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

Author

Franchi, C, Antoniazzi, S, Proietti, M, Nobili, A, Mannucci, P, Santalucia, P, Monzani, V, Marcucci, M, Bosari, S, Brignolo, B, Nicolis, E, Ardoino, I, Fenoglio, L, Melchio, R, Fabris, F, Sartori, M, Manfredini, R, De Giorgi, A, Fabbian, F, Biolo, G, Zanetti, M, Altamura, N, Sabbà, C, Suppressa, P, Bandiera, F, Usai, C, Murialdo, G, Fezza, F, Marra, A, Castelli, F, Cattaneo, F, Beccati, V, di Minno, G, Tufano, A, Contaldi, P, Lupattelli, G, Bianconi, V, Cappellini, D, Hu, C, Minonzio, F, Fargion, S, Burdick, L, Francione, P, Peyvandi, F, Rossio, R, Colombo, G, Ceriani, G, Lucchi, T, Manfellotto, D, Caridi, I, Corazza, G, Miceli, E, Padula, D, Fraternale, G, Guasti, L, Squizzato, A, Maresca, A, Liberato, N, Tognin, T, Rozzini, R, Bellucci, F, Muscaritoli, M, Molfino, A, Petrillo, E, Dore, M, Mete, F, Gino, M, Franceschi, F, Gabrielli, M, Perticone, F, Perticone, M, Bertolotti, M, Mussi, C, Borghi, C, Strocchi, E, Durazzo, M, Fornengo, P, Dallegri, F, Ottonello, L, Salam, K, Caserza, L, Barbagallo, M, Di Bella, G, Annoni, G, Bruni, A, Odetti, P, Nencioni, A, Monacelli, F, Napolitano, A, Brucato, A, Valenti, A, Castellino, P, Zanoli, L, Mazzeo, M, Franchi, Carlotta, Antoniazzi, Stefania, Proietti, Marco, Nobili, Alessandro, Mannucci, Pier Mannuccio, Mannucci, PM, Brignolo,B, Ardoino,I, Fenoglio, LM, Sartori, MT, Hu,C, Corazza, GR, Liberato, NL, Bellucci, FB, Ottonello, LC, Bruni, AA, Franchi, C, Antoniazzi, S, Proietti, M, Nobili, A, Mannucci, P, Santalucia, P, Monzani, V, Marcucci, M, Bosari, S, Brignolo, B, Nicolis, E, Ardoino, I, Fenoglio, L, Melchio, R, Fabris, F, Sartori, M, Manfredini, R, De Giorgi, A, Fabbian, F, Biolo, G, Zanetti, M, Altamura, N, Sabbà, C, Suppressa, P, Bandiera, F, Usai, C, Murialdo, G, Fezza, F, Marra, A, Castelli, F, Cattaneo, F, Beccati, V, di Minno, G, Tufano, A, Contaldi, P, Lupattelli, G, Bianconi, V, Cappellini, D, Hu, C, Minonzio, F, Fargion, S, Burdick, L, Francione, P, Peyvandi, F, Rossio, R, Colombo, G, Ceriani, G, Lucchi, T, Manfellotto, D, Caridi, I, Corazza, G, Miceli, E, Padula, D, Fraternale, G, Guasti, L, Squizzato, A, Maresca, A, Liberato, N, Tognin, T, Rozzini, R, Bellucci, F, Muscaritoli, M, Molfino, A, Petrillo, E, Dore, M, Mete, F, Gino, M, Franceschi, F, Gabrielli, M, Perticone, F, Perticone, M, Bertolotti, M, Mussi, C, Borghi, C, Strocchi, E, Durazzo, M, Fornengo, P, Dallegri, F, Ottonello, L, Salam, K, Caserza, L, Barbagallo, M, Di Bella, G, Annoni, G, Bruni, A, Odetti, P, Nencioni, A, Monacelli, F, Napolitano, A, Brucato, A, Valenti, A, Castellino, P, Zanoli, L, Mazzeo, M, Franchi, Carlotta, Antoniazzi, Stefania, Proietti, Marco, Nobili, Alessandro, Mannucci, Pier Mannuccio, Mannucci, PM, Brignolo,B, Ardoino,I, Fenoglio, LM, Sartori, MT, Hu,C, Corazza, GR, Liberato, NL, Bellucci, FB, Ottonello, LC, and Bruni, AA

