Clinical characteristics and outcomes in extreme elderly (age ≥85) Japanese patients with atrial fibrillation: The Fushimi AF Registry

Background: Atrial fibrillation (AF) is increasingly prevalent with age, and increasing age is an independent risk factor for ischemic stroke. Oral anticoagulant (OAC) therapy use in the extreme elderly (age ≥85 years) is challenging.

Methods: The Fushimi AF Registry is a community-based prospective study of Japanese AF patients (79 participating medical institutions in Fushimi-ku, Kyoto). The enrollment of patients was started in March 2011, and follow-up data were available for 3,304 patients as of July 2014. We compared clinical characteristics and outcomes between the extreme elderly group (n=479, 14.5%) and others.

Results: The extreme elderly had a higher prevalence of major co-morbidities and risk scores for stroke, but received less OAC. After a mean follow-up of 2.0 years, endpoints in the extreme elderly group were as follows: all-cause death 17.6, stroke or systemic embolism (SE) 5.1, and major bleeding 2.0 per 100 person-years, respectively. The extreme elderly group was associated with a higher incidence of combined stroke/SE and all-cause death (hazard ratio (HR) 3.20, 95% confidence interval (CI) 2.66-3.84, p<0.01), higher incidences of stroke/SE (HR 2.57, 95% CI 1.77-3.65, p<0.01) and mortality (HR 3.48, 95% CI 2.84-4.25, p<0.01), compared with others (aged ≤84). The incidence of major bleeding was not significantly different (HR 1.40, 95% CI 0.78-2.36, p=0.25).

Conclusions: In our community-based prospective cohort, Japanese extreme elderly AF patients had a higher incidence of stroke but similar major bleeding risks compared with the younger AF population.

Trial Registry: UMIN Clinical Trials Registry; No.: UMIN000005834; URL: http://www.umin.ac.jp/ctr/index.htm.