Abstract

Purpose. This study aims to analyze the characteristics of institutionalized geriatric population with NVAF according to the type of anticoagulant treatment, especially in patients with severe functional and cognitive decline and those who met palliative care criteria.

Methods. This cross-sectional observational study was conducted in 13 nursing homes with a population diagnosed with NVAF. Sociodemographic and functional assessment variables, the type of prescribed anticoagulant treatment, frailty status and palliative care criteria were collected. The clinical and functional assessment was analysed based on treatment type.

Results. Of the 342 residents fulfilled the inclusion criteria, 78.1%werewomen and 48%were ≥ 90 years of age.  Furthermore, 99.4% had high comorbidity (Charlson ≥ 3), 98.8% were at high risk of stroke (CHADS2-VASc ≥ 2), 90.1% were in a frailty stage (IF-CSS > 0.2), and 86.3% were polymedicated. Additionally, 51.4% were anticoagulated with direct oral anticoagulants (DOAcs), 28.4% with vitamin K antagonists (VKAs), and 1.8% with low-molecular-weight heparins (LMWHs). Finally, 8.5% were receiving antiplatelet agents (AAs), while 9.9% were not receiving any  antithrombotic treatment. Patients treated with AAs were older (p = 0.028), while those not receiving treatment had greater cognitive deterioration (p = 0.004),met the palliative criteria (p = 0.027), and had a lower frequency of polymedication (p < 0.001).

Conclusions. Our study shows that very elderly patients consume DOAcs and VKAs in advanced stages of frailty and dependency. The findings suggest the need to tailor anticoagulation in geriatric patients to align treatment with quality of life and end-of-life goals.