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1. Simulation-Based Education for Physicians to Increase Oral Anticoagulants in Hospitalized Elderly Patients with Atrial Fibrillation

Author

Franchi, C, Antoniazzi, S, Ardoino, I, Proietti, M, Marcucci, M, Santalucia, P, Monzani, V, Mannucci, Pm, Nobili, A, Bosari, S, Brignoto, B, Nicolis, E, Fenoglio, Lm, Melchio, R, Fabris, F, Sartori, Mt, Manfredini, R, De Giorgi, A, Fabbian, F, Biolo, G, Zanetti, M, Altamura, N, Sabba, C, Suppressa, P, Bandiera, F, Usai, CINZIA PATRIZIA, Murialdo, G, Fezza, Fabrizio, 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, Gherardo, 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, Raviolo, P, Mete, F, Gino, M, Franceschi, F, Gabrielli, M, Perticone, F, Perticone, M, Bertolotti, M, Mussi, C, Borghi, C, Strocchi, E, Durazzo, M, Fornengo, P, Ruatta, C, 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
Male, medicine.medical_specialty, Cluster randomized trial, Socio-culturale, Administration, Oral, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine and geriatric wards, Intervention (counseling), Hospital discharge, medicine, Odds Ratio, Cluster Analysis, Humans, 030212 general & internal medicine, Cluster randomised controlled trial, Medical prescription, Simulation based, Simulation Training, Simulation-based education, LS4_7, Aged, Aged, 80 and over, business.industry, Anticoagulants, Atrial fibrillation, General Medicine, Odds ratio, medicine.disease, Older people, Oral anticoagulants, SIM-AF trial, Confidence interval, Atrial fibrillation, Cluster randomized trial, Internal medicine and geriatric wards, Older people, Oral anticoagulants, SIM-AF trial, Simulation-based education, Patient Simulation, Stroke, Geriatrics, Emergency medicine, Education, Medical, Continuing, Female, Clinical Competence, business
Abstract

Purpose This study was intended to determine whether a simulation-based education addressed to physicians was able to increase the proportion of hospitalized elderly with atrial fibrillation prescribed with oral anticoagulants (OACs) compared with the usual practice. Methods We conducted a cluster randomized trial (from April 2015 to September 2018) on 32 Italian internal medicine and geriatric wards randomized 1:1 to intervention or control arms. The physicians of wards randomized to intervention received a computer-based e-learning tool with clinical scenarios (Dr Sim), and those of wards randomized to control received no formal educational intervention. The primary outcome was the OAC prescription rate at hospital discharge in the intervention and control arms. Results Of 452 patients scrutinized, 247 were included in the analysis. Of them, 186 (75.3%) were prescribed with OACs at hospital discharge. No difference was found between the intervention and control arms in the post-intervention phase (odds ratio, 1.46; 95% confidence interval [CI], 0.81-2.64). The differences from the pre- to post-intervention phases in the proportions of patients prescribed with OACs (15.1%; 95% CI, 0%-31.5%) and with direct oral anticoagulants (DOACs) (20%; 95% CI, 0%-39.8%) increased more in the intervention than in the control arm. Conclusions This simulation-based course did not succeed in increasing the rate of elderly patients prescribed with OACs at hospital discharge compared with the usual practice. Notwithstanding, over time there was a greater increase in the intervention than in the control arm in the proportion of patients prescribed with OACs and DOACs. Trial Registration ClinicalTrials.gov identifier: NCT03188211.

Published
2019

2. 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, SIM-AF, Investigators, 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, Mazzeo, M, 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, Proietti, M, Antoniazzi, S, Monzani, V, Santalucia, P, Franchi, C, and Annoni, G

Subjects
Male, Administration, Oral, 030204 cardiovascular system & hematology, Body Mass Index, Oral anticoagulant drug, 0302 clinical medicine, Elderly, Drug Prescription, Older patients, Retrospective Studie, 80 and over, Medicine, 030212 general & internal medicine, Stroke, Randomized Controlled Trials as Topic, Aged, 80 and over, Atrial fibrillation, Oral anticoagulant drugs, Prescription rate, Internal Medicine, Observational Studies as Topic, Atrial fibrillation, Elderly, Oral anticoagulant drugs, Prescription rate, Internal Medicine, Administration, Oral anticoagulant, Female, Human, Oral, medicine.medical_specialty, Socio-culturale, Drug Prescriptions, 03 medical and health sciences, Internal medicine, Humans, Aged, Retrospective Studies, business.industry, Settore MED/09 - MEDICINA INTERNA, Anticoagulant, Anticoagulants, Retrospective cohort study, medicine.disease, Atrial Fibrillation, business, Body mass index, Atrial fibrillation, Elderly, Oral anticoagulant drugs, Prescription rate
Abstract

no abstract available

Published
2018

3. 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

4. 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

8. 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

9. 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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10. Risk of complications in coeliac patients depends on age at diagnosis and type of clinical presentation.

