Oral anticoagulation in patients with atrial fibrillation and medical non-neoplastic disease in a terminal stage
- 196 Downloads
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.
KeywordsAtrial fibrillation Oral anticoagulants Calcium channel blockers Terminal stage disease Survival
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 was obtained from all individual participants included in the study.
- 1.Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV et al (2001) Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 285:2370–2375CrossRefPubMedGoogle Scholar
- 5.January CT, Wann LS, Alpert JS, Calkins H, Cleveland JC Jr, Cigarroa JE et al (2014) 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 130:2071–2104CrossRefPubMedGoogle Scholar
- 7.Díez-Manglano J, Bernabeu-Wittel M, Baron-Franco B, Murcia-Zaragoza J, Fuertes Martín A, Alemán A et al; En representación de los investigadores del proyecto PROFUND (2013) Anticoagulation in polypathological patients with atrial fibrillation. Med Clin (Barc) 140:97–103Google Scholar
- 10.Bernabeu-Wittel M, Murcia-Zaragoza J, Hernández-Quiles C, Escolano-Fernández B, Jarava-Rol G, Oliver M, PALIAR researchers (2014) Development of a six-month prognostic index in patients with advanced chronic medical conditions: the PALIAR score. J Pain Symptom Manage 47:551–565CrossRefPubMedGoogle Scholar
- 16.Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel index. Md State Med J. 4:61–65Google Scholar
- 17.National Hospice Organisation (NHO) (1996) Medical guidelines for determining prognosis in selected noncancer diseases. Hospice J 11:47–59Google Scholar
- 22.Bahri O, Roca F, Lechani T, Druesne L, Jouanny P, Serot JM et al (2015) Underuse of oral anticoagulation for individuals with atrial fibrillation in a nursing home setting in France: comparisons of resident characteristics and physician attitude. J Am Geriatr Soc 63:71–76CrossRefPubMedGoogle Scholar
- 23.Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S et al (2010) ESC Committee for Practice Guidelines. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace 12:1360–1420CrossRefPubMedGoogle Scholar
- 24.Skanes AC, Healey JS, Cairns JA, Dorian P, Gillis AM, McMurtry MS, The Canadian Cardiovascular Society Atrial Fibrillation Committee. Focused et al (2012) Update of the Canadian Cardiovascular Society Atrial Fibrillation Guidelines: Recommendations for Stroke Prevention and Rate/Rhythm Control. Can J Cardiol 28:125–136CrossRefPubMedGoogle Scholar
- 25.Culebras A, Messé SR, Chaturvedi S, Kase CS, Gronseth G (2014) Summary of evidence-based guideline update: prevention of stroke in nonvalvular atrial fibrillation. Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 82:716–724CrossRefPubMedPubMedCentralGoogle Scholar
- 28.Aliot E, Breithardt G, Brugada J, Camm J, Lip GY, Vardas PE et al (2010) Atrial fibrillation awareness and risk education group; Atrial Fibrillation Association; European Heart Rhythm Association; Stroke Alliance for Europe; World Heart Federation. An international survey of physician and patient understanding, perception, and attitudes to atrial fibrillation and its contribution to cardiovascular disease morbidity and mortality. Europace 12:626–633CrossRefPubMedPubMedCentralGoogle Scholar