Underuse of Oral Anticoagulation for Individuals with Atrial Fibrillation in a Nursing Home Setting in France: Comparisons of Resident Characteristics and Physician Attitude

@article{Bahri2015UnderuseOO,
  title={Underuse of Oral Anticoagulation for Individuals with Atrial Fibrillation in a Nursing Home Setting in France: Comparisons of Resident Characteristics and Physician Attitude},
  author={Oarda Bahri and Fr{\'e}d{\'e}ric Roca and Tarik Lechani and Laurent Druesne and Pierre Jouanny and Jean-Marie S{\'e}rot and Eric Boulanger and François Puisieux and Philippe Chassagne},
  journal={Journal of the American Geriatrics Society},
  year={2015},
  volume={63},
  pages={71 - 76}
}
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. [] Key MethodDESIGN Cross-sectional. SETTING Nursing home. PARTICIPANTS Nursing home residents with a history of AF (N = 1,085).
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Geriatric Elements and Oral Anticoagulant Prescribing in Older Atrial Fibrillation Patients: SAGE‐AF
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Geriatric elements, such as cognitive impairment and frailty, commonly occur in patients with atrial fibrillation and are often cited as reasons for not prescribing oral anticoagulants.
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This study aimed to examine the prevalence of OAC prescriptions in AF patients with dementia/CI and to identify factors associated with OAC treatment within 180 days after dementia/ CI diagnosis.
Effect of New Oral Anticoagulants on Prescribing Practices for Atrial Fibrillation in Older Adults
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To determine the effect of new oral anticoagulants (NOACs) on prescribing practices in older adults with atrial fibrillation (AF), a large number of patients with this condition are being treated with NOACs.
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TLDR
Despite further research supporting its use in this population, the medical community has been slow to implement anticoagulation, possibly due to misconceptions around life expectancy and bleeding risk.
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TLDR
The most common reason physicians cite for withholding anticoagulation in older patients with atrial fibrillation is a perception of a high risk of falling and associated bleeding, especially intracranial hemorrhage.
When to withhold oral anticoagulation in atrial fibrillation – an overview of frequent clinical discussion topics
TLDR
To guide clinical decision-making, available evidence on the most frequently reported reasons for withholding anticoagulation are reviewed: previous bleeding, frailty and age, and an overall high bleeding risk.
Trends in Anticoagulant Use at Nursing Home Admission and Variation by Frailty and Chronic Kidney Disease Among Older Adults with Atrial Fibrillation
TLDR
While the proportion of residents with AF receiving oral anticoagulant therapy following the approval of DOACs increased, over 40% remained untreated, and the impact of these recent treatment patterns on the balance between benefit and harm among residents warrant further investigation.
The Utilization of Antithrombotic Therapy in Older Patients in Aged Care Facilities With Atrial Fibrillation
  • B. Frain, R. Castelino, L. Bereznicki
  • Medicine
    Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
  • 2018
TLDR
Prescribing of anticoagulants was influenced to a greater extent by bleeding risk than it was by the risk of stroke, suggesting that physicians placed a heavier weighting on bleeding risk rather than stroke risk.
Clinical Update on Nursing Home Medicine: 2015.
Anticoagulation in Elderly Patients with Atrial Fibrillation Authors
TLDR
This chapter aims to analyze the use of direct oral anticoagulant in elderly patients by analyzing the effectiveness and safety of Vitamin K antagonists in the general population.
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References

SHOWING 1-10 OF 36 REFERENCES
Prevalence and quality of warfarin use for patients with atrial fibrillation in the long-term care setting.
TLDR
Even among apparently ideal candidates, warfarin therapy is underused for stroke prevention in patients with AF, and prescribing decisions and monitoring related to warFarin therapy in the long-term care setting warrant improvement.
Warfarin for Prevention of Thrombosis Among Long-Term Care Residents with Atrial Fibrillation: Evidence of Continuing Low Use Despite Consideration of Stroke and Bleeding Risk
TLDR
The results from two LTC databases suggest that residents with AFib have a high risk of stroke and a similar directional but more constrained trend was noted for the AnalytiCare data: only 3 and 4+ bleeding risk factors were significant.
Patterns of warfarin use and subsequent outcomes in atrial fibrillation in primary care practices
TLDR
Warfarin was underutilized in a substantial portion of eligible atrial fibrillation patients in these community-based primary care practices, and multiple interruptions were associated with over twice the risk of stroke when compared to those treated continuously.
Choosing antithrombotic therapy for elderly patients with atrial fibrillation who are at risk for falls.
TLDR
Sensitivity analysis demonstrated that, regardless of the patients' age or baseline risk of stroke, the risk of falling was not an important factor in determining their optimal antithrombotic therapy.
Cognitive Impairment Associated With Atrial Fibrillation
Atrial fibrillation (AF) has been linked with an increased risk for cognitive impairment and dementia, but whether this risk was due to stroke has been uncertain. This systematic review of 21 studi...
Bleeding Risk in Very Old Patients on Vitamin K Antagonist Treatment: Results of a Prospective Collaborative Study on Elderly Patients Followed by Italian Centres for Anticoagulation
TLDR
In this large study on very old patients on VKA carefully monitored by anticoagulation clinics, the rate of bleedings was low, suggesting that age in itself should not be considered a contraindication to treatment.
Underuse of oral anticoagulants in atrial fibrillation: a systematic review.
Risks of oral anticoagulant therapy with increasing age.
TLDR
Because higher thromboembolic risk with age often makes it unfeasible to withhold oral anticoagulation from elderly patients, future studies should focus on ways to lower the bleeding risk.
Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation.
TLDR
These findings provide further evidence against the use of lower INR target levels in patients with atrial fibrillation and suggest that anticoagulation that results in an INR of 2.0 or greater reduces not only the frequency of ischemic stroke but also its severity and the risk of death from stroke.
The Net Clinical Benefit of Warfarin Anticoagulation in Atrial Fibrillation
TLDR
The net clinical benefit of warfarin anticoagulation is quantified as the estimated reduction in rate of thromboembolism, mainly ischemic stroke, minus 1.5 times the estimated increase in rates of intracranial hemorrhage attributable to warFarin therapy in standard stroke risk subgroups in the community-based cohort of patients in the ATRIA Study.
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