Carmen Suárez Fernández1, Jose María Mostaza2, Luis Castilla Guerra3, Jesus Cantero Hinojosa4, Josep Maria Suriñach5, Fernando Acosta de Bilbao6, Juan José Tamarit7, José Luis Diaz Diaz8, Jose Luis Hernandez9, Daniel Cazorla10, Carles Ràfols10. 1. Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España. Electronic address: csuarezf@salud.madrid.org. 2. Servicio de Medicina Interna, Hospital Carlos III, Madrid, España. 3. Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, España. 4. Servicio de Medicina Interna, Hospital San Cecilio, Granada, España. 5. Servicio de Medicina Interna, Hospital Vall d'Hebron, Barcelona, España. 6. Servicio de Medicina Interna, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Las Palmas, España. 7. Servicio de Medicina Interna, Hospital General de Valencia, Valencia, España. 8. Servicio de Medicina Interna, Complejo Universitario Hospitalario de A Coruña, La Coruña, España. 9. Servicio de Medicina Interna, Hospital Marqués de Valdecilla, Universidad de Cantabria, Santander, España. 10. Departamento Médico, Bayer Hispania S. L., Barcelona, España.
Abstract
BACKGROUND AND OBJECTIVE: To evaluate the adherence to the recommendations in clinical practice performed by the Therapeutic Positioning Report (TPR) of the Spanish Agency of Medicines and Sanitary Products about the treatment with oral anticoagulants in patients aged≥75 years old with nonvalvular atrial fibrillation (NVAF) treated in Internal Medicine departments in Spain. PATIENTS AND METHODS: Observational, cross-sectional and multicenter study in which 837 patients aged≥75 years old with NVAF, with stable treatment with oral anticoagulants at least 3 months before inclusion, and that had started treatment with oral anticoagulants before the inclusion period were included. RESULTS: Mean age was 83.0±5.0 years old, mean CHADS2 score 3.2±1.2, mean CHA2DS2-VASc score 5.0±1.4, and mean HAS-BLED score 2.1±0.9. A percentage of 70.8 of patients were treated with vitamin K antagonists (VKA) and the rest of patients with direct oral anticoagulants (DOACs). A percentage of 65.6 of patients treated with VKA did not follow the recommendations made by the TPR compared with 43.0% of patients treated with DOACs (P<.0001). In the case of VKA, the main reason for being considered as not appropriate according to the TPR was having poor control of anticoagulation and not switching to DOACs, whereas in the case of DOACs, it was not receiving the adequate dose according to the TPR. CONCLUSIONS: In a high proportion of anticoagulated elderly patients with NVAF in Spain, the recommendations performed by the TPR are not followed, particularly with VKA, since patients are not switched to DOACs despite time in therapeutic range.
BACKGROUND AND OBJECTIVE: To evaluate the adherence to the recommendations in clinical practice performed by the Therapeutic Positioning Report (TPR) of the Spanish Agency of Medicines and Sanitary Products about the treatment with oral anticoagulants in patients aged≥75 years old with nonvalvular atrial fibrillation (NVAF) treated in Internal Medicine departments in Spain. PATIENTS AND METHODS: Observational, cross-sectional and multicenter study in which 837 patients aged≥75 years old with NVAF, with stable treatment with oral anticoagulants at least 3 months before inclusion, and that had started treatment with oral anticoagulants before the inclusion period were included. RESULTS: Mean age was 83.0±5.0 years old, mean CHADS2 score 3.2±1.2, mean CHA2DS2-VASc score 5.0±1.4, and mean HAS-BLED score 2.1±0.9. A percentage of 70.8 of patients were treated with vitamin K antagonists (VKA) and the rest of patients with direct oral anticoagulants (DOACs). A percentage of 65.6 of patients treated with VKA did not follow the recommendations made by the TPR compared with 43.0% of patients treated with DOACs (P<.0001). In the case of VKA, the main reason for being considered as not appropriate according to the TPR was having poor control of anticoagulation and not switching to DOACs, whereas in the case of DOACs, it was not receiving the adequate dose according to the TPR. CONCLUSIONS: In a high proportion of anticoagulated elderly patients with NVAF in Spain, the recommendations performed by the TPR are not followed, particularly with VKA, since patients are not switched to DOACs despite time in therapeutic range.
Authors: Carmen Suárez Fernández; Luis Castilla-Guerra; Jesus Cantero Hinojosa; Josep Maria Suriñach; Fernando Acosta de Bilbao; Juan José Tamarit; José Luis Diaz Diaz; Jose Luis Hernandez; Antonio Pose; Manuel Montero-Pérez-Barquero; Jaume Roquer; Jaime Gállego; José Vivancos; Jose María Mostaza Journal: Patient Prefer Adherence Date: 2018-02-19 Impact factor: 2.711
Authors: Jose María Mostaza; Manuel Jesús Romero Jiménez; Fernando José Ruiz Laiglesia; José Antonio Díaz Peromingo; Manuel Beltrán Robles; Ernesto Guevara Sierra; Ana Santander Bilbao; Carmen Suárez Journal: J Geriatr Cardiol Date: 2018-04 Impact factor: 3.327