{"database":"biostudies-literature","file_versions":[],"scores":null,"additional":{"submitter":["Sanghai SR"],"funding":["NIDA NIH HHS","NIA NIH HHS","NHLBI NIH HHS","National Heart, Lung, and Blood Institute","NIMH NIH HHS","NLM NIH HHS"],"pagination":["730-736"],"full_dataset_link":["https://www.ebi.ac.uk/biostudies/studies/S-EPMC8904680"],"repository":["biostudies-literature"],"omics_type":["Unknown"],"volume":["37(4)"],"pubmed_abstract":["<h4>Background</h4>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.<h4>Methods</h4>We used ICD-9 codes in Veterans Affairs (VA) records and Medicare claims data to identify patients with NVAF and CHA<sub>2</sub>DS<sub>2</sub>VASC ≥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.<h4>Results</h4>Of 308,664 veterans with NVAF and a CHA<sub>2</sub>DS<sub>2</sub>VASC score ≥2, 121,839 (39%) were prescribed OAC (73% VKA). The mean age was 77.7 (9.6) years; CHA<sub>2</sub>DS<sub>2</sub>VASC 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<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.<h4>Conclusions</h4>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"],"pubmed_title":["Prevalence of Frailty and Associations with Oral Anticoagulant Prescribing in Atrial Fibrillation."],"pmcid":["PMC8904680"],"funding_grant_id":["R01 HL135219","R01 HL125089","R01 HL137794","R01HL126911 R01HL13660, and R01HL141434","R01 LM012817","R01 HL141434","R03 AG060169","R01HL137794 and R01HL125089","R01 MH125027","R01 DA045816"],"pubmed_authors":["Orkaby AR","Li W","Rose AJ","McManus DD","Rongali S","Saczynski JS","Sanghai SR","Wang W","Kapoor A","Yu H","Liu W"],"additional_accession":[]},"is_claimable":false,"name":"Prevalence of Frailty and Associations with Oral Anticoagulant Prescribing in Atrial Fibrillation.","description":"<h4>Background</h4>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.<h4>Methods</h4>We used ICD-9 codes in Veterans Affairs (VA) records and Medicare claims data to identify patients with NVAF and CHA<sub>2</sub>DS<sub>2</sub>VASC ≥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.<h4>Results</h4>Of 308,664 veterans with NVAF and a CHA<sub>2</sub>DS<sub>2</sub>VASC score ≥2, 121,839 (39%) were prescribed OAC (73% VKA). The mean age was 77.7 (9.6) years; CHA<sub>2</sub>DS<sub>2</sub>VASC 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<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.<h4>Conclusions</h4>There are high rates of frailty among older veterans with NVAF. Frailty using an EHR-derived index is associated with decreased OAC prescription.","dates":{"release":"2022-01-01T00:00:00Z","publication":"2022 Mar","modification":"2025-05-29T19:45:10.803Z","creation":"2025-04-19T07:34:44.255Z"},"accession":"S-EPMC8904680","cross_references":{"pubmed":["33948795"],"doi":["10.1007/s11606-021-06834-1"]}}