Impact of advanced age on management and prognosis in XXXX : insights from a population-based study in general practice.

@entity1 @entity64 @entity204 @entity955
OBJECTIVES: to examine the use of antithrombotic therapy and predictors of @entity64 and @entity204 in very elderly (>= 85 years) @entity955 ( @entity955 ) @entity1 in a general practice cohort from the UK. DESIGN: retrospective, observational cohort study; 12-month follow-up period. SETTING: eleven general practices serving the town of Darlington, England representing a population of 105,000 @entity1 . @entity1 : two thousand two hundred and fifty-nine @entity1 with a history of @entity955 , 561 (24.8%) aged >= 85 years. MAIN OUTCOME MEASURES: use of antithrombotic therapy by age group and predictors of @entity64 and @entity204 . RESULTS: five hundred and sixty-one (24.8%) @entity955 @entity1 aged >= 85 years (mean (SD) age 89 (4) years; 66% female) identified with a mean CHA2DS2-VASc score of 4.6 (SD 1.4). Thirty-six per cent received oral anticoagulation (OAC) compared with 57% in the 75-84 years age group. Forty-nine per cent of the very elderly received antiplatelet (AP) monotherapy; recorded OAC contraindications and declines were greatest among those aged >= 85 years. @entity64 risk was highest among the very elderly (5.2% per annum), despite anticoagulation (3.9%). Multivariate analyses demonstrated an increased risk of @entity64 with AP monotherapy (odds ratio (OR) 2.45, 95% confidence intervals (CIs) 1.05-5.70) and a significant reduction in all-cause mortality with OAC therapy (OR 0.59, 95% CI 0.36-0.99). CONCLUSION: the majority of very elderly @entity955 @entity1 in general practice do not receive OAC despite their higher @entity64 risk; almost half received AP monotherapy. AP use independently increased the risk of @entity64 , signifying that effective @entity64 prevention requires OAC regardless of age, except where true contraindications exist.
