Use of oral anticoagulant drugs in older patients with atrial fibrillation in internal medicine wards

Appropriateness of prescription of oral anticoagulant therapy in acutely hospitalized older people with atrial fibrillation. Secondary analysis of the SIM‐AF cluster randomized clinical trial

“…they are frail, affected by multimorbidity, take several medications and are per se at a high risk of bleeding), the overall positive risk/benefit ratio for these drugs has been previously established also in this population . A recent study confirmed that, even if the use of OACs increased over time in older AF patients, their nonuse was due to a high bleeding risk in these patients …”

“…This study was conducted in 32 Italian internal medicine and geriatric wards participating to the SIM‐AF study (http://ClinicalTrials.gov #NCT03188211), a cluster randomized controlled trial aimed to assess the effectiveness of a simulation‐based educational course in order to increase the use of OACs in hospitalized older patients with AF. A detailed description of the trial design was published elsewhere . Briefly, the SIM‐AF study comprised a retrospective preintervention phase, which preceded the cluster randomization of the wards to intervention (educational programme with computer‐based simulation technique) or control (current clinical practice) plus in an in‐hospital postintervention prospective phase followed by a 6‐month postdischarge follow‐up.…”

“…Briefly, the SIM‐AF study comprised a retrospective preintervention phase, which preceded the cluster randomization of the wards to intervention (educational programme with computer‐based simulation technique) or control (current clinical practice) plus in an in‐hospital postintervention prospective phase followed by a 6‐month postdischarge follow‐up. During the retrospective preintervention phase (April to May 2017), the physicians of each hospital ward had to scrutinize the medical records of at least 10 AF patients aged 65 years or older and acutely hospitalized within the previous 6 months . In the postintervention prospective phase, every ward consecutively scrutinized and enrolled AF patients aged 65 years or older, and acutely admitted to their hospital wards from September 2017 up to January 2018.…”

“…These findings were also confirmed in a recent cluster randomized trial, the SIM‐AF study (SIMulation‐based technologies to improve the appropriate use of OACs in hospitalized elderly patients with Atrial Fibrillation). In the retrospective phase of the SIM‐AF study 44% of patients were inappropriately prescribed at hospital discharge, mainly for under‐prescription or wrong choice of the antithrombotic drug . By the end of September 2018 also the prospective phase of the SIM‐AF study was concluded and complete data of older patients with AF admitted to internal medicine and geriatric wards became available .…”

“…7,8 By the end of September 2018 also the prospective phase of the SIM-AF study was concluded and complete data of older patients with AF admitted to internal medicine and geriatric wards became available. 7,8 The main results showed that the prevalence of patients prescribed with OACs increased in the intervention arm from the retrospective to the prospective phase. In the present work, we present a secondary analysis on data obtained from the prospective phase of the study, in order to assess: (i) whether or not the educational intervention improved the appropriateness of OAC prescription at hospital discharge; (ii) any change in the prevalence of appropriate prescription between hospital admission and discharge; (iii) the factors independently associated with appropriateness of OAC prescription; and (iv) the related clinical outcomes.…”