Author

Biagi F, Schiepatti A, Maiorano G, Fraternale G, Agazzi S, Zingone F, Ciacci C, Volta U, Caio G, Tortora R, Klersy C, and Corazza GR

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Incidence, Italy epidemiology, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Retrospective Studies, Risk Assessment, Risk Factors, Young Adult, Celiac Disease complications, Celiac Disease mortality
Abstract

Background: Coeliac disease is characterised by an increased mortality mostly due to its complications., Aims: To study the risk of developing complications according to clinical presentation and age at diagnosis, a combined retrospective-prospective longitudinal study was performed in three Italian centres., Methods: Incidence of complications and mortality rates were calculated using type and age at diagnosis of coeliac disease, sex, and centre of diagnosis as predictors. Patients referred after being found to suffer from coeliac disease elsewhere were excluded., Results: Between 01/1999 and 06/2015, 2225 adult coeliac patients were directly diagnosed in our centres. 17 of them developed a complication and 29 died. In patients older than 60 years at diagnosis of coeliac disease, the risk of complication is 18 times higher than in patients diagnosed at 18-40 years and 9 times higher than in patients diagnosed at 40-60 years. Classical presentation increases the risk of complications by 7 times compared to non-classical presentation; in asymptomatic patients the risk of complication is virtually absent., Conclusions: The risk of developing complications in coeliac patients is linked to age at diagnosis of coeliac disease and type of clinical presentation. Follow-up methods of coeliac patients should be tailored according to these parameters., (Copyright © 2017. Published by Elsevier Ltd.)

Published
2018
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11. Short article: Mortality and differential diagnoses of villous atrophy without coeliac antibodies.

Author

Schiepatti A, Biagi F, Fraternale G, Vattiato C, Balduzzi D, Agazzi S, Alpini C, Klersy C, and Corazza GR

Subjects
Adolescent, Adult, Aged, Atrophy etiology, Atrophy mortality, Atrophy pathology, Autoantibodies blood, Biomarkers blood, Biopsy, Celiac Disease complications, Celiac Disease mortality, Common Variable Immunodeficiency complications, Common Variable Immunodeficiency diagnosis, Common Variable Immunodeficiency mortality, Diagnosis, Differential, False Negative Reactions, Female, GTP-Binding Proteins immunology, Humans, Immunoglobulin A blood, Italy epidemiology, Kaplan-Meier Estimate, Male, Middle Aged, Protein Glutamine gamma Glutamyltransferase 2, Retrospective Studies, Transglutaminases immunology, Young Adult, Celiac Disease diagnosis, Intestinal Mucosa pathology, Intestine, Small pathology
Abstract

Objective: Villous atrophy (VA) of the small bowel is mainly related to coeliac disease (CD), whose diagnosis is made on the basis of positive endomysial/tissue transglutaminase antibodies while on a gluten-containing diet in the vast majority of patients. However, VA can also occur in other conditions whose epidemiology is little known. Our aim was to study the epidemiology and clinical features of these rare enteropathies., Patients and Methods: Clinical and laboratory data of all the patients with VA directly diagnosed in our centre in the last 15 years were collected and statistically analysed., Results: Between September 1999 and June 2015, 274 patients were diagnosed with VA. A total of 260 patients were also positive to coeliac antibodies; the other 14 had VA, but no IgA endomysial antibodies: five had common variable immunodeficiency, three had dermatitis herpetiformis, two had IgA deficiency associated with CD, one had abdominal lymphoma, one had unclassified sprue, one had olmesartan-associated enteropathy and one had seronegative CD. Mortality was 6.0 deaths per 100 person years (95% confidence interval: 2.2-16) in patients with VA but negative coeliac antibodies, whereas only 0.2 deaths per 100 person years (95% confidence interval: 0.1-0.6) occurred in coeliac patients., Conclusion: Patients with VA and negative endomysial antibodies are rare. However, these forms of VA identify specific causes that can be diagnosed. These patients are affected by a very high mortality.

Published
2017
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