AIMS: Information on utilization of oral anticoagulants (OACs) in nursing homes is scarce. This study aimed to (i) describe OAC use in German nursing home residents, (ii) examine factors influencing whether treatment is initiated with vitamin K antagonists (VKAs) or non-VKA oral anticoagulants (NOACs) and (iii) assess which conditions predict switching to NOAC instead of continuing VKA. METHODS: Using claims data (2010-2014), we studied a cohort of new nursing home residents aged ≥65 years receiving OAC. Further, OAC use in patients with atrial fibrillation (AF) was examined over the years. RESULTS: Overall, 16 804 patients (median age: 85 years, 75% female, 44% with renal disease) were included. The majority received phenprocoumon as first OAC (58.0%), followed by rivaroxaban (28.1%). Over the study period, NOAC use increased substantially. Initiating NOAC instead of VKA was predicted by a previous stroke (adjusted odds ratio: 1.76; 95% confidence interval: 1.49-2.08). In contrast, renal disease predicted VKA initiation (0.66; 0.59-0.75) as did the presence of a prosthetic heart valve. Switching from VKA to NOAC was predicted by a stroke (2.55; 2.00-3.24), bleeding events and a recent hospitalization. During 2010-2014, the proportion of AF patients with a CHADS2 score ≥2 receiving OAC increased from 27% to 46%. CONCLUSIONS: NOACs are increasingly used in German nursing homes, both for initial anticoagulation but also in VKA pre-treated patients. Switching from VKA to NOAC was substantially influenced by aspects such as intended higher effectiveness and safety but probably also practicability due to less blood monitoring.
AIMS: Information on utilization of oral anticoagulants (OACs) in nursing homes is scarce. This study aimed to (i) describe OAC use in German nursing home residents, (ii) examine factors influencing whether treatment is initiated with vitamin K antagonists (VKAs) or non-VKA oral anticoagulants (NOACs) and (iii) assess which conditions predict switching to NOAC instead of continuing VKA. METHODS: Using claims data (2010-2014), we studied a cohort of new nursing home residents aged ≥65 years receiving OAC. Further, OAC use in patients with atrial fibrillation (AF) was examined over the years. RESULTS: Overall, 16 804 patients (median age: 85 years, 75% female, 44% with renal disease) were included. The majority received phenprocoumon as first OAC (58.0%), followed by rivaroxaban (28.1%). Over the study period, NOAC use increased substantially. Initiating NOAC instead of VKA was predicted by a previous stroke (adjusted odds ratio: 1.76; 95% confidence interval: 1.49-2.08). In contrast, renal disease predicted VKA initiation (0.66; 0.59-0.75) as did the presence of a prosthetic heart valve. Switching from VKA to NOAC was predicted by a stroke (2.55; 2.00-3.24), bleeding events and a recent hospitalization. During 2010-2014, the proportion of AFpatients with a CHADS2 score ≥2 receiving OAC increased from 27% to 46%. CONCLUSIONS:NOACs are increasingly used in German nursing homes, both for initial anticoagulation but also in VKA pre-treated patients. Switching from VKA to NOAC was substantially influenced by aspects such as intended higher effectiveness and safety but probably also practicability due to less blood monitoring.
Authors: Paulus Kirchhof; Stefano Benussi; Dipak Kotecha; Anders Ahlsson; Dan Atar; Barbara Casadei; Manuel Castella; Hans-Christoph Diener; Hein Heidbuchel; Jeroen Hendriks; Gerhard Hindricks; Antonis S Manolis; Jonas Oldgren; Bogdan Alexandru Popescu; Ulrich Schotten; Bart Van Putte; Panagiotis Vardas; Stefan Agewall; John Camm; Gonzalo Baron Esquivias; Werner Budts; Scipione Carerj; Filip Casselman; Antonio Coca; Raffaele De Caterina; Spiridon Deftereos; Dobromir Dobrev; José M Ferro; Gerasimos Filippatos; Donna Fitzsimons; Bulent Gorenek; Maxine Guenoun; Stefan H Hohnloser; Philippe Kolh; Gregory Y H Lip; Athanasios Manolis; John McMurray; Piotr Ponikowski; Raphael Rosenhek; Frank Ruschitzka; Irina Savelieva; Sanjay Sharma; Piotr Suwalski; Juan Luis Tamargo; Clare J Taylor; Isabelle C Van Gelder; Adriaan A Voors; Stephan Windecker; Jose Luis Zamorano; Katja Zeppenfeld Journal: Europace Date: 2016-08-27 Impact factor: 5.214
Authors: Stuart J Connolly; Janice Pogue; John Eikelboom; Gregory Flaker; Patrick Commerford; Maria Grazia Franzosi; Jeffrey S Healey; Salim Yusuf Journal: Circulation Date: 2008-10-27 Impact factor: 29.690
Authors: Christopher Southan; Joanna L Sharman; Helen E Benson; Elena Faccenda; Adam J Pawson; Stephen P H Alexander; O Peter Buneman; Anthony P Davenport; John C McGrath; John A Peters; Michael Spedding; William A Catterall; Doriano Fabbro; Jamie A Davies Journal: Nucleic Acids Res Date: 2015-10-12 Impact factor: 16.971