Anticoagulation in older people with atrial fibrillation moving to care homes: a data linkage study

The British journal of general practice: the journal of the Royal College of General Practitioners

article

Leona A Ritchie¹  Stephanie L Harrison¹  Peter E Penson²  Ashley Akbari³  Fatemeh Torabi⁴  Joe Hollinghurst⁴  Daniel Harris⁴  Oluwakayode B Oke¹  Asangaedem Akpan⁵  Julian P Halcox⁴  Sarah E Rodgers⁶  Gregory YH Lip⁷  Deirdre A Lane⁸ 

[1] Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Heart & Chest Hospital, Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool;Liverpool Centre for Cardiovascular Science, University of Liverpool, Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University;Population Data Science, Health Data Research UK and Population Data Science, Administrative Data Research Wales, Swansea University Medical School, Swansea University;Population Data Science, Health Data Research UK, Swansea University Medical School, Swansea University;Musculoskeletal and Ageing Science, Institute of Life Course & Medical Sciences, University of Liverpool, Liverpool University Hospitals NHS Foundation Trust;Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool;Price-Evans chair of cardiovascular medicine;Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Heart & Chest Hospital, Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK, Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University

关键词: anticoagulants;    atrial fibrillation;    long-term care;    nursing homes;    practice patterns;    physicians’;    primary health care;   

DOI  :  10.3399/BJGP.2022.0156

学科分类：卫生学

来源: Royal College of General Practitioners

【 摘 要 】

Background Treatment decisions about oral anticoagulants (OACs) for atrial fibrillation (AF) are complex in older care home residents.Aim To explore factors associated with OAC prescription.Design and setting Retrospective cohort study set in care homes in Wales, UK, listed in the Care Inspectorate Wales Registry 2017/18.Method Analysis of anonymised individual-level electronic health and administrative data was carried out on people aged ≥65 years entering a care home between 1 January 2003 and 31 December 2018, provisioned from the Secure Anonymised Information Linkage Databank.Results Between 2003 and 2018, 14 493 people with AF aged ≥65 years became new residents in care homes in Wales and 7057 (48.7%) were prescribed OACs (32.7% in 2003 compared with 72.7% in 2018) within 6 months before care home entry. Increasing age and prescription of antiplatelet therapy were associated with lower odds of OAC prescription (adjusted odds ratio [aOR] 0.96 per 1-year age increase, 95% confidence interval [CI] = 0.95 to 0.96 and aOR 0.91, 95% CI = 0.84 to 0.98, respectively). Conversely, prior venous thromboembolism (aOR 4.06, 95% CI = 3.17 to 5.20), advancing frailty (mild: aOR 4.61, 95% CI = 3.95 to 5.38; moderate: aOR 6.69, 95% CI = 5.74 to 7.80; and severe: aOR 8.42, 95% CI = 7.16 to 9.90), and year of care home entry from 2011 onwards (aOR 1.91, 95% CI = 1.76 to 2.06) were associated with higher odds of an OAC prescription.Conclusion There has been an increase in OAC prescribing in older people newly admitted to care homes with AF. This study provides an insight into the factors influencing OAC prescribing in this population.

【 授权许可】

Free