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Internal and Emergency Medicine

, Volume 12, Issue 1, pp 53–61 | Cite as

Oral anticoagulation in patients with atrial fibrillation and medical non-neoplastic disease in a terminal stage

  • Jesús Díez-ManglanoEmail author
  • Máximo Bernabeu-Wittel
  • José Murcia-Zaragoza
  • Belén Escolano-Fernández
  • Guadalupe Jarava-Rol
  • Carlos Hernández-Quiles
  • Miguel Oliver
  • Susana Sanz-Baena
  • On behalf of the researchers of PALIAR study
IM - ORIGINAL

Abstract

Many patients with non-neoplastic disease develop atrial fibrillation in advanced stages of their disease. The aim of this study is to determine the factors associated with the use of oral anticoagulants in patients with atrial fibrillation and non-neoplastic medical disease in a terminal stage, and whether their use is associated with a longer survival. Design is prospective, observational, multicentre study. Patients with atrial fibrillation and non-neoplastic disease (severe not reversible organ insufficiency) in a terminal stage were included between February 2009 and September 2010. A 6-month follow-up was carried out. We included 314 patients with a mean (SD) age of 82.6 (7.0) years. Their mean (SD) scores in CHADS2 and ATRIA scales were 3.4 (1.2) and 4.7 (2.0), respectively. Anticoagulants were prescribed to 112 (37.5 %) patients. The use of anticoagulants was associated with age (OR 0.96 95 % CI 0.93–0.99, p = 0.046) and to the Barthel index (OR 1.01 95 % CI 1.00–1.02; p = 0.034). After performing a propensity score matching analysis, 262 patients were included in the survival analysis. After 6 months, 133 (50.8 %) patients were dead. The mortality is higher among patients who are not treated with oral anticoagulants (57.1 vs. 39.4 %; p = 0.006), but it is independently associated only with the Barthel index score (HR 0.99 95 % CI 0.98–1.00; p = 0.039), delirium (HR 1.60, 95 % CI 1.08–2.36; p = 0.018), anorexia (HR 1.58 95 % CI 1.05–2.38; p = 0.027), and with the use of calcium channel blockers (HR 0.50 95 % CI 0.30–0.84; p = 0.009). In patients with atrial fibrillation and non-neoplastic disease in a terminal stage, the use of oral anticoagulants is not independently associated with a higher probability of survival.

Keywords

Atrial fibrillation Oral anticoagulants Calcium channel blockers Terminal stage disease Survival 

Notes

Acknowledgments

This study was supported by the Ministerio de Sanidad, Política Social e Igualdad, Spain (Health Promotion Grants, 2009).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© SIMI 2016

Authors and Affiliations

  • Jesús Díez-Manglano
    • 1
    • 2
    • 3
    Email author
  • Máximo Bernabeu-Wittel
    • 4
  • José Murcia-Zaragoza
    • 5
  • Belén Escolano-Fernández
    • 6
  • Guadalupe Jarava-Rol
    • 6
  • Carlos Hernández-Quiles
    • 4
  • Miguel Oliver
    • 7
  • Susana Sanz-Baena
    • 8
  • On behalf of the researchers of PALIAR study
    • 9
  1. 1.Internal Medicine DepartmentHospital Royo VillanovaSaragossaSpain
  2. 2.Research Group of Comorbidity and Polypathology in AragonAragon Health Sciences InstituteSaragossaSpain
  3. 3.Department of Medicine, Dermatology and PsychiatryUniversity of Zaragoza School of MedicineSaragossaSpain
  4. 4.Internal Medicine DepartmentComplejo Hospitalario Virgen del RocíoSevilleSpain
  5. 5.Internal Medicine DepartmentHospital de la Vega BajaOrihuelaSpain
  6. 6.Internal Medicine DepartmentHospital de la SerraníaRondaSpain
  7. 7.Internal Medicina DepartmentHospital Virgen del CaminoSanlúcar de BarramedaSpain
  8. 8.Internal Medicine DepartmentHospital Central de la Cruz Roja Santa Adela y San JoséMadridSpain
  9. 9.Working Group on Elderly and Polypathological patient Spanish Society of Internal MedicineMadridSpain

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