Prevalence of Frailty and Associations with Oral Anticoagulant Prescribing in Atrial Fibrillation. Sanghai, S. R, Liu, W., Wang, W., Rongali, S., Orkaby, A. R, Saczynski, J. S, Rose, A. J, Kapoor, A., Li, W., Yu, H., & McManus, D. D Journal of General Internal Medicine, May, 2021.
doi  abstract   bibtex   
Background: Frailty is often cited as a factor influencing oral anticoagulation (OAC) prescription in patients with non-valvular atrial fibrillation (NVAF). We sought to determine the prevalence of frailty and its association with OAC prescription in older veterans with NVAF. Methods: We used ICD-9 codes in Veterans Affairs (VA) records and Medicare claims data to identify patients with NVAF and CHA2DS2VASC ≥2 receiving care between February 2010 and September 2015. We examined rates of OAC prescription, further stratified by direct oral anticoagulant (DOAC) or vitamin K antagonist (VKA). Participants were characterized into 3 categories: non-frail, pre-frail, and frail based on a validated 30-item EHR-derived frailty index. We examined relations between frailty and OAC receipt; and frailty and type of OAC prescribed in regression models adjusted for factors related to OAC prescription. Results: Of 308,664 veterans with NVAF and a CHA2DS2VASC score ≥2, 121,839 (39%) were prescribed OAC (73% VKA). The mean age was 77.7 (9.6) years; CHA2DS2VASC and ATRIA scores were 4.6 (1.6) and 5.0 (2.9) respectively. Approximately a third (38%) were frail, another third (32%) were pre-frail, and the remainder were not frail. Veterans prescribed OAC were younger, had higher bleeding risk, and were less likely to be frail than participants not receiving OAC (all p's\textless0.001). After adjustment for factors associated with OAC use, pre-frail (OR: 0.89, 95% CI: 0.87-0.91) and frail (OR: 0.66, 95% CI: 0.64-0.68) veterans were significantly less likely to be prescribed OAC than non-frail veterans. Of those prescribed OAC, pre-frail (OR:1.27, 95% CI: 1.22-1.31) and frail (OR: 1.75, 95% CI: 1.67-1.83) veterans were significantly more likely than non-frail veterans to be prescribed a DOAC than a VKA. Conclusions: There are high rates of frailty among older veterans with NVAF. Frailty using an EHR-derived index is associated with decreased OAC prescription.
@article{sanghai_prevalence_2021,
	title = {Prevalence of {Frailty} and {Associations} with {Oral} {Anticoagulant} {Prescribing} in {Atrial} {Fibrillation}},
	doi = {10.1007/s11606-021-06834-1},
	abstract = {Background: Frailty is often cited as a factor influencing oral anticoagulation (OAC) prescription in patients with non-valvular atrial fibrillation (NVAF). We sought to determine the prevalence of frailty and its association with OAC prescription in older veterans with NVAF.

Methods: We used ICD-9 codes in Veterans Affairs (VA) records and Medicare claims data to identify patients with NVAF and CHA2DS2VASC ≥2 receiving care between February 2010 and September 2015. We examined rates of OAC prescription, further stratified by direct oral anticoagulant (DOAC) or vitamin K antagonist (VKA). Participants were characterized into 3 categories: non-frail, pre-frail, and frail based on a validated 30-item EHR-derived frailty index. We examined relations between frailty and OAC receipt; and frailty and type of OAC prescribed in regression models adjusted for factors related to OAC prescription.

Results: Of 308,664 veterans with NVAF and a CHA2DS2VASC score ≥2, 121,839 (39\%) were prescribed OAC (73\% VKA). The mean age was 77.7 (9.6) years; CHA2DS2VASC and ATRIA scores were 4.6 (1.6) and 5.0 (2.9) respectively. Approximately a third (38\%) were frail, another third (32\%) were pre-frail, and the remainder were not frail. Veterans prescribed OAC were younger, had higher bleeding risk, and were less likely to be frail than participants not receiving OAC (all p's{\textless}0.001). After adjustment for factors associated with OAC use, pre-frail (OR: 0.89, 95\% CI: 0.87-0.91) and frail (OR: 0.66, 95\% CI: 0.64-0.68) veterans were significantly less likely to be prescribed OAC than non-frail veterans. Of those prescribed OAC, pre-frail (OR:1.27, 95\% CI: 1.22-1.31) and frail (OR: 1.75, 95\% CI: 1.67-1.83) veterans were significantly more likely than non-frail veterans to be prescribed a DOAC than a VKA.

Conclusions: There are high rates of frailty among older veterans with NVAF. Frailty using an EHR-derived index is associated with decreased OAC prescription.},
	journal = {Journal of General Internal Medicine},
	author = {Sanghai, Saket R and Liu, Weisong and Wang, Weijia and Rongali, Subendhu and Orkaby, Ariela R and Saczynski, Jane S and Rose, Adam J and Kapoor, Alok and Li, Wenjun and Yu, Hong and McManus, David D},
	month = may,
	year = {2021},
	pmid = {33948795},
}

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