Appropriateness of oral anticoagulant therapy prescription and its associated factors in hospitalized older people with atrial fibrillation.
Br J Clin Pharmacol. 2018 May 10;:
Authors: Franchi C, Antoniazzi S, Proietti M, Nobili A, Mannucci PM, SIM-AF Investigators
BACKGROUND: Oral anticoagulants (OACs) are effective in preventing stroke in older people with atrial fibrillation (AF). Despite this, they are often underused in this at particularly high risk population.
OBJECTIVES: To assess the appropriateness of OAC prescription and its associated factors in hospitalized patients aged 65 years or older.
METHODS: Data were obtained from the retrospective phase of SIM-AF study, held in 32 Italian internal medicine and geriatric wards. Appropriateness of OAC prescription was assessed grouping patients in those prescribed or not at hospital discharge. Multivariable logistic regression was used to establish factors independently associated with appropriateness of OAC prescription.
RESULTS: 328 patients were included in the retrospective phase of the study. Of them 44% (N=143) were inappropriately prescribed with OACs, being mainly under prescribed or prescribed with an inappropriate antithrombotic drug (N=88). Among those patients prescribed with OACs (N=221), errors on the prescribed doses were the most frequent cause of inappropriate use (N=55). Factors associated with a higher degree of patient frailty were inversely associated with the appropriateness of OAC prescription.
CONCLUSION: In hospitalized older patients with AF there is still a high prevalence of inappropriate OAC prescribing. Characteristics usually related to frailty are associated with the inappropriate prescribing. These findings point out the need for targeted interventions designed for internists and geriatricians aimed at improving the appropriate prescribing of OACs in this complex and at high risk population.
PMID: 29745441 [PubMed - as supplied by publisher]