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

Francesco Franceschi, Maurizio Gabrielli, Carlotta Franchi, Stefania Antoniazzi, Marco Proietti, Alessandro Nobili, Pier Mannuccio Mannucci, Paola Santalucia, Valter Monzani, Maura Marcucci, Stefania Antoniazzi, Silvano Bosari, Pier Mannuccio Mannucci, Carlotta Franchi, Barbara Brignolo, Marco Proietti, Enrico Nicolis, Ilaria Ardoino, Luigi M. Fenoglio, Remo MelchioFabrizio 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, Giovanni Murialdo, Francesca Fezza, Alessio Marra, Francesca Castelli, Federico Cattaneo, Valentina Beccati, 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, Francesca Mete, Miriam Gino, Francesco Perticone, Maria Perticone, Marco Bertolotti, Chiara Mussi, Claudio Borghi, Enrico Strocchi, Marilena Durazzo, Paolo Fornengo, Franco Dallegri, Luciano Carlo Ottonello, Kassem Salam, Lara Caserza, Mario Barbagallo, Giovanna Di Bella, Giorgio Annoni, Adriana Antonella Bruni, Patrizio Odetti, Alessio Nencioni, Fiammetta Monacelli, Armando Napolitano, Antonio Brucato, Anna Valenti, Pietro Castellino, Luca Zanoli, Marco Mazzeo

Risultato della ricerca: Contributo in rivistaArticolo in rivista

13 Citazioni (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.
Lingua originaleEnglish
pagine (da-a)2010-2019
Numero di pagine10
RivistaBRITISH JOURNAL OF CLINICAL PHARMACOLOGY
Volume84
DOI
Stato di pubblicazionePubblicato - 2018

Keywords

  • Administration, Oral
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anticoagulants
  • Atrial Fibrillation
  • Dose-Response Relationship, Drug
  • Drug Prescriptions
  • Female
  • Hemorrhage
  • Humans
  • Inappropriate Prescribing
  • Male
  • Prospective Studies
  • Retrospective Studies
  • Risk Factors
  • Stroke
  • appropriateness of prescription
  • atrial fibrillation
  • internal medicine and geriatric wards
  • older patients
  • oral anticoagulant

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