EXAMINING THE ASSOCIATION BETWEEN FRAILTY AND ORAL ANTICOAGULANT USE FOR ATRIAL FIBRILLATION: DATA FROM A CONTEMPORARY AMBULATORY VA COHORT

Background: Oral Anticoagulant (OAC) prescription is challenging in older patients with atrial fibrillation (AF) given their elevated risk for both thromboembolism and OAC-related bleeding. Clinicians’ perception of frailty is oft-cited as a reason for withholding OAC. Hence, we sought to examine whether a formal electronic health record (EHR) derived frailty measure is associated with OAC prescription practices Methods: We used ICD codes to identify patients with AF treated within the Veterans Administration network between 2007 and 2017. Baseline characteristics and rates of OAC use were examined. A previously validated 31-item EHR-derived frailty index based on the cumulative deficit theory of frailty, incorporated variables related to functional status, cognition and mood, multi-morbidity, sensory impairment, and other geriatric syndromes was used. Participants were characterized into 5 frailty categories: non-frail, pre-frail, mildly frail, moderately frail and severely frail Results: Out of 696,172 VA beneficiaries with AF, 315,375 (45%) were prescribed OAC. The mean age was 77 years; 13,929 (2%) were women and 597,681 (86%) were Caucasian. The mean CHADS2VASC score was 3.3, ATRIA score was 3.4. There were no differences in OAC prescription across frailty categories (Table 1) Conclusion We observed low overall rates of OAC use among VA beneficiaries with AF.