The Utilization of Antithrombotic Therapy in Older Patients in Aged Care Facilities With Atrial Fibrillation

Abstract

Oral anticoagulants are essential drugs for the prevention of thromboembolic events in patients with atrial fibrillation (AF). Anticoagulants are, however, commonly withheld in older people due to the risk and fear of hemorrhage. Although the underutilization of anticoagulants in patients with AF has been demonstrated internationally, few studies have been conducted among aged care residents. The aim of this study was to determine the utilization of anticoagulants among people with AF residing in aged care facilities. We performed a non-experimental, retrospective analysis designed to evaluate antithrombotic usage in patients with AF in Australia residing in aged care facilities, using data collected by pharmacists while performing Residential Medication Management Reviews (RMMRs). The utilization of antithrombotic therapy and the appropriateness of therapy were determined based on the CHADS, CHADS-VASc, and HAS-BLED risk stratification schemes in consideration of documented contraindications to treatment. Predictors of anticoagulant use were determined using multivariate logistic regression. A total of 1952 RMMR patients with AF were identified. Only 35.6% of eligible patients (CHADS score ≥2 and no contraindications to anticoagulants) received an anticoagulant. As age increased, the likelihood of receiving an anticoagulant decreased and the likelihood of receiving an antiplatelet or no therapy increased. In patients at high risk of stroke (CHADS score ≥2), utilization of anticoagulants dropped by 19.7% when the HAS-BLED score increased from 2 to 3, suggesting that physicians placed a heavier weighting on bleeding risk rather than stroke risk. Prescribing of anticoagulants was influenced to a greater extent by bleeding risk than it was by the risk of stroke. Further research investigating whether the growing availability of direct oral anticoagulants influences practice in this patient population is needed.

Utilization of Anticoagulants in Nonvalvular Atrial Fibrillation Before and After Catheter Ablation at Shanghai, China

“…Underutilization of anticoagulant therapy of these eligible high-risk patients was observed in our study. This finding is in line with the China 15 and International 16 –19 studies reporting that anticoagulants are commonly underutilized in AF patients. Antiplatelet therapy cannot be recommended for stroke prevention in NVAF patients.…”

A study of knowledge, attitudes, and practices of primary care physicians toward anticoagulant therapy in patients with non-valvular atrial fibrillation in Shanghai, China

“…Therefore, most PCPs did not provide adequate levels of education to NVAF patients. The latest studies have shown that among patients with NVAF, NOAC is superior to warfarin for the prevention of AF-related strokes [19]. However, we found that 81.39% of PCPs did not know of NOAC therapy because most PCPs in the community did not have a good understanding of the literature, despite having a positive attitude toward acquiring such knowledge.…”

The study on knowledge-attitude-practice of primary care physician toward anticoagulants therapy in Non-valvular atrial fibrillation patients in Shanghai of China

“…Therefore, most PCPs did not provide adequate levels of education to NVAF patients. The latest studies have shown that among NVAF patients, the newer OAC is superior to warfarin for the prevention of AF-related strokes [22] . However, we found that 81.39% of PCPs did not know of the In the multiple linear regression analysis, the PCPs' knowledge score was related to their years of practice, whether they were in outpatient service, and their type of CHS center.…”