The role of comprehensive geriatric assessment and functional status in evaluating the patterns of antithrombotic use among older people with atrial fibrillation |
| |
| Affiliation: | 1. School of Medicine and Surgery, University of Milano-Bicocca, Italy;2. Geriatric Unit, S. Gerardo Hospital, Monza, Italy;3. Milan Center for Neuroscience (Neuro-Mi), Milan, Italy;4. SCDU Geriatria e Malattie Metaboliche dell’Osso, Città della Salute e della Scienza-Molinette, Torino, Italy;5. Center of Biostatistics for Clinical Epidemiology, University of Milano-Bicocca, Milan, Italy;1. Cardiology Department, Health Sciences North, Sudbury, Ontario, Canada;2. Health Sciences North Research Institute, Sudbury, Ontario, Canada;3. Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada;4. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada;5. Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada;6. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada;7. Electrophysiology Unit, Cardiology Department, Hillel Yaffe Medical Center, Hadera, Israel;8. Department of Medicine, University of Toronto, Toronto, Ontario, Canada;9. Medical Pharmacies Group Limited, Toronto, Ontario, Canada;1. Unit of Geriatric Cardiology and Medicine, Department of Critical Care Medicine and Surgery, University of Florence, Viale Pieraccini 6, 50141 Florence, Italy;2. Division of Geriatrics, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland;3. CNR Aging Branch, Institute of Neuroscience, Via Giustiniani 2, 35128 Padua, Italy;4. Hospital Universitario Gregorio Marañón, Universidad Europea de Madrid, Madrid, Spain;5. Geneva Medical School and University, Geneva, Switzerland;1. Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;3. Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;2. Department of Cardiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;4. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina |
| |
| Abstract: | Aim of the study is to investigate the use of antithrombotic drugs in older patients with atrial fibrillation (AF) at the time of hospital discharge. We enrolled 399 ≥65 years old patients with AF consecutively admitted to our acute geriatric unit from September 2012 to February 2014. Utilization of antithrombotic drugs, comorbidities, functional, mental and nutritional status were evaluated through a comprehensive geriatric assessment (CGA). A Logistic regression model was used to assess variables associated with antithrombotic use. On admission, 198 patients (49.6%) used oral anticoagulants (OAC), 125 (21.3%) antiplatelets, 32 (8%) low weight molecular heparin (LMWH) and 44 (11%) none of them. At discharge the proportion of patients on OAC increased to 55.7%. Age > 90 years (OR = 2.57, CI = 1.28–5.16, p-value = 0.008), severe functional impairment (OR = 3.38, CI = 1.63–7.01, p-value = 0.001), polypharmacy (OR = 2.07, CI = 1.1–3.86, p-value = 0.023), HAS-BLED score (OR = 1.64, CI = 1.09–2.47, p-value = 0.019) and ≥1 OAC contraindication (OR = 5.01, CI = 2.68–9.34, p-value < 0.001) were all associated with OAC underuse.In conclusion, OAC is underused in geriatric patients with AF, while antiplatelet, LMWH and no antithrombotic therapy are relatively overused. Factors associated with the decision to not prescribe OAC lie on a mix of clinical and geriatric variables, among which functional status is particularly relevant. |
| |
| Keywords: | Atrial fibrillation Elderly Antithrombotics Comprehensive geriatric assessment |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
