Stefania Antoniazzi1,2, Ilaria Ardoino3, Marco Proietti3, Valter Monzani4, Pier Mannuccio Mannucci1, Alessandro Nobili3, Carlotta Franchi3. 1. Scientific Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 2. Department of Biomedical and Clinical Sciences, Clinical Pharmacology Unit, ASST Fatebenefratelli-Sacco University Hospital, University of Milan, Milan, Italy. 3. Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy. 4. Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Abstract
AIMS: To assess the appropriateness of oral anticoagulant (OAC) prescription and its associated factors in acutely hospitalized elderly patients. METHODS: Data were obtained from the prospective phase of SIM-AF (SIMulation-based technologies to improve the appropriate use of oral anticoagulants in hospitalized elderly patients with Atrial Fibrillation) randomized controlled trial, aimed to test whether an educational intervention improved OAC prescription, compared to current clinical practice, in internal medicine wards. In this secondary analysis, appropriateness of OAC prescription was assessed at hospital admission and discharge. RESULTS: For 246 patients, no significant differences were found between arms (odds ratio 1.38, 95% confidence interval [CI] 0.84-2.28) in terms of appropriateness of OAC prescription. Globally, 92 patients (37.4%, 95% CI = 31.6-43.6%) were inappropriately prescribed or not prescribed at hospital discharge. Among 51 patients inappropriately prescribed, 82% showed errors on dosage, being mainly under-dosed (n = 29, 56.9%), and among 41 inappropriately not prescribed, 98% were taking an antiplatelet drug. Factors independently associated with a lower probability of appropriateness at discharge were those related to a higher risk of bleeding (older age, higher levels of aspartate aminotransferase, history of falls, alcohol consumption) and antiplatelet prescription at admission. The prescription of OACs at admission was the strongest predictor of appropriateness at discharge (odds ratio = 7.43, 95% CI = 4.04-13.73). CONCLUSIONS: A high proportion of hospitalized older patients with AF remains inappropriately prescribed or nonprescribed with OACs. The management of these patients at hospital admission is the strongest predictor of prescription appropriateness at discharge.
RCT Entities:
AIMS: To assess the appropriateness of oral anticoagulant (OAC) prescription and its associated factors in acutely hospitalized elderly patients. METHODS: Data were obtained from the prospective phase of SIM-AF (SIMulation-based technologies to improve the appropriate use of oral anticoagulants in hospitalized elderly patients with Atrial Fibrillation) randomized controlled trial, aimed to test whether an educational intervention improved OAC prescription, compared to current clinical practice, in internal medicine wards. In this secondary analysis, appropriateness of OAC prescription was assessed at hospital admission and discharge. RESULTS: For 246 patients, no significant differences were found between arms (odds ratio 1.38, 95% confidence interval [CI] 0.84-2.28) in terms of appropriateness of OAC prescription. Globally, 92 patients (37.4%, 95% CI = 31.6-43.6%) were inappropriately prescribed or not prescribed at hospital discharge. Among 51 patients inappropriately prescribed, 82% showed errors on dosage, being mainly under-dosed (n = 29, 56.9%), and among 41 inappropriately not prescribed, 98% were taking an antiplatelet drug. Factors independently associated with a lower probability of appropriateness at discharge were those related to a higher risk of bleeding (older age, higher levels of aspartate aminotransferase, history of falls, alcohol consumption) and antiplatelet prescription at admission. The prescription of OACs at admission was the strongest predictor of appropriateness at discharge (odds ratio = 7.43, 95% CI = 4.04-13.73). CONCLUSIONS: A high proportion of hospitalized older patients with AF remains inappropriately prescribed or nonprescribed with OACs. The management of these patients at hospital admission is the strongest predictor of prescription appropriateness at discharge.
Authors: Shivaraj Gowda; Prakash B Desai; Vinayak V Hull; Avinash A K Math; Sonal N Vernekar; Shruthi S Kulkarni Journal: Pan Afr Med J Date: 2009-11-22
Authors: Margaret C Fang; Alan S Go; Elaine M Hylek; Yuchiao Chang; Lori E Henault; Nancy G Jensvold; Daniel E Singer Journal: J Am Geriatr Soc Date: 2006-08 Impact factor: 5.562
Authors: C Franchi; I Ardoino; A Nobili; L Pasina; P M Mannucci; A Marengoni; F Perticone Journal: Pharmacoepidemiol Drug Saf Date: 2017-10-13 Impact factor: 2.890
Authors: Maegan M Whitworth; Krystal K Haase; David S Fike; Ravindra M Bharadwaj; Rodney B Young; Eric J MacLaughlin Journal: Int J Gen Med Date: 2017-03-10
Authors: Clara Bonanad; Francisca Esteve-Claramunt; Sergio García-Blas; Ana Ayesta; Pablo Díez-Villanueva; Jose-Ángel Pérez-Rivera; José Luis Ferreiro; Joaquim Cánoves; Francisco López-Fornás; Albert Ariza Solé; Sergio Raposerias; David Vivas; Regina Blanco; Daznia Bompart Berroterán; Alberto Cordero; Julio Núñez; Lorenzo Fácila; Iván J Núñez-Gil; José Luis Górriz; Vicente Bodí; Manuel Martínez-Selles; Juan Miguel Ruiz Nodar; Francisco Javier Chorro Journal: J Clin Med Date: 2022-05-26 Impact factor: 4.964