• Samuel Z Goldhaber, Jean-Pierre Bassand, A John Camm, Saverio Virdone, Karen Pieper, Frank Cools, Ramon Corbalan, Bernard J Gersh, Shinya Goto, Sylvia Haas, Frank Misselwitz, Alexander Parkhomenko, Jan Steffel, Janina Stepinska, TurpieAlexander G GAGGMcMaster University, Hamilton, Ont, Canada., VerheugtFreek W AFWAOnze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands., Gloria Kayani, Ajay K Kakkar, and GARFIELD-AF Investigators.
• Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. Electronic address: sgoldhaber@partners.org.
• Am. J. Med. 2024 Feb 1; 137 (2): 128136.e13128-136.e13.

BackgroundOral anticoagulants (OAC) are underutilized in older patients with atrial fibrillation, despite proven clinical benefits. Our objective was to investigate baseline characteristics, treatment patterns, and impact of anticoagulation upon clinical outcomes with respect to age.MethodsAdults with newly diagnosed atrial fibrillation were recruited into the prospective observational registry, GARFIELD-AF, and followed up for 24 months. Adjusted hazard ratios (HR) were obtained via Cox proportional-hazards models with applied weights, to quantify the association of age with clinical outcomes. Comparative effectiveness of OAC vs No OAC and non-vitamin K oral anticoagulants (NOAC) vs vitamin K antagonists (VKA) were assessed using a propensity score with an overlap weighting scheme.ResultsOf 52,018 patients, 32.6% were 65-74 years of age, 29.3% were 75-84 years, and 7.9% were ≥85 years. OAC treatment was associated with a numerical reduction in all-cause mortality among those aged 65-74 years (HR; 95% confidence interval) (0.86; 0.69-1.06) and aged 75-84 years (0.89; 0.75-1.05) and a significant reduction in patients ≥85 years (0.77; 0.63-0.95) vs no OAC. Similarly, OACs were associated with a decrease in stroke: 65-74 (0.51; 0.35-0.76) and ≥85 years (0.58; 0.34-0.99) and a numerical decrease in 75-84 years (0.84; 0.59-1.18). No increase in major bleeding was observed in patients aged ≥85 treated with OACs. Compared with VKA, NOACs were associated with a significant reduction in all-cause mortality in patients aged <65 and 65-74, with numerical reductions in those aged 75-84 and ≥85 years.ConclusionsOlder patients using OACs saw lower all-cause mortality and stroke risk; NOACs had less mortality and major bleeding compared with VKAs.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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