Introduction

This bicentric retrospective analysis describes the choice of rate vs. rhythm control strategies as well as the use of oral anticoagulants in patients with atrial fibrillation (AF) aged 89 years or older in two tertiary medical centers over a timeframe of 10 years.

Methods and Results

A total of 608 consecutive patients (female 394 (65%), age 91.0 years (90.0-93.0), CHA2DS2-VASc 5.0 (4.0-6.0), HAS-BLED 3.0 (2.0-3.0)) presenting to one of the two study sites with AF were included in the analysis.

A rate control strategy was chosen in 516 patients (84.9%), while rhythm control was performed in 92 patients (15.1%). At the time of discharge 461 patients (75.8%) were prescribed anticoagulants. 302 patients (49.2%) were prescribed DOACs, 132 patients (21.6%) received vitamin K antagonists 27 (4.4%) LMWH. During the observational period the percentage of patients discharged with DOACs rose from 0% in 2010 to 89.9% in 2020 (see table 1). Reduced NOAC dose was prescribed 253/302 patients (83.8%). Incorrect dose reduction was identified in 47 patients (15.6%).

The main reason for withholding OAC in this patient group were frequent falls (31 patients, 21.1%) followed by gastrointestinal bleeding (14 patients, 9.5%), other bleedings (10 patients 6.8%) and intracranial bleedings (8 patients 5.4%). While for 66 patients (44.9%) no apparent reason for withholding OAC could be identified.

Conclusion

Rate control strategies are common for AF treatment in this very elderly patient group. Due to availability of DOACs the number of patients receiving OAC treatment rose continuously during the observational period. Most common reasons for withholding OAC were frequent falls or prior GI bleeding.