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

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

Author

Franchi, C., Antoniazzi, S., Proietti, M., Nobili, A., Mannucci, P. M., Santalucia, P., Monzani, V., Marcucci, M., Bosari, S., Brignolo, B., Nicolis, E., Ardoino, I., Fenoglio, L. M., Melchio, R., Fabris, F., Sartori, M. T., Manfredini, R., De Giorgi, A., Fabbian, F., Biolo, G., Zanetti, M., Altamura, N., Sabba, C., Suppressa, P., Bandiera, F., Usai, C., Murialdo, G., Fezza, F., Marra, A., Castelli, F., Cattaneo, F., Beccati, V., di Minno, G., Tufano, A., Contaldi, P., Lupattelli, G., Bianconi, V., Cappellini, D., Hu, C., Minonzio, F., Fargion, S., Burdick, L., Francione, P., Peyvandi, F., Rossio, R., Colombo, G., Ceriani, G., Lucchi, T., Manfellotto, D., Caridi, I., Corazza, G. R., Miceli, E., Padula, D., Fraternale, G., Guasti, L., Squizzato, A., Maresca, A., Liberato, N. L., Tognin, T., Rozzini, R., Bellucci, F. B., Muscaritoli, M., Molfino, A., Petrillo, E., Dore, M., Mete, F., Gino, M., Franceschi, Francesco, Gabrielli, Maurizio, Perticone, F., Perticone, M., Bertolotti, M., Mussi, C., Borghi, C., Strocchi, E., Durazzo, M., Fornengo, P., Dallegri, F., Ottonello, L. C., Salam, K., Caserza, L., Barbagallo, M., Di Bella, G., Annoni, G., Bruni, A. A., Odetti, P., Nencioni, A., Monacelli, F., Napolitano, A., Brucato, A., Valenti, A., Castellino, P., Zanoli, L., Mazzeo, M., Franceschi F. (ORCID:0000-0001-6266-445X), Gabrielli M., Franchi, C., Antoniazzi, S., Proietti, M., Nobili, A., Mannucci, P. M., Santalucia, P., Monzani, V., Marcucci, M., Bosari, S., Brignolo, B., Nicolis, E., Ardoino, I., Fenoglio, L. M., Melchio, R., Fabris, F., Sartori, M. T., Manfredini, R., De Giorgi, A., Fabbian, F., Biolo, G., Zanetti, M., Altamura, N., Sabba, C., Suppressa, P., Bandiera, F., Usai, C., Murialdo, G., Fezza, F., Marra, A., Castelli, F., Cattaneo, F., Beccati, V., di Minno, G., Tufano, A., Contaldi, P., Lupattelli, G., Bianconi, V., Cappellini, D., Hu, C., Minonzio, F., Fargion, S., Burdick, L., Francione, P., Peyvandi, F., Rossio, R., Colombo, G., Ceriani, G., Lucchi, T., Manfellotto, D., Caridi, I., Corazza, G. R., Miceli, E., Padula, D., Fraternale, G., Guasti, L., Squizzato, A., Maresca, A., Liberato, N. L., Tognin, T., Rozzini, R., Bellucci, F. B., Muscaritoli, M., Molfino, A., Petrillo, E., Dore, M., Mete, F., Gino, M., Franceschi, Francesco, Gabrielli, Maurizio, Perticone, F., Perticone, M., Bertolotti, M., Mussi, C., Borghi, C., Strocchi, E., Durazzo, M., Fornengo, P., Dallegri, F., Ottonello, L. C., Salam, K., Caserza, L., Barbagallo, M., Di Bella, G., Annoni, G., Bruni, A. A., Odetti, P., Nencioni, A., Monacelli, F., Napolitano, A., Brucato, A., Valenti, A., Castellino, P., Zanoli, L., Mazzeo, M., Franceschi F. (ORCID:0000-0001-6266-445X), and Gabrielli M.

