JAMA Internal Medicine
Gregory M Ouellet, Terri R Fried, Lauren G Gilstrap, John R O’Leary, Andrea M Austin, Jonathan S Skinner, Andrew B Cohen
In this cross-sectional study, we used Medicare data to identify nursing home residents 65 years or older with advanced dementia and AF who had at least moderate stroke risk (CHA2DS2VASC score≥ 2), and who died between January 1, 2014, and December 31, 2017. Advanced dementia was defined as a diagnosis of Alzheimer disease or another dementia, Cognitive Performance Score of 5 or 6, 5 and dependence in all activities of daily living on 2 Minimum Data Set assessments within the last 6 months of life. We used Chronic Condition Warehouse flags to ascertain AF. We excluded residents not enrolled in fee-for-service Medicare and those with claims for venous thromboembolism and valvular heart disease (including mechanical valves) in the 2 years before death. This study was approved by the institutional review boards at Yale University and the VA Connecticut Healthcare System, which …