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Clinical Summary

Risk Factors Influencing Oral Anticoagulant Prescription in Older adults


  • Less than half of new care home residents with atrial fibrillation (AF) aged ≥65 years were prescribed oral anticoagulants between 2003 and 2018.
  • The proportion of new residents with AF who were prescribed an oral anticoagulant within 6 months before entering a care home more than doubled from 2003 to 2018.

Why This Matters

  • The findings shed light on the factors that influence oral anticoagulant prescribing for new care home residents with AF, a high-risk group that has been underrepresented in research.

Study Design

  • This was a retrospective cohort study that included 14,493 patients (age ≥65 years) with AF entering a care home, identified using data from the Secure Anonymised Information Linkage Databank on CARE home residents with AF (2003-2018).
  • Funding: Health Data Research UK and others.

Key Results

  • Overall, 7057 (48.7%) patients with AF were prescribed oral anticoagulants within 6 months before entering a care home.
  • The proportion of new care home residents with AF who were prescribed oral anticoagulants increased from 32.7% in 2003 to 72.7% in 2018.
  • Increasing age (adjusted OR [aOR] per 1-year age increase 0.96; 95% CI 0.95 to 0.96; P<0.001) and prescription of antiplatelet therapy without non-steroidal anti-inflammatory drugs (aOR 0.91; 95% CI 0.84 to 0.98; P=0.014) were associated with a lower risk of oral anticoagulant prescription.
  • Risk factors associated with oral anticoagulant prescription were (aOR; 95% CI):
    • prior venous thromboembolism (4.06; 3.17 to 5.20; P<0.001);
    • advancing frailty:
      • mild (4.61; 3.95 to 5.38);
      • moderate (6.69; 5.74 to 7.80); and
      • severe (8.42; 7.16 to 9.90; P<0.001 for all).
    • year of care home entry from 2011 onwards (1.91; 1.76 to 2.06; P<0.001).


  • Retrospective design.