Hospitalization As An Opportunity To Correct Errors In Anticoagulant Treatment In Patients With Atrial Fibrillation.
Br J Clin Pharmacol. 2019 Sep 04;:
Authors: Angel Y, Zeltser D, Berliner S, Ingbir M, Shapira I, Shenhar-Tsarfaty S, Rogowski O
AIM: To assess whether hospitalization may assist in correcting errors in anticoagulant therapy among patients with atrial fibrillation (AF).
METHODS: Our cohort included patients admitted to our institution with a history of AF between 2016-2018. We categorized patient's treatment upon admission and discharge as "lacking" (No treatment despite indication), "Inadequate" (according to individual characteristics), or "Adequate". We assessed adequacy of treatment upon discharge and determined factors associated with correcting admission errors.
RESULTS: Of 4,427 patients admitted with a history of AF, the categorization to Lacking, Inadequate and Adequate treatment was 1,746 (39.4%), 1,237 (27.9%) and 1,444 (32.6%) patients, respectively. Of those with inadequate treatment, the most common types of errors were Direct Oral Anticoagulant (DOAC) under-dosing (n=578; 46.7%), Vitamin-K Antagonists (VKA) when DOAC was indicated (n=258; 20.9%), DOAC despite contraindication to DOAC (n=166; 13.4%) and DOAC over dosing (n=124; 10%). Upon discharge 688 (18.6%, out of n=3,694) corrections but also 316 (8.6%) new mistakes were found. On multivariate logistic regression, the factors associated with correction of an error on admission were hospitalization due to AF (OR 2.94 [2.39-3.61]), hospitalization in the neurologic or geriatric wards (OR 2.79 [2.04-3.80]), female gender (OR 1.34 [1.10-1.63]) and a history of stroke (OR 1.47 [1.17-1.86]), while the presence of a contraindication to DOAC decreased the chance of correction (OR 0.10 [0.06-0.18]).
CONCLUSIONS: Hospitalization for any reason may contribute to correction of errors in AC treatment in patients with AF. Unfortunately, a significant portion of patients remains inadequately treated by both outpatient and inpatient providers.
PMID: 31483510 [PubMed - as supplied by publisher]