Risk scores and geriatric profile: can they really help us in anticoagulation decision making among older patients suffering from atrial fibrillation?

Frédéric Maes,1,* Olivia Dalleur,2,3,* Séverine Henrard,4 Dominique Wouters,2 Christophe Scavée,1 Anne Spinewine,3,5 Benoit Boland4,6 1Cardiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; 2Pharmac...

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Autores principales:	Maes F, Dalleur O, Henrard S, Wouters D, Scavée C, Spinewine A, Bol, B
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	atrial fibrillation anticoagulation antiplatelet therapy geriatric medicine under-prescribing Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/f977b45c818c42bdb56d24cdfa837ec7
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spelling	oai:doaj.org-article:f977b45c818c42bdb56d24cdfa837ec72021-12-02T06:34:30ZRisk scores and geriatric profile: can they really help us in anticoagulation decision making among older patients suffering from atrial fibrillation?1178-1998https://doaj.org/article/f977b45c818c42bdb56d24cdfa837ec72014-07-01T00:00:00Zhttps://www.dovepress.com/risk-scores-and-geriatric-profile-can-they-really-help-us-in-anticoagu-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Frédéric Maes,1,* Olivia Dalleur,2,3,* Séverine Henrard,4 Dominique Wouters,2 Christophe Scavée,1 Anne Spinewine,3,5 Benoit Boland4,6 1Cardiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; 2Pharmacy Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; 3Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium; 4Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium; 5Pharmacy Department, CHU Dinant-Godinne, Université catholique de Louvain, Yvoir, Belgium; 6Geriatric Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium *The first two authors have contributed equally to the work Objectives: Anticoagulation for the prevention of cardio-embolism is most frequently indicated but largely underused in frail older patients with atrial fibrillation (AF). This study aimed at identifying characteristics associated with anticoagulation underuse.Methods: A cross-sectional study of consecutive geriatric patients aged ≥75 years, with AF and clear anticoagulation indication (CHADS2 [Congestive heart failure, Hypertension, Age >75, Diabetes mellitus, and prior Stroke or transient ischemic attack] ≥2) upon hospital admission. All patients benefited from a comprehensive geriatric assessment. Their risks of stroke and bleeding were predicted using CHADS2 and HEMORR2HAGES (Hepatic or renal disease, Ethanol abuse, Malignancy, Older (age >75 years), Reduced platelet count or function, Rebleed risk, Hypertension (uncontrolled), Anemia, Genetic factors, Excessive fall risk, and Stroke) scores, respectively. Results: Anticoagulation underuse was observed in 384 (50%) of 773 geriatric patients with AF (median age 85 years; female 57%, cognitive disorder 33%, nursing home 20%). No geriatric characteristic was found to be associated with anticoagulation underuse. Conversely, anticoagulation underuse was markedly increased in the patients treated with aspirin (odds ratio [OR] [95% confidence interval]: 5.3 [3.8; 7.5]). Other independent predictors of anticoagulation underuse were ethanol abuse (OR: 4.0 [1.4; 13.3]) and age ≥90 years (OR: 2.0 [1.2; 3.4]). Anticoagulation underuse was not inferior in patients with a lower bleeding risk and/or a higher stroke risk and underuse was surprisingly not inferior either in the AF patients who had previously had a stroke. Conclusion: Half of this geriatric population did not receive any anticoagulation despite a clear indication, regardless of their individual bleeding or stroke risks. Aspirin use is the main characteristic associated with anticoagulation underuse. Keywords: atrial fibrillation, anticoagulation, antiplatelet therapy, geriatric medicine, under-prescribingMaes FDalleur OHenrard SWouters DScavée CSpinewine ABolBDove Medical Pressarticleatrial fibrillationanticoagulationantiplatelet therapygeriatric medicineunder-prescribingGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 9, Pp 1091-1099 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	atrial fibrillation anticoagulation antiplatelet therapy geriatric medicine under-prescribing Geriatrics RC952-954.6
