Introduction. Atrial fibrillation (AF), a common geriatric disease, is associated with increased risk of death mainly due to cardioembolic stroke. Guidelines for AF suggest that the choice to use an antithrombotic therapy should be based on thromboembolic and bleeding risks. The aim of the study was to investigate domiciliary treatment in elderly patients with AF, to evaluate its appropriateness on the basis of guidelines and, if the therapy was inappropriate, to identify factors that limit the correct therapeutic prescription. Methods. We examined the appropriateness of antithrombotic therapy and factors (socio-demographic characteristics, home therapy, medical conditions, CHA2DS2-VASc and HAS-BLED score) potentially involved in the treatment choice in 189 elderly patients with AF admitted to our department of Internal Medicine. Results. 54.5% of the sample did not take appropriate antithrombotic therapy according to the guidelines. We found a significant correlation among lack of antithrombotic prescription with old age, high bleeding risk and severe disability. Discussion. Most patients, despite a high thromboembolic risk, were not adequately treated due to bleeding risk, old age, social, cognitive and functional conditions. These results reinforce the notion that current guidelines are not sufficiently tailored to complex geriatric patients and that clinicians should decide on treatment options by a thorough evaluation.
Home antithrombotic therapy in elderly patients with atrial fibrillation: Prescription appropriateness and factors related
BROMBO, Gloria;SAVINO, Elisabetta;BIANCHI, Lara;ZULIANI, Giovanni;VOLPATO, Stefano
2013
Abstract
Introduction. Atrial fibrillation (AF), a common geriatric disease, is associated with increased risk of death mainly due to cardioembolic stroke. Guidelines for AF suggest that the choice to use an antithrombotic therapy should be based on thromboembolic and bleeding risks. The aim of the study was to investigate domiciliary treatment in elderly patients with AF, to evaluate its appropriateness on the basis of guidelines and, if the therapy was inappropriate, to identify factors that limit the correct therapeutic prescription. Methods. We examined the appropriateness of antithrombotic therapy and factors (socio-demographic characteristics, home therapy, medical conditions, CHA2DS2-VASc and HAS-BLED score) potentially involved in the treatment choice in 189 elderly patients with AF admitted to our department of Internal Medicine. Results. 54.5% of the sample did not take appropriate antithrombotic therapy according to the guidelines. We found a significant correlation among lack of antithrombotic prescription with old age, high bleeding risk and severe disability. Discussion. Most patients, despite a high thromboembolic risk, were not adequately treated due to bleeding risk, old age, social, cognitive and functional conditions. These results reinforce the notion that current guidelines are not sufficiently tailored to complex geriatric patients and that clinicians should decide on treatment options by a thorough evaluation.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
