Atrial fibrillation (AF) is the most common significant cardiac arrhythmia, and its prevalence increases with age. In fact, the number of nursing home residents with a diagnosis of AF is projected to exceed 300,000 by 2030. Anticoagulant use in nursing homes continues to present challenges. Although clinical guidelines recommend oral anticoagulants (OACs) to reduce stroke risk, OACs are often underused or discontinued in older adults, particularly in nursing homes, because of concerns about bleeding risk and falls.

The decreased use of OACs in this population may have important consequences because prior studies have shown that individuals with activities of daily living (ADL) disability have a significantly elevated risk of stroke. Additionally, older adults with AF at high risk of falls experience substantially higher rates of intracranial hemorrhage. In a recent study published in JAMA Network Open, researchers evaluated the association between OAC use and clinical outcomes.

Findings from the study showed that among nursing home residents with AF and ADL disability, OAC use was associated with lower rates of ischemic stroke but higher rates of major bleeding compared with those not prescribed OACs. Apixaban (brand name Eliquis) demonstrated the most favorable benefit-risk profile among the OACs evaluated. A recent McKnight’s Long-Term Care News article also highlighted these findings.

This might be a great performance improvement project (PIP) for your QAPI committee. Have your pharmacy send you a report on anticoagulant use in nursing homes, starting with your own community. Identify those residents at high risk for negative outcomes related to medications and gather your physicians, pharmacy, and clinical staff to determine next steps. Maybe everything is great and nothing needs to change. Maybe everything ISN’T great and it is time to address areas of risk.

Stay well and stay informed!