oa Stroke prevention therapy in elderly patients hospitalized with atrial fibrillation: A 20-year experience from Qatar

Objectives: Stroke prevention therapy with oral anticoagulants (OAC) is reported to be under-utilized in patients with atrial fibrillation (AF) despite the overwhelming evidence supporting their use for stroke prevention. Rates and trends of the use of OAC from the developing world in this setting are lacking particularly in elderly patients. The aim of this study is to evaluate trends of utilization of OAC in elderly patients hospitalized with AF in a real-world population in a Middle-Eastern country over 20 years. Methods: Retrospective analysis of prospective registry of all patients aged above 70 years hospitalized with AF in Qatar from 1991 through 2010 was made. Rate and trends of OAC use was examined over the 20 years of the study. Results: During the 20-years period; 744 patients above the age of 70 years old were hospitalized for AF. Overall 26.1% of these patients received OAC with warfarin at hospital discharge while 60.2% received anti-platelets therapy with aspirin. The use of warfarin in this elderly group was significantly trending higher over the study period from 3.7% in the earlier years of the study to 39.5% in the latter years (P= 0.001). Anti-platelets therapy with aspirin also significantly increased from 47.4% in the earlier years of the study to 67.3% in the latter years (P= 0.001) [Table]. Conclusions: Although our study demonstrates that stroke prevention therapy with OAC and anti-platelets therapy are used with increasing frequency in elderly patients aged above 70 years over the 20-year study period, nonetheless they remain under-utilized. Further prospective studies are needed to investigate the reasons behind under-utilization of OAC in our region to help guide healthcare providers involved in the care of elderly people with AF to maximize potential benefit from OAC and anti-platelets while minimizing the hemorrhagic risk associated with these drugs.