1b) This is a #journalclub review of an excellent article published in late 2022 in @JAMANetworkOpen 🔓 https://t.co/qoP1gddS4o. 👏to @darae_ko et al for such an important look at this topic that is only gaining in importance as the population ages.#CardioTwitter #FOAMed pic.twitter.com/xz4iulP5d4
— cardio-met (@cardiomet_CE) February 28, 2023
2b) This #tweetorial is supported by an unrestricted educational grant from Anthos Therapeutics.#Physicians #PhysicianAssociates #Nurses #NursePractitioners #Pharmacists all earn credit! FOLLOW US more weekly expert-authored education and 🆓credit in the #cardiometabolic space!
— cardio-met (@cardiomet_CE) February 28, 2023
3b) SO critical to focus on this population as our population ages . . .
— cardio-met (@cardiomet_CE) February 28, 2023
Refs: https://t.co/Juco67pbfS https://t.co/NQ2T5pN6tm pic.twitter.com/iu9bi0dIMZ
5a) Over the past decade, there has been a rapidly⬆️ing appreciation of both the risk of incident #AFib (🔓 https://t.co/tayHJIdVUZ) and the associated #stroke risk (1⃣ in 3⃣ ischemic strokes, 🔓https://t.co/DHvSkPJ8JI) in those 65 and ⤴️.
— cardio-met (@cardiomet_CE) February 28, 2023
5c) Indeed, in 2010, only ~55% of older adults w/ #AFib and guideline eligibility for #OAC were Rx'd #warfarin in 2010 (🔓 https://t.co/JlFp6VMyA8), for various reasons such as concerns for 🩸, falls, #frailty, cognitive impairment, & complexity of warfarin.
— cardio-met (@cardiomet_CE) February 28, 2023
5e) It happened! In parallel with #DOAC uptake, #OAC initiation for #Medicare #FFS beneficiaries 65+ any time after new #AFib dx 34% in 2011 ➡️53% in 2016❗️ 🔓 https://t.co/zoj7rREy9v
— cardio-met (@cardiomet_CE) February 28, 2023
👉@darae_ko et al asked: what has happened since then? pic.twitter.com/Ey9Co2hskp
7a) The OAC-eligible incident AF cohort ranged 21,603-51, 236 pts/y (total 2010-20 = 381 ,488).
— cardio-met (@cardiomet_CE) February 28, 2023
👉mean (SD) age 77.2 (6.1) – 77.4 (6.8) years;
👉51.8%-49.8% pts ♀️
👉%White ⬇️78.4% in 2010 to 74.7% in 2020, while %Black ⬆️7.4% to 8.8%, & %Hispanic ⬆️7.5% to 8.8%.
7c)
— cardio-met (@cardiomet_CE) February 28, 2023
🩸mean (SD) #HAS_BLED score (without labile INR component) 3.7 (0.9) to 3.8 (1.0)
🩼 14.5% to 17.4% were #frail
🧠9.9% to 11.8% had #dementia
😩24.7% to 28.1% had #anemia
🦴2.2% to 2.8% had a history of hip or pelvic #fracture
🦽8.0% to 9.7% had #osteoporosis pic.twitter.com/ggBJruqFgf
9) Across the 10 yrs studied, #OAC initiation was lower in pts aged 80 & older and in pts with #dementia, #frailty, and #anemia .
— cardio-met (@cardiomet_CE) February 28, 2023
💊OAC initiation & DOAC uptake were similar across subgroups by race & ethnicity, HAS-BLED, & prior stroke
11a) Over time, the median (IQR) proportion of days covered #PDC ⬆️77.6% (41.0%-96.4%) to 90.2% (57.4%-96.6%), & the prevalence of #OAC #nonadherence ⬇️by 13.2%, from 52.2% to 39.0%, similar across all subgroups.
— cardio-met (@cardiomet_CE) February 28, 2023
12a) So what have we learned?
— cardio-met (@cardiomet_CE) February 28, 2023
1⃣ In the "DOAC era," 12-month initiation of #OAC in patients w/ newly dx'd #AFib ⬆️ by 12.7%, 2010-20.
2⃣ Initiation of OAC remains suboptimal in older adults with AFib, particularly among those with #dementia, #frailty, and #anemia.
13a) There are still TALL ⛰️s to climb to improve safe & guidelines-concordant provision of #SPAF. We must address fear of adverse events associated w/ #OAC–still cited as the 🔑reason for lack of OAC Rx in pts w/advanced age & high comorbidity burden.
— cardio-met (@cardiomet_CE) February 28, 2023
🔓https://t.co/RM7kN6quuv
13c) And key to remember, in our target group here of 65+ patients, the risk of major bleeding is 2x higher in pts w/ >/= 6 #comorbidities vs those w/ 0-2 comorbidities. See https://t.co/sftCPRnbLL
— cardio-met (@cardiomet_CE) February 28, 2023
0-2: 36%;
3-5: moderate multi-morbidity (51%);
≥6 comorbidities (high, 13%) pic.twitter.com/SmsVEFbndi
14a) Finally, there may be new options emerging on the pharmacological front–perhaps #aFXa #DOACs aren't the final 🏹in our anticoagulation quiver? Several #FXI/#FXIa inhibitors will be tested in phase 3 trials.
— cardio-met (@cardiomet_CE) February 28, 2023
15a) So what have we learned? Which of the following is NOT a predictor of poor adherence to #guidelines-concordant Rx of #anticoagulation therapy within 1yr of a new dx of #Afib?
— cardio-met (@cardiomet_CE) February 28, 2023
15c) It's A. #Heartfailure is a common #comorbidity to #AFib, especially in the elderly, and is predictive of #stroke risk in AF but not of bleeding while on #anticoagulation–at least per the #HAS_BLED score, nor for #HEMORR2HAGES or #ORBIT.
— cardio-met (@cardiomet_CE) February 28, 2023
16) You just earned 0.5hr 🆓CE/#CME! Grab your certificate for credit at https://t.co/orYQvmXHu9, and follow us here on @cardiomet_ce for more education on this & other topics related to #thrombosis & #antithrombotic therapy! @darae_ko & @md_pollack 🙏for joining!
— cardio-met (@cardiomet_CE) February 28, 2023