The effect of age and quality of life on doctors' decisions to anticoagulate patients with atrial fibrillation

Introduction: we report the results of a questionnaire survey into the effect of patients' age and of medico-social factors on hospital consultants' and general practitioners' reported use of warfarin anticoagulation to treat patients with non-valvular atrial fibrillation (NVAF). Methods: half of the general practitioners (n = 824) and all consultants in specialities likely to be involved in treating such patients (n = 207) in the former Northern Region were sent questionnaires asking for their views on the treatment of patients with atrial fibrillation using anticoagulants. Results: the response rate was 56% (459/824) for general practitioners and 76% (163/207) for consultants. A patient's age was of significance to many clinicians. Forty-six percent of consultants and 43% of general practitioners felt that no patient above the age of 84 years should be treated. Medico-social factors also had an important effect on whether clinicians felt patients ought to be treated with anticoagulants. ii patient's quality of life was the most important medico-social factor, with handicap and place of residence having much smaller effects. Conclusions: age and medico-social factors have an important effect on clinicians use of anticoagulants in NVAF and reluctance to treat elderly subjects is likely to explain much of the apparent under-use of this treatment.