Prevalence of Frailty and Associations with Oral Anticoagulant Prescribing in Atrial Fibrillation

Saket R. Sanghai*, Weisong Liu, Weijia Wang, Subendhu Rongali, Ariela R. Orkaby, Jane S. Saczynski, Adam J. Rose, Alok Kapoor, Wenjun Li, Hong Yu, David D. McManus

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: Frailty is often cited as a factor influencing oral anticoagulation (OAC) prescription in patients with non-valvular atrial fibrillation (NVAF). We sought to determine the prevalence of frailty and its association with OAC prescription in older veterans with NVAF. Methods: We used ICD-9 codes in Veterans Affairs (VA) records and Medicare claims data to identify patients with NVAF and CHA2DS2VASC ≥2 receiving care between February 2010 and September 2015. We examined rates of OAC prescription, further stratified by direct oral anticoagulant (DOAC) or vitamin K antagonist (VKA). Participants were characterized into 3 categories: non-frail, pre-frail, and frail based on a validated 30-item EHR-derived frailty index. We examined relations between frailty and OAC receipt; and frailty and type of OAC prescribed in regression models adjusted for factors related to OAC prescription. Results: Of 308,664 veterans with NVAF and a CHA2DS2VASC score ≥2, 121,839 (39%) were prescribed OAC (73% VKA). The mean age was 77.7 (9.6) years; CHA2DS2VASC and ATRIA scores were 4.6 (1.6) and 5.0 (2.9) respectively. Approximately a third (38%) were frail, another third (32%) were pre-frail, and the remainder were not frail. Veterans prescribed OAC were younger, had higher bleeding risk, and were less likely to be frail than participants not receiving OAC (all p’s<0.001). After adjustment for factors associated with OAC use, pre-frail (OR: 0.89, 95% CI: 0.87–0.91) and frail (OR: 0.66, 95% CI: 0.64–0.68) veterans were significantly less likely to be prescribed OAC than non-frail veterans. Of those prescribed OAC, pre-frail (OR:1.27, 95% CI: 1.22–1.31) and frail (OR: 1.75, 95% CI: 1.67–1.83) veterans were significantly more likely than non-frail veterans to be prescribed a DOAC than a VKA. Conclusions: There are high rates of frailty among older veterans with NVAF. Frailty using an EHR-derived index is associated with decreased OAC prescription.

Original languageAmerican English
Pages (from-to)730-736
Number of pages7
JournalJournal of General Internal Medicine
Issue number4
StatePublished - Mar 2022
Externally publishedYes

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© 2021, Society of General Internal Medicine.


  • atrial fibrillation
  • frailty
  • oral anticoagulation


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