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Research Letter
Less Is More
May 10, 2021

Anticoagulant Use for Atrial Fibrillation Among Persons With Advanced Dementia at the End of Life

Author Affiliations
  • 1Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
  • 2VA Connecticut Healthcare System, West Haven, Connecticut
  • 3The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
JAMA Intern Med. Published online May 10, 2021. doi:10.1001/jamainternmed.2021.1819

Atrial fibrillation (AF) affects almost 20% of individuals with dementia.1 By virtue of their age and comorbidities, nearly all patients with AF and dementia meet the threshold stroke risk, as estimated by the CHA2DS2VASC score (a score to predict annual stroke risk in persons with AF based on the following risk factors: congestive heart failure, hypertension, age [>65 years  = 1 point; >75 years = 2 points], diabetes, previous stroke or transient ischemic attack [2 points], vascular disease),2 for which guidelines recommend anticoagulation.3 As dementia progresses, function is gradually but irretrievably lost, so that the potential benefits of preventing a stroke become increasingly attenuated. In advanced dementia, patients develop profound cognitive deficits; require help with basic self-care activities, including eating; and have a very limited life expectancy.4 Our objective was to determine how often anticoagulation is continued among nursing home residents in this final stage of life and to examine clinical associations of its use.

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