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Underuse of Anticoagulation in Older Patients with Atrial Fibrillation and CHADS2 Score ≥ 2: Are We Doing Better Since the Marketing of Direct Oral Anticoagulants?

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Henrard, Séverine [UCL] Vandenabeele, Caroline [UCL] Marien, Sophie [UCL] Boland, Benoît [UCL] Dalleur, Olivia [UCL]

Our objectives were to (1) describe the evolution of the underuse of anticoagulants in older people with atrial fibrillation (AF) and a CHADS2 score ≥ 2 since direct oral anticoagulants (DOACs) were introduced to the market and (2) describe factors associated with this underuse. We conducted a retrospective cross-sectional study including geriatric patients admitted during the pre-DOAC (2008-2011) and post-DOAC (2013-2015) periods in an academic hospital in Belgium. Five inclusion criteria were met: age ≥ 75 years, diagnosis of AF, indication for anticoagulation (CHADS2 score ≥ 2), risk of functional decline (Identification of Seniors At Risk [ISAR] score ≥ 2), and comprehensive geriatric assessment. The use of anticoagulants and antiplatelets at home before admission was recorded. Risks of stroke and bleeding were calculated using CHADS2 and HEMORR2HAGES scores, respectively. Three different logistic regression models were performed to describe the evolution of and factors associated with the underuse of anticoagulants after DOAC marketing. Anticoagulant underuse, present in 209 of 614 (34%) geriatric patients with AF, was lower in patients with a history of stroke (28.5%) or congestive heart failure (26.9%) but higher in those receiving antiplatelets (56.2%) and in older individuals. Anticoagulant underuse decreased significantly from the pre-DOAC (37.3%) to the post-DOAC (29.7%) era, as shown by two analyses using propensity scores. In older patients with AF, anticoagulant underuse was mainly associated with antiplatelet use. Anticoagulant underuse and antiplatelet use have both decreased since DOAC marketing. Underuse of anticoagulants was still a concern for three in ten geriatric patients with AF at high risk of stroke (CHADS2 score ≥ 2).

