Nothing new today. The sweep found no fresh approvals, safety communications or guideline releases relevant to the care of older adults.
What is worth reading instead is a study of what happened after the last relevant guideline. In 2014 the ACC and AHA moved away from aspirin for atrial fibrillation and recommended oral anticoagulation. This observational study followed 4,994 Veterans Affairs nursing home residents with atrial fibrillation and a CHA2DS2-VASc score of 2 or more, from 2014 to 2019.
Use of oral anticoagulation rose from 31.2% to 46.6%, and aspirin fell from 47.7% to 39.3%. So the guideline moved practice. It also left more than half of eligible residents untreated five years on, and the gaps were not random: each additional decade of age reduced the likelihood of anticoagulation, as did cognitive impairment and greater disability, and Black and Hispanic veterans were less likely to be anticoagulated than white veterans.
That pattern is the reason to read it on a geriatrics desk. The residents least likely to receive a guideline-recommended drug were the oldest, the frailest and the most cognitively impaired — which is to say the population the guideline evidence least covers, and the population this desk exists for. The authors say so directly, calling for the evidence base to be extended to frail older adults rather than for adherence simply to be pushed harder.
- No new approvals or safety communications for this desk today.
- In your own long-term care patients with atrial fibrillation, check whether age or cognitive impairment alone is doing the deciding.
- Treat an untreated CHA2DS2-VASc of 2 or more as a decision to be documented, not a default.
- Note the racial and ethnic gaps: they persisted after adjustment for comorbidity and function.
- This sweep covers drug regulators; deprescribing and capacity guidance is published without a feed and has to be checked separately.
The statistics, in plain English
A relative risk ratio of 0.79 per decade of age means that with each ten years older, residents were about 21% less likely to be anticoagulated rather than untreated, and the interval of 0.71 to 0.87 keeps that clear of no effect. The prevalence figures are age-standardised, which matters: without that adjustment a change in the age mix of nursing homes could produce the same-looking rise. This is observational, so it describes what happened and not why — an older resident may be untreated because of a considered bleeding-risk decision, and the data cannot separate that from an unconsidered one. The racial and ethnic differences persisted after adjustment for comorbidity and function, which makes them harder to explain away but still not a demonstration of cause.
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