Anticoagulation in older people with atrial fibrillation moving to care homes: a data linkage study

Background Treatment decisions about oral anticoagulants (OAC) for atrial fibrillation (AF) are complex in older care home residents. Aim To explore factors associated with OAC prescription. Design and Setting Retrospective cohort study set in care homes in Wales, United Kingdom, listed in the Care Inspectorate Wales Registry 2017/18. Method Analysis of anonymised individual-level electronic health and administrative data on people aged ≥65 years entering a care home between 1 ^st January 2003 and 31 ^st December 2018, provisioned from the Secure Anonymised Information Linkage Databank. Results Between 2003 and 2018, 14,493 people with AF aged ≥65 years became new residents in care homes in Wales and 7,057 (48.7%) were prescribed OAC (32.7% in 2003 compared to 72.7% in 2018) within six months prior to care entry. Increasing age and prescription of antiplatelet therapy were associated with lower odds of OAC prescription (adjusted odds ratio [aOR] 0.96 per one year age increase [95% confidence interval [CI] 0.95 to 0.96] and aOR 0.91 [0.84 to 0.98], respectively). Conversely, prior venous thromboembolism (aOR 4.06 [3.17 to 5.20]), advancing frailty (mild: aOR 4.61 [3.95 to 5.38]; moderate: aOR 6.69 [5.74 to 7.80]; severe: aOR 8.42 [7.16 to 9.90]) and year of care home entry from 2011 onwards (aOR 1.91 [1.76 to 2.06]) were associated with higher odds of OAC prescription. Conclusions There has been an increase in OAC prescribing in older people newly admitted to care homes with AF. This study provides an insight into the factors influencing OAC prescribing in this population.