Geriatric conditions do not predict stroke or bleeding in long-term care residents with atrial fibrillation

Background Long-term care (LTC) providers prescribe anticoagulation (AC) less frequently in residents with atrial fibrillation (AF) and geriatric conditions independent of CHA(2)DS(2)-VASc stroke risk score. Geriatric conditions include recent fall, activities of daily living dependency, mobility impairment, cognitive impairment, low body mass index, and weight loss. Multiple publications have suggested that patients with geriatric conditions are at increased risk for stroke. Understanding better the risk of stroke and bleeding in residents with AF and geriatric conditions would be valuable to LTC providers for AC decision-making. Methods and results We measured the association of geriatric conditions with composite of stroke/transient ischemic attack (TIA)/systemic embolism and bleeding in residents with AF and elevated stroke risk (CHA(2)DS(2)-VASc score >= 2) living in American LTC facilities in 2015. After merging nursing home assessments (Minimum Data Set) with medication and hospital utilization records, we identified 209,413 eligible residents. Using generalized estimating equations, we found that the incidence of stroke/TIA/systemic embolism ranged from 0.13% to 0.26% over 30 days (1.43%-3.08%/year) in residents off AC with and without geriatric conditions adjusting for other resident characteristics including CHA(2)DS(2)-VASc score and propensity to receive AC. Similarly, the monthly incidence of bleeding on AC ranged from 0.22% to 0.28% (2.61%-3.31%/year) without increased risk with geriatric conditions. Residents with a CHA(2)DS(2)-VASc score of >= 7 had a 2.4-fold increased risk of stroke compared with those with score of 2-4 (0.30% vs. 0.12%/month). Conclusion Calculating a CHA(2)DS(2)-VASc score can be helpful in AC decision-making for residents with and without geriatric conditions.

Automated summary

Residents with atrial fibrillation and geriatric conditions are at increased risk for stroke, but the presence of geriatric conditions does not increase the risk of bleeding. Calculating a CHA(2)DS(2)-VASc score can help LTC providers make decisions about anticoagulation therapy for these residents.