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2. 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

3. Appropriateness of prescription of oral anticoagulant therapy in acutely hospitalized older people with atrial fibrillation. Secondary analysis of the SIM-AF cluster randomized clinical trial

Author

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

Subjects
Male, Antiplatelet drug, appropriateness of prescription, Health Services for the Aged, medicine.medical_treatment, Administration, Oral, Inappropriate Prescribing, 030226 pharmacology & pharmacy, law.invention, 0302 clinical medicine, Patient Admission, Randomized controlled trial, law, Risk Factors, Atrial Fibrillation, Prevalence, Pharmacology (medical), 030212 general & internal medicine, Prospective Studies, Practice Patterns, Physicians', LS4_7, Aged, 80 and over, Clinical pharmacology, prescribing, Atrial fibrillation, Patient Discharge, Stroke, Female, drug utilization, medicine.medical_specialty, Socio-culturale, Hemorrhage, Drug Prescriptions, 03 medical and health sciences, Internal medicine, medicine, Humans, Medical prescription, Aged, Pharmacology, clinical trials, business.industry, Anticoagulants, Odds ratio, Original Articles, medicine.disease, Confidence interval, appropriateness of prescription, clinical pharmacology, clinical trials, drug utilization, medication errors, prescribing, Clinical trial, medication errors, clinical pharmacology, business
Abstract

Aims To assess the appropriateness of oral anticoagulant (OAC) prescription and its associated factors in acutely hospitalized elderly patients. Methods Data were obtained from the prospective phase of SIM-AF (SIMulation-based technologies to improve the appropriate use of oral anticoagulants in hospitalized elderly patients with Atrial Fibrillation) randomized controlled trial, aimed to test whether an educational intervention improved OAC prescription, compared to current clinical practice, in internal medicine wards. In this secondary analysis, appropriateness of OAC prescription was assessed at hospital admission and discharge. Results For 246 patients, no significant differences were found between arms (odds ratio 1.38, 95% confidence interval [CI] 0.84-2.28) in terms of appropriateness of OAC prescription. Globally, 92 patients (37.4%, 95% CI = 31.6-43.6%) were inappropriately prescribed or not prescribed at hospital discharge. Among 51 patients inappropriately prescribed, 82% showed errors on dosage, being mainly under-dosed (n = 29, 56.9%), and among 41 inappropriately not prescribed, 98% were taking an antiplatelet drug. Factors independently associated with a lower probability of appropriateness at discharge were those related to a higher risk of bleeding (older age, higher levels of aspartate aminotransferase, history of falls, alcohol consumption) and antiplatelet prescription at admission. The prescription of OACs at admission was the strongest predictor of appropriateness at discharge (odds ratio = 7.43, 95% CI = 4.04-13.73). Conclusions A high proportion of hospitalized older patients with AF remains inappropriately prescribed or nonprescribed with OACs. The management of these patients at hospital admission is the strongest predictor of prescription appropriateness at discharge.

Published
2018

5. Use of oral anticoagulant drugs in older patients with atrial fibrillation in internal medicine wards

Author

Proietti, Marco, Antoniazzi, Stefania, Monzani, Valter, Santalucia, Paola, Franchi, Carlotta, 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, Brignolo, Barbara, 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, Franceschi, Francesco (ORCID:0000-0001-6266-445X), Proietti, Marco, Antoniazzi, Stefania, Monzani, Valter, Santalucia, Paola, Franchi, Carlotta, 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, Brignolo, Barbara, 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, and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

Atrial fibrillation (AF) is independently associated with a higher risk of morbidity and mortality, in particular with an increased risk of thromboembolic events [1]. Use of oral anticoagulant (OAC) drugs reduces the risk of stroke and systemic embolism, as well as mortality among patients with AF [1]. In recent years, the non-vitamin K antagonist oral anticoagulants (NOACs) have been proved to be at least as effective and safer than warfarin, the most widely used VKA [2], such that NOACs are the recommended choice in many patients [1]. Notwithstanding, the number of untreated patients is still relevant [3]. In particular, in the clinical setting of internal medicine and geriatric wards, previous data showed that elderly hospitalized patients with AF were largely not prescribed with OAC [4] or treated in a non-guideline adherent manner [5]. After NOACs have been marketed, a significant increase in OAC uptake was recorded, but a substantial portion of patients still does not receive the appropriate treatment based on their cardioembolic risk [3,6]. In particular, scarce data are available about NOACs use in the non-cardiologic setting. Furthermore, elderly AF patients are less likely prescribed with OAC compared to the younger ones [5,7], even though the net clinical benefit of OAC treatment in these patients has been demonstrated [8]. With the aim to provide evidences about use of OAC and NOACs in older hospitalized patients, we here report data about the retrospective observational phase of the “Simulation-Based Technologies to Improve the Appropriate Use of Oral Anticoagulants in Hospitalized Elderly Patients with Atrial Fibrillation” (SIM-AF) Trial. The SIM-AF is a cluster randomized controlled trial aimed at increasing the rate of OAC prescription in elderly (≥65 years) AF patients admitted to 32 Italian Internal Medicine and Geriatric wards through a simulation-based e-learning educational intervention (ClinicalTrials.gov #NCT03188211). In this retrospective pr

Published
2018

10. Use of oral anticoagulant drugs in older patients with atrial fibrillation in internal medicine wards.

Author

Proietti M, Antoniazzi S, Monzani V, Santalucia P, Franchi C, Fenoglio LM, Melchio R, Fabris F, Sartori MT, 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, Monzani V, Ceriani G, Lucchi T, Brignolo B, Manfellotto D, Caridi I, Corazza GR, Miceli E, Padula D, Fraternale G, Guasti L, Squizzato A, Maresca A, Liberato NL, Tognin T, Rozzini R, Bellucci FB, 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 LC, Salam K, Caserza L, Barbagallo M, Di Bella G, Annoni G, Bruni AA, Odetti P, Nencioni A, Monacelli F, Napolitano A, Brucato A, Valenti A, Castellino P, Zanoli L, and Mazzeo M

Subjects
Administration, Oral, Aged, Aged, 80 and over, Anticoagulants adverse effects, Body Mass Index, Female, Humans, Internal Medicine organization & administration, Male, Observational Studies as Topic, Randomized Controlled Trials as Topic, Retrospective Studies, Stroke prevention & control, Anticoagulants administration & dosage, Atrial Fibrillation drug therapy, Drug Prescriptions statistics & numerical data
Published
2018
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