Anticoagulation common at end of life in nursing home residents with dementia, AF

ByAnthony Vecchione

Nearly one-third of nursing home residents with atrial fibrillation and advanced dementia stayed on anticoagulation in the last 6 months of life, according to a research letter published in JAMA Internal Medicine.

“These findings underscore the fact that, while practice guidelines contain a well-defined threshold for starting anticoagulation for AF, there is no clear standard for stopping it,” Gregory M. Ouellet, MD, MHS, geriatrician investigator at the Yale School of Medicine, and colleagues wrote.

Photo of a nursing home common area — *Source: Adobe Stock*

Researchers analyzed Medicare data to identify nursing home residents aged 65 years and older with advanced dementia and AF who had at least moderate stroke risk (CHA₂DS₂-VASC score 2) and who died from 2014 to 2017.

Among the cohort of 15,217 nursing home residents with AF and advanced dementia (68% women), 33% received an anticoagulant in the last 6 months of life.

In a multivariable analysis, higher CHA₂DS₂-VASC score (OR for score > 7 = 1.38; 95% CI, 1.23-1.54), higher ATRIA score (OR for SCORE > 7 = 1.25; 95% CI, 1.13-1.39), nursing home length of stay of at least 1 year (OR = 2.68; 95% CI, 2.48-2.89), not having Medicaid (OR = 1.59; 95% CI, 1.45-1.69), weight loss (OR = 1.09; 95% CI, 1.01-1.18), pressure ulcers (OR = 1.37; 95% CI, 1.27-1.48) and difficulty swallowing (OR = 1.12; 95% CI, 1.02-1.22) were associated with greater odds of anticoagulant use.

In contrast, age 80 to 89 years (OR = 0.82; 95% CI, 0.74-0.92) age 90 years or older (OR = 0.59; 95% CI, 0.52-0.66), female sex (OR = 0.88; 95% CI, 0.81-0.95), requiring restraints (OR = 0.79; 95% CI, 0.66-0.95) and enrollment in hospice (OR = 0.76; 95% CI, 0.7-0.83) were characteristics associated with less likely use of anticoagulants.

“This study is limited by its cross-sectional design and includes only persons with AF and advanced dementia in the nursing home setting. Nonetheless, our work points to the need for high-quality data to inform decision-making about anticoagulation in this population,” the researchers wrote.

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Source:

Ouellet GM, et al. JAMA Intern Med. 2021;doi:10.1001/jamainternmed.2021.1819.

Disclosures: Ouellet reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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Anticoagulation common at end of life in nursing home residents with dementia, AF

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