Underuse of Oral Anticoagulation for ...
Type de document :
Article dans une revue scientifique
DOI :
PMID :
URL permanente :
Titre :
Underuse of Oral Anticoagulation for Individuals with Atrial Fibrillation in a Nursing Home Setting in France: Comparisons of Resident Characteristics and Physician Attitude
Auteur(s) :
Bahri, Oarda [Auteur]
Service de Médecine Gériatrique [CHU Rouen]
Roca, Frederic [Auteur]
Service de Médecine Gériatrique [CHU Rouen]
Lechani, Tarik [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Druesne, Laurent [Auteur]
Service de Médecine Gériatrique [CHU Rouen]
Jouanny, Pierre [Auteur]
CHU Amiens-Picardie
Serot, Jean-Marie [Auteur]
CHU Amiens-Picardie
Boulanger, Eric [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]
Puisieux, Francois [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Chassagne, Philippe [Auteur]
Service de Médecine Gériatrique [CHU Rouen]
Service de Médecine Gériatrique [CHU Rouen]
Roca, Frederic [Auteur]
Service de Médecine Gériatrique [CHU Rouen]
Lechani, Tarik [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Druesne, Laurent [Auteur]
Service de Médecine Gériatrique [CHU Rouen]
Jouanny, Pierre [Auteur]
CHU Amiens-Picardie
Serot, Jean-Marie [Auteur]
CHU Amiens-Picardie
Boulanger, Eric [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]
Puisieux, Francois [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Chassagne, Philippe [Auteur]
Service de Médecine Gériatrique [CHU Rouen]
Titre de la revue :
Journal of the American Geriatrics Society
Nom court de la revue :
J. Am. Geriatr. Soc.
Numéro :
63
Pagination :
71-76
Date de publication :
2015-01-01
ISSN :
0002-8614
Mot(s)-clé(s) :
anticoagulation
atrial fibrillation
nursing home
atrial fibrillation
nursing home
Discipline(s) HAL :
Sciences du Vivant [q-bio]
Résumé en anglais : [en]
Objectives
To describe the characteristics of nursing home residents diagnosed with atrial fibrillation (AF) and eligible for oral anticoagulants who did not receive these drugs and to detail the conditions that physicians ...
Lire la suite >Objectives To describe the characteristics of nursing home residents diagnosed with atrial fibrillation (AF) and eligible for oral anticoagulants who did not receive these drugs and to detail the conditions that physicians who decide not to prescribe anticoagulants take into account. Design Cross-sectional. Setting Nursing home. Participants Nursing home residents with a history of AF (N = 1,085). Measurements Data were collected on clinical characteristics, geriatric syndromes, and antithrombotic regimen. Multivariate logistic regression was used to identify factors associated with nonprescription of anticoagulants. A standardized questionnaire was submitted to physicians in charge of patients with AF, to detail conditions associated with their medical decision not to prescribe anticoagulants. Results History of AF was present in 1,085 nursing home residents (10.1%), mean age 87, with a mean CHA2DS2-VASc score of 5.1 ± 1.4. Of these residents with AF, 544 (50.1%) did not receive anticoagulants. Recurrent falls (odds ratio (OR) = 4.9, 95% confidence interval (CI) = 2.4–9.9, P < .001), past history of bleeding (OR = 3.62, 95% CI = 1.54–8.51, P = .003), paroxysmal AF (OR = 3.5, 95% CI = 1.83–6.66, P < .001), and advanced age (OR = 1.1, 95% CI = 1.01–1.17, P = .02) were significantly associated with not prescribing anticoagulants. Recurrent falls (47%), cognitive impairment (22.6%), and advanced age (16.4%) were the main reasons for not prescribing anticoagulants. Conclusion The prevalence of AF in a cohort of very old nursing home residents was 10%. Anticoagulation was prescribed in fewer than 50% of eligible cases despite high individual risk of stroke. Geriatric syndromes, especially falls and cognitive disorders, were the main reported contraindications for prescribing anticoagulants. Physicians caring for those residents wrongly thought that paroxysmal AF caused fewer thromboembolic events than permanent AF, which explains lower rates of anticoagulant prescription in individuals with paroxysmal AFLire moins >
Lire la suite >Objectives To describe the characteristics of nursing home residents diagnosed with atrial fibrillation (AF) and eligible for oral anticoagulants who did not receive these drugs and to detail the conditions that physicians who decide not to prescribe anticoagulants take into account. Design Cross-sectional. Setting Nursing home. Participants Nursing home residents with a history of AF (N = 1,085). Measurements Data were collected on clinical characteristics, geriatric syndromes, and antithrombotic regimen. Multivariate logistic regression was used to identify factors associated with nonprescription of anticoagulants. A standardized questionnaire was submitted to physicians in charge of patients with AF, to detail conditions associated with their medical decision not to prescribe anticoagulants. Results History of AF was present in 1,085 nursing home residents (10.1%), mean age 87, with a mean CHA2DS2-VASc score of 5.1 ± 1.4. Of these residents with AF, 544 (50.1%) did not receive anticoagulants. Recurrent falls (odds ratio (OR) = 4.9, 95% confidence interval (CI) = 2.4–9.9, P < .001), past history of bleeding (OR = 3.62, 95% CI = 1.54–8.51, P = .003), paroxysmal AF (OR = 3.5, 95% CI = 1.83–6.66, P < .001), and advanced age (OR = 1.1, 95% CI = 1.01–1.17, P = .02) were significantly associated with not prescribing anticoagulants. Recurrent falls (47%), cognitive impairment (22.6%), and advanced age (16.4%) were the main reasons for not prescribing anticoagulants. Conclusion The prevalence of AF in a cohort of very old nursing home residents was 10%. Anticoagulation was prescribed in fewer than 50% of eligible cases despite high individual risk of stroke. Geriatric syndromes, especially falls and cognitive disorders, were the main reported contraindications for prescribing anticoagulants. Physicians caring for those residents wrongly thought that paroxysmal AF caused fewer thromboembolic events than permanent AF, which explains lower rates of anticoagulant prescription in individuals with paroxysmal AFLire moins >
Langue :
Anglais
Audience :
Internationale
Vulgarisation :
Non
Établissement(s) :
Inserm
Université de Lille
CHU Lille
Université de Lille
CHU Lille
Collections :
Équipe(s) de recherche :
Glycation from inflammation to aging
Date de dépôt :
2019-03-01T14:58:38Z
2022-09-28T09:18:42Z
2022-09-28T09:18:42Z