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

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

Author

Franchi, Carlotta, Antoniazzi, Stefania, Proietti, Marco, Nobili, Alessandro, Mannucci, Pier Mannuccio, Santalucia, Paola, Monzani, Valter, Marcucci, Maura, Bosari, Silvano, Brignolo, Barbara, Nicolis, Enrico, Ardoino, Ilaria, Fenoglio, Luigi M., Melchio, Remo, Fabris, Fabrizio, Sartori, Maria Teresa, Manfredini, Roberto, De Giorgi, Alfredo, Fabbian, Fabio, Biolo, Gianni, Zanetti, Michela, Altamura, Nicola, Sabbà, Carlo, Suppressa, Patrizia, Bandiera, Francesco, Usai, Carlo, Murialdo, Giovanni, Fezza, Francesca, Marra, Alessio, Castelli, Francesca, Cattaneo, Federico, Beccati, Valentina, di Minno, Giovanni, Tufano, Antonella, Contaldi, Paola, Lupattelli, Graziana, Bianconi, Vanessa, Cappellini, Domenica, Cinzia, Hu, Minonzio, Francesca, Fargion, Silvia, Burdick, Larry, Francione, Paolo, Peyvandi, Flora, Rossio, Raffaella, Colombo, Giulia, Ceriani, Giuliana, Lucchi, Tiziano, Manfellotto, Dario, Caridi, Irene, Corazza, Gino Roberto, Miceli, Emanuela, Padula, Donatella, Fraternale, Giacomo, Guasti, Luigina, Squizzato, Alessandro, Maresca, Andrea, Liberato, Nicola Lucio, Tognin, Tiziana, Rozzini, Renzo, Bellucci, Francesco Baffa, Muscaritoli, Maurizio, Molfino, Alessio, Petrillo, Enrico, Dore, Maurizio, Mete, Francesca, Gino, Miriam, Franceschi, Francesco, Gabrielli, Maurizio, Perticone, Francesco, Perticone, Maria, Bertolotti, Marco, Mussi, Chiara, Borghi, Claudio, Strocchi, Enrico, Durazzo, Marilena, Fornengo, Paolo, Dallegri, Franco, Ottonello, Luciano Carlo, Salam, Kassem, Caserza, Lara, Barbagallo, Mario, Di Bella, Giovanna, Annoni, Giorgio, Bruni, Adriana Antonella, Odetti, Patrizio, Nencioni, Alessio, Monacelli, Fiammetta, Napolitano, Armando, Brucato, Antonio, Valenti, Anna, Castellino, Pietro, Zanoli, Luca, Mazzeo, Marco, Franchi, Carlotta, Antoniazzi, Stefania, Proietti, Marco, Nobili, Alessandro, Mannucci, Pier Mannuccio, Santalucia, Paola, Monzani, Valter, Marcucci, Maura, Bosari, Silvano, Brignolo, Barbara, Nicolis, Enrico, Ardoino, Ilaria, Fenoglio, Luigi M., Melchio, Remo, Fabris, Fabrizio, Sartori, Maria Teresa, Manfredini, Roberto, De Giorgi, Alfredo, Fabbian, Fabio, Biolo, Gianni, Zanetti, Michela, Altamura, Nicola, Sabbà, Carlo, Suppressa, Patrizia, Bandiera, Francesco, Usai, Carlo, Murialdo, Giovanni, Fezza, Francesca, Marra, Alessio, Castelli, Francesca, Cattaneo, Federico, Beccati, Valentina, di Minno, Giovanni, Tufano, Antonella, Contaldi, Paola, Lupattelli, Graziana, Bianconi, Vanessa, Cappellini, Domenica, Hu, Cinzia, Minonzio, Francesca, Fargion, Silvia, Burdick, Larry, Francione, Paolo, Peyvandi, Flora, Rossio, Raffaella, Colombo, Giulia, Ceriani, Giuliana, Lucchi, Tiziano, Manfellotto, Dario, Caridi, Irene, Corazza, Gino