Appropriateness of oral anticoagulant therapy prescription and its associated factors in hospitalized older people with atrial fibrillation

on behalf of the SIM-AF Collaborators

Research output: Contribution to journalArticle

7 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)2010-2019
Number of pages10
JournalBritish Journal of Clinical Pharmacology
Volume84
Issue number9
DOIs
Publication statusPublished - Sep 1 2018

Fingerprint

Anticoagulants
Atrial Fibrillation
Prescriptions
Therapeutics
Inappropriate Prescribing
Internal Medicine
Geriatrics
Population
Retrospective Studies
Logistic Models
Stroke
Technology

Keywords

  • appropriateness of prescription
  • atrial fibrillation
  • internal medicine and geriatric wards
  • older patients
  • oral anticoagulant

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

Cite this

Appropriateness of oral anticoagulant therapy prescription and its associated factors in hospitalized older people with atrial fibrillation. / on behalf of the SIM-AF Collaborators.

In: British Journal of Clinical Pharmacology, Vol. 84, No. 9, 01.09.2018, p. 2010-2019.

Research output: Contribution to journalArticle

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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.",
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author = "{on behalf of the SIM-AF Collaborators} and Carlotta Franchi and Stefania Antoniazzi and Marco Proietti and Alessandro Nobili and Mannucci, {Pier Mannuccio} and Paola Santalucia and Valter Monzani and Maura Marcucci and Stefania Antoniazzi and Silvano Bosari and Mannucci, {Pier Mannuccio} and Carlotta Franchi and Barbara Brignolo and Marco Proietti and Enrico Nicolis and Ilaria Ardoino and Fenoglio, {Luigi M.} and Remo Melchio and Fabrizio Fabris and Sartori, {Maria Teresa} and Roberto Manfredini and {De Giorgi}, Alfredo and Fabio Fabbian and Gianni Biolo and Michela Zanetti and Nicola Altamura and Carlo Sabb{\`a} and Patrizia Suppressa and Francesco Bandiera and Carlo Usai and Giovanni Murialdo and Francesca Fezza and Alessio Marra and Francesca Castelli and Federico Cattaneo and Valentina Beccati and {di Minno}, Giovanni and Antonella Tufano and Paola Contaldi and Silvia Fargion and Flora Peyvandi and Tiziano Lucchi and Corazza, {Gino Roberto} and Emanuela Miceli and Marco Bertolotti and Chiara Mussi and Mario Barbagallo and Patrizio Odetti and Alessio Nencioni and Fiammetta Monacelli",
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AU - Franchi, Carlotta

AU - Antoniazzi, Stefania

AU - Proietti, Marco

AU - Nobili, Alessandro

AU - Mannucci, Pier Mannuccio

AU - Santalucia, Paola

AU - Monzani, Valter

AU - Marcucci, Maura

AU - Antoniazzi, Stefania

AU - Bosari, Silvano

AU - Mannucci, Pier Mannuccio

AU - Franchi, Carlotta

AU - Brignolo, Barbara

AU - Proietti, Marco

AU - Nicolis, Enrico

AU - Ardoino, Ilaria

AU - Fenoglio, Luigi M.

AU - Melchio, Remo

AU - Fabris, Fabrizio

AU - Sartori, Maria Teresa

AU - Manfredini, Roberto

AU - De Giorgi, Alfredo

AU - Fabbian, Fabio

AU - Biolo, Gianni

AU - Zanetti, Michela

AU - Altamura, Nicola

AU - Sabbà, Carlo

AU - Suppressa, Patrizia

AU - Bandiera, Francesco

AU - Usai, Carlo

AU - Murialdo, Giovanni

AU - Fezza, Francesca

AU - Marra, Alessio

AU - Castelli, Francesca

AU - Cattaneo, Federico

AU - Beccati, Valentina

AU - di Minno, Giovanni

AU - Tufano, Antonella

AU - Contaldi, Paola

AU - Fargion, Silvia

AU - Peyvandi, Flora

AU - Lucchi, Tiziano

AU - Corazza, Gino Roberto

AU - Miceli, Emanuela

AU - Bertolotti, Marco

AU - Mussi, Chiara

AU - Barbagallo, Mario

AU - Odetti, Patrizio

AU - Nencioni, Alessio

AU - Monacelli, Fiammetta

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N2 - 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.

AB - 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.

KW - appropriateness of prescription

KW - atrial fibrillation

KW - internal medicine and geriatric wards

KW - older patients

KW - oral anticoagulant

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