Temporal trends in the use of oral anticoagulants and clinical outcomes in older, elderly, and very elderly patients with atrial fibrillation: a Danish nationwide study

BACKGROUND AND AIMS: Anticoagulation therapy in patients with atrial fibrillation (AF) has changed over time, particularly following the introduction of direct oral anticoagulants. However, it is unknown how the uptake of anticoagulation therapy and the related clinical outcomes in elderly patients with AF have changed over time. METHODS: Patients with new-onset AF were included and divided into three age groups: older adults (65-74 years), elderly (75-84 years), and very elderly (≥85 years). Temporal trends in the initiation of oral anticoagulants (OACs), the stroke-free survival, major bleedings including intracerebral haemorrhage (ICH), and all-cause mortality were investigated from 1999 to 2022. RESULTS: In total, 243 938 patients were included, of whom 89 184 (36.6%) were older adults, 99 002 were elderly (40.6%), and 55 752 (22.8%) were very elderly. The proportion of very elderly patients with AF receiving OACs was 71% in 2022. The absolute improvement in the 5-year probability of stroke-free survival was 10.1% in the older adult patients, 12.8% in the elderly patients, and 3.5% in the very elderly patients. The 5-year absolute risk of ICH increased among the elderly and very elderly AF patients. CONCLUSIONS: Over the past two decades, the risk of stroke decreased significantly among all age groups, with no subsequent increase in the risk of bleeding among older adults in an era where OACs were almost fully implemented. In the very elderly patients aged ≥85 years, the risk of stroke only slightly improved over time, with an increase in the risk of ICH.