Roberto, Miceli, Emanuela, Padula, Donatella, Fraternale, Giacomo, Guasti, Luigina, Squizzato, Alessandro, Maresca, Andrea, Liberato, Nicola Lucio, Tognin, Tiziana, Rozzini, Renzo, Bellucci, Francesco Baffa, Muscaritoli, Maurizio, Molfino, Alessio, Petrillo, Enrico, Dore, Maurizio, Mete, Francesca, Gino, Miriam, Franceschi, Francesco, Gabrielli, Maurizio, Perticone, Francesco, Perticone, Maria, Bertolotti, Marco, Mussi, Chiara, Borghi, Claudio, Strocchi, Enrico, Durazzo, Marilena, Fornengo, Paolo, Dallegri, Franco, Ottonello, Luciano Carlo, Salam, Kassem, Caserza, Lara, Barbagallo, Mario, Di Bella, Giovanna, Annoni, Giorgio, Bruni, Adriana Antonella, Odetti, Patrizio, Nencioni, Alessio, Monacelli, Fiammetta, Napolitano, Armando, Brucato, Antonio, Valenti, Anna, Castellino, Pietro, Zanoli, Luca, Mazzeo, Marco, Franchi, C, Antoniazzi, S, Proietti, M, Nobili, A, Mannucci, P, Santalucia, P, Monzani, V, Marcucci, M, Bosari, S, Brignolo, B, Nicolis, E, Ardoino, I, Fenoglio, L, Melchio, R, Fabris, F, Sartori, M, Manfredini, R, De Giorgi, A, Fabbian, F, Biolo, G, Zanetti, M, Altamura, N, Sabbà, C, Suppressa, P, Bandiera, F, Usai, C, Murialdo, G, Fezza, F, Marra, A, Castelli, F, Cattaneo, F, Beccati, V, di Minno, G, Tufano, A, Contaldi, P, Lupattelli, G, Bianconi, V, Cappellini, D, Hu, C, Minonzio, F, Fargion, S, Burdick, L, Francione, P, Peyvandi, F, Rossio, R, Colombo, G, Ceriani, G, Lucchi, T, Manfellotto, D, Caridi, I, Corazza, G, Miceli, E, Padula, D, Fraternale, G, Guasti, L, Squizzato, A, Maresca, A, Liberato, N, Tognin, T, Rozzini, R, Bellucci, F, Muscaritoli, M, Molfino, A, Petrillo, E, Dore, M, Mete, F, Gino, M, Franceschi, F, Gabrielli, M, Perticone, F, Perticone, M, Bertolotti, M, Mussi, C, Borghi, C, Strocchi, E, Durazzo, M, Fornengo, P, Dallegri, F, Ottonello, L, Salam, K, Caserza, L, Barbagallo, M, Di Bella, G, Annoni, G, Bruni, A, Odetti, P, Nencioni, A, Monacelli, F, Napolitano, A, Brucato, A, Valenti, A, Castellino, P, Zanoli, L, and Mazzeo, M

Subjects
Male, Oral, appropriateness of prescription, appropriateness of prescription, atrial fibrillation, internal medicine, geriatric wards, older patients, oral anticoagulant, Socio-culturale, Administration, Oral, Hemorrhage, Inappropriate Prescribing, Drug Prescriptions, internal medicine and geriatric ward, Dose-Response Relationship, older patient, Risk Factors, oral anticoagulant, 80 and over, Humans, atrial fibrillation, Pharmacology (medical), Prospective Studies, Aged, Retrospective Studies, Aged, 80 and over, Pharmacology, geriatric wards, Dose-Response Relationship, Drug, Settore MED/09 - MEDICINA INTERNA, Age Factors, Anticoagulants, internal medicine and geriatric wards, Original Articles, older patients, Stroke, internal medicine, Administration, Female, Drug
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 65years 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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