Presence of Geriatric Conditions Is Prognostic of Major Bleeding in Older Patients with Atrial Fibrillation: a Cohort Study

Background In older patients with atrial fibrillation (AF), physical, cognitive, and psychosocial limitations are prevalent. The prognostic value of these conditions for major bleeding is unclear. Objective To determine whether geriatric conditions are prospectively associated with major bleeding in older patients with AF on anticoagulation. Design Multicenter cohort study with 2-year follow-up from 2016 to 2020 in Massachusetts and Georgia from cardiology, electrophysiology, and primary care clinics. Participants Diagnosed with AF, age 65 years or older, CHA 2 DS 2 -VASc score of 2 or higher, and taking oral anticoagulant ( n =1,064). A total of 6507 individuals were screened. Main Measures A six-component geriatric assessment of frailty, cognitive function, social support, depressive symptoms, vision, and hearing. Main outcome was major bleeding adjudicated by a physician panel. Key Results At baseline, participants were, on average, 75.5 years old and 49% were women. Mean CHA 2 DS 2 -VASc score was 4.5 and the mean HAS-BLED score was 3.3. During 2.0 (± 0.4) years of follow-up, 95 (8.9%) participants developed an episode of major bleeding. After adjusting for key covariates and accounting for competing risk from death, cognitive impairment (hazard ratio [HR] 1.62, 95% confidence interval [CI]: 1.02–2.56) and frailty (HR 2.77, 95% CI 1.38–5.58) were significantly associated with the development of major bleeding. Conclusions In older patients with AF taking anticoagulants, cognitive impairment and frailty were independently associated with major bleeding.