Tugba Erdogan1, Onur Erdogan2, Savas Ozturk3, Meryem Merve Oren4, Mehmet Akif Karan1, Gulistan Bahat5. 1. Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul Medical School, Istanbul, Turkey. 2. Department of Cardiology, Istinye State Hospital, Istanbul, Turkey. 3. Department of Nephrology, Haseki Training and Research Hospital, Istanbul, Turkey. 4. Department of Public Health, Istanbul University, Istanbul Medical School, Istanbul, Turkey. 5. Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul Medical School, Istanbul, Turkey. gbahatozturk@yahoo.com.
Abstract
BACKGROUND/ PURPOSE: There has been a rapid increase in the use of non-vitamin K-antagonist oral anticoagulants (NOAC). Current guidelines recommend dose adjustments be made in accordance with certain criteria for each NOAC. This study is aimed at determining whether or not NOAC were prescribed for non-valvular atrial fibrillation (AF) in guideline-recommended doses in community-dwelling older adults. METHODS: Older adults taking NOAC for non-valvular AF presenting to a cardiology outpatient clinic for the first time were included in the study. The NOAC dose for each patient was assessed based on the recommendations of the European Society of Cardiology and were categorized as appropriate or inappropriate (low or high dose). The patients were also evaluated for demographic data, diseases, CHA2DS2-VASc score, HASBLED score, frailty and falls in the previous year. RESULTS: A total of 302 older adults were included in the study, with a mean age of 75.5 ± 7.5 years. One hundred eighty-four patients (60.9%) were found to be on appropriate doses of NOAC, while 109 (36.1%) were on inappropriately low doses and nine (2.98%) were on inappropriately high doses. Accordingly, 39.1% of the AF patients were found to be on inappropriate doses of NOAC, 92.4% of which were inappropriately low. A multivariate logistic regression analysis revealed that the only factor associated with inappropriate low-dose NOAC use was patient age (OR = 1.061, 95% CI = 1.009-1.116, p = 0.022). CONCLUSION: Our study suggests that the inappropriate use of lower dose NOAC may emerge as a significant problem in outpatient older adults. This inappropriate practice seems to be associated with older age rather than the diseases, CHA2DS2-VASc/HASBLED scores, frailty and presence of falls.
BACKGROUND/ PURPOSE: There has been a rapid increase in the use of non-vitamin K-antagonist oral anticoagulants (NOAC). Current guidelines recommend dose adjustments be made in accordance with certain criteria for each NOAC. This study is aimed at determining whether or not NOAC were prescribed for non-valvular atrial fibrillation (AF) in guideline-recommended doses in community-dwelling older adults. METHODS: Older adults taking NOAC for non-valvular AF presenting to a cardiology outpatient clinic for the first time were included in the study. The NOAC dose for each patient was assessed based on the recommendations of the European Society of Cardiology and were categorized as appropriate or inappropriate (low or high dose). The patients were also evaluated for demographic data, diseases, CHA2DS2-VASc score, HASBLED score, frailty and falls in the previous year. RESULTS: A total of 302 older adults were included in the study, with a mean age of 75.5 ± 7.5 years. One hundred eighty-four patients (60.9%) were found to be on appropriate doses of NOAC, while 109 (36.1%) were on inappropriately low doses and nine (2.98%) were on inappropriately high doses. Accordingly, 39.1% of the AFpatients were found to be on inappropriate doses of NOAC, 92.4% of which were inappropriately low. A multivariate logistic regression analysis revealed that the only factor associated with inappropriate low-dose NOAC use was patient age (OR = 1.061, 95% CI = 1.009-1.116, p = 0.022). CONCLUSION: Our study suggests that the inappropriate use of lower dose NOAC may emerge as a significant problem in outpatient older adults. This inappropriate practice seems to be associated with older age rather than the diseases, CHA2DS2-VASc/HASBLED scores, frailty and presence of falls.
Authors: Benjamin A Steinberg; Peter Shrader; Karen Pieper; Laine Thomas; Larry A Allen; Jack Ansell; Paul S Chan; Michael D Ezekowitz; Gregg C Fonarow; James V Freeman; Bernard J Gersh; Peter R Kowey; Kenneth W Mahaffey; Gerald V Naccarelli; James A Reiffel; Daniel E Singer; Eric D Peterson; Jonathan P Piccini Journal: J Am Heart Assoc Date: 2018-02-16 Impact factor: 5.501
Authors: M Cristina Polidori; Mariana Alves; Gulistan Bahat; Anne Sophie Boureau; Serdar Ozkok; Roman Pfister; Alberto Pilotto; Nicola Veronese; Mario Bo Journal: Eur Geriatr Med Date: 2021-11-02 Impact factor: 1.710