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Original Research: Cardiovascular Disease |

Clinical Characteristics and Outcomes in Extreme Elderly (Age ≥ 85 Years) Japanese Patients With Atrial Fibrillation: The Fushimi AF Registry

Yugo Yamashita, MD; Yasuhiro Hamatani, MD; Masahiro Esato, MD, PhD; Yeong-Hwa Chun, MD, PhD; Hikari Tsuji, MD, PhD; Hiromichi Wada, MD, PhD; Koji Hasegawa, MD, PhD; Mitsuru Abe, MD, PhD; Gregory Y.H. Lip, MD; Masaharu Akao, MD, PhD
Author and Funding Information

Drs Lip and Akao are joint senior authors.

FUNDING/SUPPORT: The Fushimi AF Registry is supported by research funding from Boehringer Ingelheim GmbH; Bayer HealthCare AG; Pfizer Inc; Bristol-Myers Squibb Company; Astellas Pharma US, Inc; AstraZeneca; Daiichi Sankyo Company, Limited; Novartis; Merck Sharp & Dohme Corp, sanofi-aventis; and Takeda Pharmaceuticals USA, Inc.

CORRESPONDENCE TO: Masaharu Akao, MD, PhD, Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(2):401-412. doi:10.1378/chest.15-1095
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Background  Atrial fibrillation (AF) is increasingly prevalent with age, and increasing age is an independent risk factor for ischemic stroke. Oral anticoagulant (OAC) therapy use in the extreme elderly (aged ≥ 85 years) is challenging.

Methods  The Fushimi AF Registry is a community-based prospective study of Japanese patients with AF (79 participating medical institutions in Fushimi-ku, Kyoto, Japan). Patient enrollment started in March 2011, and follow-up data were available for 3,304 patients as of July 2014. We compared clinical characteristics and outcomes between the extreme elderly group (n = 479 [14.5%]) and other age-groups.

Results  The extreme elderly group had a higher prevalence of major comorbidities and risk scores for stroke but received fewer OACs. After a mean follow-up of 2.0 years, end points in the extreme elderly group were as follows: all-cause death, 17.6; stroke/systemic embolism, 5.1; and major bleeding, 2.0 per 100 person-years. Extreme age was associated with a higher incidence of combined stroke/systemic embolism and all-cause death (hazard ratio [HR], 3.20; 95% CI, 2.66-3.84; P < .01) and higher incidences of stroke/systemic embolism (HR, 2.57; 95% CI, 1.77-3.65; P < .01) and mortality (HR, 3.48; 95% CI, 2.84-4.25; P < .01) compared with other patients (aged ≤ 84 years). The incidence of major bleeding was not significantly different (HR, 1.40; 95% CI, 0.78-2.36; P = .25).

Conclusions  In the present community-based prospective cohort, Japanese extreme elderly patients with AF had a higher incidence of stroke but similar major bleeding risks compared with the younger AF population.

Trial Registry  UMIN Clinical Trials Registry; No.: UMIN000005834; URL: http://www.umin.ac.jp/ctr/index.htm

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