Contents lists available at ScienceDirect Archives of Gerontology and Geriatrics journal homepage: www.elsevier.com/locate/archger Dementia correlates with anticoagulation underuse in older patients with atrial fibrillation Giovanni Viscogliosi a,b, ⁎ , Evaristo Ettorre a , Iulia Maria Chiriac c a Division of Gerontology, Department of Cardiovascular, Nephrologic, Anesthesiologic and Geriatric Sciences, Sapienza University, Rome, Italy b Department of Epidemiology, Surveillance and Promotion of Health, National Institute of Health, Rome, Italy c Geriatric Rehabilitation, Salus Infirmorum Clinic, Italy ARTICLE INFO Keywords: Anticoagulants Atrial fibrillation Dementia Underuse ABSTRACT Objectives: Stroke prevention in older atrial fibrillation (AF) patients remains a challenge. This study aimed to investigate whether a dementia diagnosis is an independent correlate of lower prescription rate of oral antic- oagulant treatment (OAT) in a sample of older AF patients. Methods: Cross-sectional retrospective study. Consecutive older community-dwelling AF patients referred for a comprehensive geriatric assessment, were considered. Evaluation of physical, social and mental health, and administration of the Cumulative Illness Rating Scale (CIRS) and Barthel Index were performed. Dementia cases were ascertained by consensus of 2 experienced geriatricians. Dementia severity was assessed using the Clinical Dementia Rating scale (CDR). Results: 316 AF patients (ages 74.7 ± 7.0 years, 55.7% women) with high stroke risk (77.5% had a CHA 2 DS 2 VASC score ≥3), low bleeding and falling risk, and no neuropsychiatric/behavioral symptoms, were included. 60.1% were prescribed with OAT. Among patients with dementia (n = 86, 27.2%), 22.0% received inadequate antithrombotic prophylaxis (i.e. antiplatelet) and 38.5% no treatment. Proportion of those receiving inadequate or no prophylaxis increased at increasing CDR score. By multiple regression models, either dementia (yes vs no), OR = 1.33, 95%CI = 1.11–1.46, p < 0.001, and dementia severity (CDR > 1), OR = 2.38, 95%CI = 2.19–2.60, p < 0.001, were associated with lack of OAT prescription independently of age, parox- ysmal AF, and comorbidity burden. Conclusions: Dementia might be associated with underuse of OAT in older AF patients even in the absence of established contraindications. Future studies are needed to assess the real dimension of the problem and clin- ician’s barriers to prescribing OAT in demented patients. 1. Introduction Atrial fibrillation (AF), the most common arrhythmia encountered in the clinical practice, affects 10% of people older than 80 years, and confers 4–5 fold increased risk of ischemic stroke (Camm et al., 2012; Go et al., 2001). Stroke risk associated with AF can be reduced by 64%–70% with use of oral anticoagulants (Camm et al., 2012; Go et al., 2001). Current evidence suggests that oral anticoagulant treatment (OAT) should be recommended at ≥75 years of age regardless of ad- ditional risk factors for stroke (Camm et al., 2012). However, many older AF patients are not prescribed with OAT (Steinberg et al., 2015; Zarraga & Kron, 2013). Although age itself is a risk factor for bleeding (Go et al., 2001), older individuals seldom have absolute contra- indications to OAT (Steinberg et al., 2015). The benefit of OAT for stroke prevention in AF has been demonstrated at any age (Go et al., 2001; Mant et al., 2007). Dementia might be associated with lower prescription rate of OAT in older AF patients (Bahri et al., 2015; Dreischulte et al., 2014; Holt et al., 2012; Löppönen et al., 2006; Tanislav et al., 2014). However, it remains unclear the extent to which a dementia diagnosis is associated with lower OAT prescription in older AF patients independently of concomitant factors that might contraindicate OAT. Decision to pre- scribe or not to prescribe OAT to older subjects is indeed based on several issues. Demented subjects might be more likely to carry more risk factors for bleeding, e.g. greater comorbidity, polypharmacy, dis- ability and risk of falling, when compared to age-matched controls (Steinberg et al., 2015). This study sought to assess whether dementia is independently associated with lower rate of OAT prescription in a sample of older AF patients with low bleeding risk. http://dx.doi.org/10.1016/j.archger.2017.05.014 Received 9 December 2016; Received in revised form 4 May 2017; Accepted 27 May 2017 ⁎ Correspondence to: Viale del Policlinico 155, Rome, Italy. E-mail address: giovanni.viscogliosi@libero.it (G. Viscogliosi). Archives of Gerontology and Geriatrics 72 (2017) 108–112 Available online 08 June 2017 0167-4943/ © 2017 Published by Elsevier Ireland Ltd. MARK