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Background <p>Recent international guidelines emphasize a multidisciplinary, patient-centered approach to managing atrial fibrillation (AF), particularly regarding antithrombotic (antiplatelet and anticoagulant) management. These guidelines advocate establishing multidisciplinary AF teams, but the clinical benefits of this approach for high-risk, clinically complex subgroups—particularly among very old and frail patients—remain uncertain. Our objective was to evaluate the impact of a hospital multidisciplinary team meeting dedicated to antithrombotics management on a composite measure of all-cause death, major thromboembolic events, or major or clinically relevant bleeding within 6&#xa0;months in older adults with AF.</p> Methods <p>A prospective multicenter cohort study was conducted in five acute geriatric departments in the Paris area between May 2021 and January 2024. Using a target trial emulation approach (cloning, censoring, weighting strategies), outcomes were analyzed in patients aged ≥ 75&#xa0;years with AF or atrial flutter, followed in the geriatric departments (via outpatient consultation or hospitalization; &gt; 98% were hospitalized). Participants were followed for 6&#xa0;months or until death. The primary exposure was a hospital multidisciplinary team meeting within 45&#xa0;days of inclusion, involving geriatricians, cardiologists, neurovascular specialists, and hemostasis experts. Cumulative incidences were estimated using the reverse Kaplan–Meier method.&#xa0;</p> Results <p>The study included 818 patients, 138 (16.9%) in the hospital multidisciplinary-team meeting arm (median age 89 (Q1Q3 84–93), 57% female). The 6-month cumulative incidence of the primary composite outcome was 35.3% (95% CI, 29.6 to 41.8) in the multidisciplinary-team meeting arm and 36.2% (95% CI, 32.2 to 40.1) in the control arm (risk difference − 0.9 (95% CI, − 7.5 to 6.0); <i>p</i> = .79). The 2 arms did not differ in individual events within the composite measure.</p> Conclusions <p>A hospital multidisciplinary team meeting dedicated to antithrombotics management in older adults with AF was not associated with a reduction in all-cause death, major thromboembolic events, or major or clinically relevant bleeding within 6&#xa0;months. These findings should be interpreted with caution due to the observational design and potential for residual confounding.</p> Trial registration <p>ClinicalTrials.gov registration: NCT04932603.&#xa0;</p>

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Multidisciplinary team for antithrombotics management and clinical outcomes in older adults with atrial fibrillation: a target trial emulation

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月29日

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  • Maïwenn Prunel,
  • Alexis Cochard,
  • Leila Abbas,
  • Elodie Baudry,
  • Eric Pautas,
  • Nicolas Legris,
  • Patrick Assayag,
  • Corinne Frere,
  • Marc Verny,
  • Noémie Simon-Tillaux,
  • Lorene Zerah

摘要

Background

Recent international guidelines emphasize a multidisciplinary, patient-centered approach to managing atrial fibrillation (AF), particularly regarding antithrombotic (antiplatelet and anticoagulant) management. These guidelines advocate establishing multidisciplinary AF teams, but the clinical benefits of this approach for high-risk, clinically complex subgroups—particularly among very old and frail patients—remain uncertain. Our objective was to evaluate the impact of a hospital multidisciplinary team meeting dedicated to antithrombotics management on a composite measure of all-cause death, major thromboembolic events, or major or clinically relevant bleeding within 6 months in older adults with AF.

Methods

A prospective multicenter cohort study was conducted in five acute geriatric departments in the Paris area between May 2021 and January 2024. Using a target trial emulation approach (cloning, censoring, weighting strategies), outcomes were analyzed in patients aged ≥ 75 years with AF or atrial flutter, followed in the geriatric departments (via outpatient consultation or hospitalization; > 98% were hospitalized). Participants were followed for 6 months or until death. The primary exposure was a hospital multidisciplinary team meeting within 45 days of inclusion, involving geriatricians, cardiologists, neurovascular specialists, and hemostasis experts. Cumulative incidences were estimated using the reverse Kaplan–Meier method. 

Results

The study included 818 patients, 138 (16.9%) in the hospital multidisciplinary-team meeting arm (median age 89 (Q1Q3 84–93), 57% female). The 6-month cumulative incidence of the primary composite outcome was 35.3% (95% CI, 29.6 to 41.8) in the multidisciplinary-team meeting arm and 36.2% (95% CI, 32.2 to 40.1) in the control arm (risk difference − 0.9 (95% CI, − 7.5 to 6.0); p = .79). The 2 arms did not differ in individual events within the composite measure.

Conclusions

A hospital multidisciplinary team meeting dedicated to antithrombotics management in older adults with AF was not associated with a reduction in all-cause death, major thromboembolic events, or major or clinically relevant bleeding within 6 months. These findings should be interpreted with caution due to the observational design and potential for residual confounding.

Trial registration

ClinicalTrials.gov registration: NCT04932603.