Appropriateness of oral anticoagulant therapy prescription and its associated factors in hospitalized older people with atrial fibrillation. (19th June 2018)

• Record Type: Journal Article
• Authors: Franchi, Carlotta; Antoniazzi, Stefania; Proietti, Marco; Nobili, Alessandro; Mannucci, Pier Mannuccio
• Other Names: Santalucia Paola investigator.; Monzani Valter investigator.; Marcucci Maura investigator.; Antoniazzi Stefania investigator.; Bosari Silvano investigator.; Mannucci Pier Mannuccio investigator.; Franchi Carlotta investigator.; Brignolo Barbara investigator.; Proietti Marco investigator.; Nicolis Enrico investigator.; Ardoino Ilaria investigator.; Fenoglio Luigi M. investigator.; Melchio Remo investigator.; Fabris Fabrizio investigator.; Sartori Maria Teresa investigator.; Manfredini Roberto investigator.; De Giorgi Alfredo investigator.; Fabbian Fabio investigator.; Biolo Gianni investigator.; Zanetti Michela investigator.; Altamura Nicola investigator.; Sabbà Carlo investigator.; Suppressa Patrizia investigator.; Bandiera Francesco investigator.; Usai Carlo investigator.; Murialdo Giovanni investigator.; Fezza Francesca investigator.; Marra Alessio investigator.; Castelli Francesca investigator.; Cattaneo Federico investigator.; Beccati Valentina investigator.; di Minno Giovanni investigator.; Tufano Antonella investigator.; Contaldi Paola investigator.; Lupattelli Graziana investigator.; Bianconi Vanessa investigator.; Cappellini Domenica investigator.; Hu Cinzia investigator.; Minonzio Francesca investigator.; Fargion Silvia investigator.; Burdick Larry investigator.; Francione Paolo investigator.; Peyvandi Flora investigator.; Rossio Raffaella investigator.; Colombo Giulia investigator.; Ceriani Giuliana investigator.; Lucchi Tiziano investigator.; Manfellotto Dario investigator.; Caridi Irene investigator.; Corazza Gino Roberto investigator.; Miceli Emanuela investigator.; Padula Donatella investigator.; Fraternale Giacomo investigator.; Guasti Luigina investigator.; Squizzato Alessandro investigator.; Maresca Andrea investigator.; Liberato Nicola Lucio investigator.; Tognin Tiziana investigator.; Rozzini Renzo investigator.; Bellucci Francesco Baffa investigator.; Muscaritoli Maurizio investigator.; Molfino Alessio investigator.; Petrillo Enrico investigator.; Dore Maurizio investigator.; Mete Francesca investigator.; Gino Miriam investigator.; Franceschi Francesco investigator.; Gabrielli Maurizio investigator.; Perticone Francesco investigator.; Perticone Maria investigator.; Bertolotti Marco investigator.; Mussi Chiara investigator.; Borghi Claudio investigator.; Strocchi Enrico investigator.; Durazzo Marilena investigator.; Fornengo Paolo investigator.; Dallegri Franco investigator.; Ottonello Luciano Carlo investigator.; Salam Kassem investigator.; Caserza Lara investigator.; Barbagallo Mario investigator.; Di Bella Giovanna investigator.; Annoni Giorgio investigator.; Bruni Adriana Antonella investigator.; Odetti Patrizio investigator.; Nencioni Alessio investigator.; Monacelli Fiammetta investigator.; Napolitano Armando investigator.; Brucato Antonio investigator.; Valenti Anna investigator.; Castellino Pietro investigator.; Zanoli Luca investigator.; Mazzeo Marco investigator.;
• Is Part Of: British journal of clinical pharmacology. Volume 84:Number 9(2018)
• Page Start: 2010
• Page End: 2019
• Publication Date: 2018-06-19
• Subjects: appropriateness of prescription -- atrial fibrillation -- internal medicine and geriatric wards -- older patients -- oral anticoagulant; Pharmacology -- Periodicals; Drugs -- Periodicals; 615.1
• DOI: 10.1111/bcp.13631
• Languages: English
• ISSNs: 0306-5251

Abstract

Abstract : Aims: Although oral anticoagulants (OACs) are effective in preventing stroke in older people with atrial fibrillation (AF), they are often underused in this particularly high‐risk population. The aim of the present study was 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 Simulation‐based Technologies to Improve the Appropriate Use of Oral Anticoagulants in Hospitalized Elderly Patients With Atrial Fibrillation (SIM‐AF) study, held in 32 Italian internal medicine and geriatric wards. The appropriateness of OAC prescription was assessed, grouping patients in those who were and were not prescribed OACs at hospital discharge. Multivariable logistic regression was used to establish factors independently associated with the appropriateness of OAC prescription. Results: A total of 328 patients were included in the retrospective phase of the study. Of these, almost 44% ( N = 143) were inappropriately prescribed OACs, being mainly underprescribed or prescribed an inappropriate antithrombotic drug ( N = 88). Among the patients prescribed OACs ( N = 221), errors in 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. Conclusions: 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 to the need for targeted interventions designed for internists and geriatricians, aimed at improving the appropriate prescribing of OACs in this complex and high‐risk population.