Summary

Sex-related differences in benefits of anticoagulation therapy in elderly patients with atrial fibrillation: a subanalysis of the EMERG-AF study

Mercedes Varona1,2, Alfonso Martín1,3, Juan Sánchez1,4, Juan Tamargo5, Manuel Cancio1,6, Susana Sánchez1,7, José Carbajosa1,8, Amparo Fernández de Simón1,9, José Ríos10, Carmen del Arco1,11, José Ormaetxe12, Coral Suero1,13, Blanca Coll-Vinent1,14, en representación de los investigadores del estudio EMERG-AF (*)

Affiliation of the authors

1Group of Cardiac Arrhythmias and Syncope of the Syncope Group of the Spanish Society of Emergency Medicine (SEMES), Spain. 2Emergency Department, Hospital Hospital Universitario de Basurto, University of the Basque Country, Bilbao, Spain. 3Emergency Department, Hospital Hospital Universitario de Móstoles, Madrid, Spain.4Emergency Department, Hospital Virgen de las Nieves University Hospital, Granada, Spain. 5Department of Pharmacology, CIBERCV, Universidad Complutense, Madrid, Spain. 6Emergency Department, Hospital Universitario Donostia, San Sebastián, Spain. 7Emergency Department, Hospital Río Hortega University Hospital, University of Valladolid, Valladolid, Spain. 8Emergency Department, Hospital Universitario de Alicante Dr. Balmis, Alicante, Spain. Balmis, Alicante, Spain. 9Emergency Department, Hospital Virgen del Rocío University Hospital, Seville, Spain. 10Biostatistics and Epidemiology and Epidemiology Laboratory, Universitat Autònoma de Barcelona, Spain. 11Emergency Department, Hospital Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Spain. 12Cardiology Service, Basurto University Hospital, University of the Basque Country, Bilbao, Spain. 13Emergency and Critical Care Critical Care, Hospital de la Axarquía, Velez-Malaga, Spain. 14Emergency Department. Research Group Research Group “Urgències: processos i patologies”. IDIBAPS. Atrial Fibrillation Unit (UFA). Hospital Clínic. Barcelona, Spain.

DOI

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Varona M, Martín A, Sánchez J, Tamargo J, Cancio M, Sánchez S, et al. Sex-related differences in benefits of anticoagulation therapy in elderly patients with atrial fibrillation: a subanalysis of the EMERG-AF study. Emergencias. 2023;35:252-60

Summary

Objectives.

To analyze the long-term benefits and safety of oral anticoagulation therapy prescribed in emergency departments for elderly patients with atrial fibrillation, and to detect any sex-related differences present.

Methods.

Post-hoc analysis of data compiled by the EMERG-AF group (Spanish acronym for Emergency Department Stroke Prophylaxis and Guidelines Implementation in Atrial Fibrillation). Consecutive patients aged 75 years or older with atrial fibrillation who were treated in 62 EDs were included. We recorded clinical data and anticoagulants prescribed. Patients were followed for 1 year. The main outcome variable was a composite of death, thromboembolism, or major bleeding within 1 year.

Results.

Data for 690 patients were registered; 386 (55.9%) were women. At discharge, 575 patients (83.3%) were on anticoagulants; therapy was started in the ED for 96 of them. A total of 158 patients (22.9%) had experienced at least 1 component of the main outcome within 1 year: 118 (17.1%) died, 22 (2.7%) had thromboembolic complications, and 34 (4.9%) had major bleeding. After adjustment for main clinical characteristics, hazard ratios (HRs) showed that anticoagulation therapy was associated with a reduction in the composite outcome (HR, 0.372; 95% CI, 0.236-0.587; P < .001) but not specifically with major bleeding overall. When data for women were analyzed separately, anticoagulant therapy was again associated with a reduction in the composite outcome (HR, 0.372; 95% CI, 0.236 0.587; P < .001) and also with death (HR, 0.281; 95% CI, 0.168-0.469; P < .001), even in patients with anticoagulant prescriptions initiated on discharge from the ED. These associations did not reach statistical significance in men.

Conclusions.

ED anticoagulant prescription for elderly patients with atrial fibrillation is safe and contributes to a reduction in mortality. Women in this age group benefited more than men from starting anticoagulation during the acute phase in the ED.

 

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