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Published on: February 28, 2012
The gap between indicated and prescribed stroke prevention therapies in a high-risk geriatric population
Mohammed Shurrab1,2, Eugene Crystal3, Denis O'Donnell4
1Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Room E241, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. shurrabm@hotmail.com.
Insights
Many elderly atrial fibrillation patients in long-term care facilities do not receive recommended oral anticoagulation therapy. This study highlights a significant gap in stroke prevention for eligible residents, indicating a need for improved treatment strategies.
Area of Science:
- Geriatrics
- Cardiology
- Pharmacology
Background:
- Inconsistent use of oral anticoagulation (OAC) for elderly patients with atrial fibrillation (AF) in long-term care (LTC) facilities.
- Need to understand the gap between indicated and prescribed OAC in this vulnerable population.
Purpose of the Study:
- To examine the magnitude of the gap in OAC prescription for elderly AF patients in LTC facilities.
- To identify potential sources contributing to the underutilization of OAC therapy.
Main Methods:
- Retrospective analysis of electronic medical record and pharmacy data from 25 LTC facilities in Ontario, Canada.
- Identification of residents with AF and assessment of OAC prescription status.
- Examination of attributable risk factors for failure to prescribe OAC.
Main Results:
- Out of 433 elderly residents with AF (mean age 87 years), only 273 (63%) were on OAC therapy.
- Warfarin, rivaroxaban, and apixaban were the most common OACs used.
- A significant proportion received antiplatelet therapy alone (20%) or no antithrombotic therapy (17%).
Conclusions:
- Approximately 37% of eligible elderly residents in LTC facilities did not receive recommended stroke prevention therapies.
- No consistent risk factors were identified for the failure to prescribe indicated OAC therapy.
Purpose:
The use of oral anticoagulation (OAC) in the elderly population with atrial fibrillation (AF) treated in long-term care (LTC) facilities is inconsistent. We examined the magnitude and sources of the gap between indicated and prescribed OAC in the elderly population with AF.
Methods:
We retrospectively scanned the electronic medical record (EMR) and pharmacy data of 25 LTC facilities in Ontario, Canada. The diagnosis of AF was drawn from EMR. Different attributable risk factors for possible failure to prescribe OAC were examined.
Results:
In total, 3378 active resident data were examined in the 25 LTC facilities. All the residents were ≥65 years old with mean age of 85 ± 8 years and 2449 (72%) were female. We identified 433 (13%) residents with AF with mean age 87 ± 7 years and mean CHADS2 score of 3 ± 1. Out of all residents with AF, 273 (63%) were on OAC therapy. Residents were mostly treated with warfarin (N = 114 (42%)), rivaroxaban (N = 71 (26%)) or apixaban (N = 62 (23%)) followed by dabigatran (N = 26 (10%)). Antiplatelet drugs as the only stroke prevention therapy were used in 88 (20%) residents, and 28 (6%) residents were on anticoagulation and antiplatelet drugs. Seventy-two (17%) residents were not on any antiplatelet or antithrombotic therapy. None of the potential attributable risks identified consistently correlated with the failure to prescribe indicated therapy.
Conclusions:
This data set suggests that 37% of eligible elderly LTC residents failed to receive recommended stroke prevention therapies.
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