1. Appropriateness of oral anticoagulant therapy prescription and its associated factors in hospitalized older people with atrial fibrillation
- Author
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Paola Santalucia, Giacomo Fraternale, Alessandro Squizzato, Irene Caridi, Fabrizio Fabris, Stefania Antoniazzi, Luigina Guasti, Francesca Castelli, Paola Contaldi, Ilaria Ardoino, Anna Valenti, Marco Proietti, Marilena Durazzo, Tiziana Tognin, Francesca Minonzio, Francesco Baffa Bellucci, Giorgio Annoni, Carlo Sabbà, Francesca Mete, Patrizia Suppressa, Graziana Lupattelli, Alessandro Nobili, Valter Monzani, Pietro Castellino, Hu Cinzia, Maurizio Muscaritoli, Chiara Mussi, Raffaella Rossio, Roberto Manfredini, Miriam Gino, Vanessa Bianconi, Silvano Bosari, Antonio Brucato, V. Beccati, Giovanni Murialdo, Luciano Ottonello, Marco Mazzeo, Donatella Padula, Tiziano Lucchi, Francesco Bandiera, G. Colombo, Franco Dallegri, Nicola Altamura, Carlo Usai, Mario Barbagallo, Maria Perticone, Giovanna Di Bella, Luca Zanoli, L. Burdick, Fabio Fabbian, Maurizio Gabrielli, Kassem Salam, G. Ceriani, Adriana Bruni, Andrea Maria Maresca, Maura Marcucci, Luigi Fenoglio, Francesca Fezza, Gino Roberto Corazza, Armando Napolitano, Enrico Strocchi, Patrizio Odetti, Renzo Rozzini, Michela Zanetti, Remo Melchio, Alessio Marra, Antonella Tufano, Enrico Petrillo, Carlotta Franchi, Francesco Franceschi, Barbara Brignolo, Flora Peyvandi, Nicola Lucio Liberato, Paolo Fornengo, Emanuela Miceli, Francesco Perticone, Marco Bertolotti, Lara Caserza, Alfredo De Giorgi, Dario Manfellotto, Enrico Nicolis, Domenica Cappellini, Claudio Borghi, Pier Mannuccio Mannucci, Alessio Molfino, Maurizio Dore, Paolo Francione, Alessio Nencioni, Gianni Biolo, Silvia Fargion, Federico Cattaneo, Maria Teresa Sartori, Fiammetta Monacelli, and Giovanni Di Minno
- Subjects
Pharmacology ,medicine.medical_specialty ,education.field_of_study ,business.industry ,Population ,Atrial fibrillation ,030204 cardiovascular system & hematology ,medicine.disease ,Logistic regression ,03 medical and health sciences ,0302 clinical medicine ,Emergency medicine ,Antithrombotic ,medicine ,Oral anticoagulant ,Pharmacology (medical) ,030212 general & internal medicine ,Medical prescription ,Older people ,education ,business ,Stroke - 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.
- Published
- 2018
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