as hypertension, diabetes, congestive heart failure, yet women are being undertreted.”
And, although current treatment was discordant from recommended treatment in 35% (89/258) of participants aged 85 and older and in 43% (575/1,328) of those younger than 85 (P = .01), many undertreated elderly adults were receiving aspirin as the sole antithrombotic agent.
Researchers said that physicians should understand that female sex is a significant risk factor for AF-related stroke and incorporate this into decision-making about thromboprophylaxis. And treating older adults with aspirin instead of OAT exposes them to significant risk of bleeding with little to no reduction in AF-related stroke risk. —Amanda Del Signore