spellingShingle	atrial fibrillation anticoagulation antiplatelet therapy geriatric medicine under-prescribing Geriatrics RC952-954.6 Maes F Dalleur O Henrard S Wouters D Scavée C Spinewine A Bol B Risk scores and geriatric profile: can they really help us in anticoagulation decision making among older patients suffering from atrial fibrillation?
description	Frédéric Maes,1,* Olivia Dalleur,2,3,* Séverine Henrard,4 Dominique Wouters,2 Christophe Scavée,1 Anne Spinewine,3,5 Benoit Boland4,6 1Cardiology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; 2Pharmacy Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; 3Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium; 4Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium; 5Pharmacy Department, CHU Dinant-Godinne, Université catholique de Louvain, Yvoir, Belgium; 6Geriatric Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium *The first two authors have contributed equally to the work Objectives: Anticoagulation for the prevention of cardio-embolism is most frequently indicated but largely underused in frail older patients with atrial fibrillation (AF). This study aimed at identifying characteristics associated with anticoagulation underuse.Methods: A cross-sectional study of consecutive geriatric patients aged ≥75 years, with AF and clear anticoagulation indication (CHADS2 [Congestive heart failure, Hypertension, Age >75, Diabetes mellitus, and prior Stroke or transient ischemic attack] ≥2) upon hospital admission. All patients benefited from a comprehensive geriatric assessment. Their risks of stroke and bleeding were predicted using CHADS2 and HEMORR2HAGES (Hepatic or renal disease, Ethanol abuse, Malignancy, Older (age >75 years), Reduced platelet count or function, Rebleed risk, Hypertension (uncontrolled), Anemia, Genetic factors, Excessive fall risk, and Stroke) scores, respectively. Results: Anticoagulation underuse was observed in 384 (50%) of 773 geriatric patients with AF (median age 85 years; female 57%, cognitive disorder 33%, nursing home 20%). No geriatric characteristic was found to be associated with anticoagulation underuse. Conversely, anticoagulation underuse was markedly increased in the patients treated with aspirin (odds ratio [OR] [95% confidence interval]: 5.3 [3.8; 7.5]). Other independent predictors of anticoagulation underuse were ethanol abuse (OR: 4.0 [1.4; 13.3]) and age ≥90 years (OR: 2.0 [1.2; 3.4]). Anticoagulation underuse was not inferior in patients with a lower bleeding risk and/or a higher stroke risk and underuse was surprisingly not inferior either in the AF patients who had previously had a stroke. Conclusion: Half of this geriatric population did not receive any anticoagulation despite a clear indication, regardless of their individual bleeding or stroke risks. Aspirin use is the main characteristic associated with anticoagulation underuse. Keywords: atrial fibrillation, anticoagulation, antiplatelet therapy, geriatric medicine, under-prescribing
format	article
author	Maes F Dalleur O Henrard S Wouters D Scavée C Spinewine A Bol B
author_facet	Maes F Dalleur O Henrard S Wouters D Scavée C Spinewine A Bol B
author_sort	Maes F
title	Risk scores and geriatric profile: can they really help us in anticoagulation decision making among older patients suffering from atrial fibrillation?
title_short	Risk scores and geriatric profile: can they really help us in anticoagulation decision making among older patients suffering from atrial fibrillation?
title_full	Risk scores and geriatric profile: can they really help us in anticoagulation decision making among older patients suffering from atrial fibrillation?
title_fullStr	Risk scores and geriatric profile: can they really help us in anticoagulation decision making among older patients suffering from atrial fibrillation?
title_full_unstemmed	Risk scores and geriatric profile: can they really help us in anticoagulation decision making among older patients suffering from atrial fibrillation?
title_sort	risk scores and geriatric profile: can they really help us in anticoagulation decision making among older patients suffering from atrial fibrillation?
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/f977b45c818c42bdb56d24cdfa837ec7
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Risk scores and geriatric profile: can they really help us in anticoagulation decision making among older patients suffering from atrial fibrillation?

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