Document type Article de périodique (Journal article) – Article de recherche
Publication date 2017
Language Anglais
Journal information "Drugs & Aging" - Vol. Nov;34(11), p. 841-850 (2017)
Peer reviewed yes
Publisher Adis International Ltd. ((New Zealand) Auckland)
issn 1170-229X
e-issn 1179-1969
Publication status Publié
Affiliations UCL - SSS/LDRI - Louvain Drug Research Institute
UCL - SSS/IRSS - Institut de recherche santé et société
UCL - (SLuc) Service de gériatrie
UCL - (SLuc) Autre
UCL - (SLuc) Département de pharmacie
Links
  1. Fuster Valentin, Rydén Lars E, Asinger Richard W, Cannom David S, Crijns Harry J, Frye Robert L, Halperin Jonathan L, Kay G.Neal, Klein Werner W, Lévy Samuel, McNamara Robert L, Prystowsky Eric N, Wann L.Samuel, Wyse D.George, Gibbons Raymond J, Antman Elliott M, Alpert Joseph S, Faxon David P, Fuster Valentin, Gregoratos Gabriel, Hiratzka Loren F, Jacobs Alice K, Russell Richard O, Smith Sidney C, Klein Werner W, Alonso-Garcia Angeles, Blomström-Lundqvist Carina, De Backer Guy, Flather Marcus, Hradec Jaromir, Oto Ali, Parkhomenko Alexander, Silber Sigmund, Torbicki Adam, ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary, 10.1016/s0735-1097(01)01587-x
  2. Fuchs P., Vogel T., Lang P.-O., L’anticoagulation du patient âgé en fibrillation atriale : que prescrivent les cardiologues, les gériatres et les médecins généralistes ?, 10.1016/j.revmed.2015.03.330
  3. , Camm A. J., Lip G. Y. H., De Caterina R., Savelieva I., Atar D., Hohnloser S. H., Hindricks G., Kirchhof P., Bax J. J., Baumgartner H., Ceconi C., Dean V., Deaton C., Fagard R., Funck-Brentano C., Hasdai D., Hoes A., Kirchhof P., Knuuti J., Kolh P., McDonagh T., Moulin C., Popescu B. A., Reiner Z., Sechtem U., Sirnes P. A., Tendera M., Torbicki A., Vahanian A., Windecker S., Vardas P., Al-Attar N., Alfieri O., Angelini A., Blomstrom-Lundqvist C., Colonna P., De Sutter J., Ernst S., Goette A., Gorenek B., Hatala R., Heidbuchel H., Heldal M., Kristensen S. D., Kolh P., Le Heuzey J.-Y., Mavrakis H., Mont L., Filardi P. P., Ponikowski P., Prendergast B., Rutten F. H., Schotten U., Van Gelder I. C., Verheugt F. W. A., , , 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: An update of the 2010 ESC Guidelines for the management of atrial fibrillation * Developed with the special contribution of the European Heart Rhythm Association, 10.1093/eurheartj/ehs253
  4. Chugh S. S., Havmoeller R., Narayanan K., Singh D., Rienstra M., Benjamin E. J., Gillum R. F., Kim Y.-H., McAnulty J. H., Zheng Z.-J., Forouzanfar M. H., Naghavi M., Mensah G. A., Ezzati M., Murray C. J. L., Worldwide Epidemiology of Atrial Fibrillation: A Global Burden of Disease 2010 Study, 10.1161/circulationaha.113.005119
  5. Sinnaeve P. R., Brueckmann M., Clemens A., Oldgren J., Eikelboom J., Healey J. S., Stroke prevention in elderly patients with atrial fibrillation: challenges for anticoagulation : Review: Stroke in the elderly with AF, 10.1111/j.1365-2796.2011.02464.x
  6. Deedwania Prakash C., New Oral Anticoagulants in Elderly Patients with Atrial Fibrillation, 10.1016/j.amjmed.2012.10.012
  7. Gage Brian F., Waterman Amy D., Shannon William, Boechler Michael, Rich Michael W., Radford Martha J., Validation of Clinical Classification Schemes for Predicting Stroke : Results From the National Registry of Atrial Fibrillation, 10.1001/jama.285.22.2864
  8. Lip Gregory Y.H., Nieuwlaat Robby, Pisters Ron, Lane Deirdre A., Crijns Harry J.G.M., Refining Clinical Risk Stratification for Predicting Stroke and Thromboembolism in Atrial Fibrillation Using a Novel Risk Factor-Based Approach, 10.1378/chest.09-1584
  9. Gage Brian F., Yan Yan, Milligan Paul E., Waterman Amy D., Culverhouse Robert, Rich Michael W., Radford Martha J., Clinical classification schemes for predicting hemorrhage: Results from the National Registry of Atrial Fibrillation (NRAF), 10.1016/j.ahj.2005.04.017
  10. Monte S., Antithrombotic treatment is strongly underused despite reducing overall mortality among high-risk elderly patients hospitalized with atrial fibrillation, 10.1093/eurheartj/ehl208
  11. De Breucker Sandra, Herzog Gertraud, Pepersack Thierry, Could Geriatric Characteristics Explain the Under-Prescription of Anticoagulation Therapy for Older Patients Admitted with Atrial Fibrillation? : A Retrospective Observational Study, 10.2165/11537900-000000000-00000
  12. Maes F, Dalleur O, Henrard S, Wouters D, Scavee C, Spinewine A, et al. Risk scores and geriatric profile: can they really help us in anticoagulation decision making among older patients suffering from atrial fibrillation? Clin Interv Aging. 2014;9:1091–9.
  13. Denoël Paule, Vanderstraeten Jacques, Mols Pierre, Pepersack Thierry, Could Some Geriatric Characteristics Hinder the Prescription of Anticoagulants in Atrial Fibrillation in the Elderly?, 10.1155/2014/693740
  14. Granziera Serena, Cohen Alexander T., Nante Giovanni, Manzato Enzo, Sergi Giuseppe, Thromboembolic Prevention in Frail Elderly Patients With Atrial Fibrillation: A Practical Algorithm, 10.1016/j.jamda.2014.12.008
  15. Man-Son-Hing Malcolm, Laupacis Andreas, Anticoagulant-Related Bleeding in Older Persons With Atrial Fibrillation : Physicians' Fears Often Unfounded, 10.1001/archinte.163.13.1580
  16. Ruff Christian T, Giugliano Robert P, Braunwald Eugene, Hoffman Elaine B, Deenadayalu Naveen, Ezekowitz Michael D, Camm A John, Weitz Jeffrey I, Lewis Basil S, Parkhomenko Alexander, Yamashita Takeshi, Antman Elliott M, Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials, 10.1016/s0140-6736(13)62343-0
  17. Eikelboom John W., Wallentin Lars, Connolly Stuart J., Ezekowitz Mike, Healey Jeff S., Oldgren Jonas, Yang Sean, Alings Marco, Kaatz Scott, Hohnloser Stefan H., Diener Hans-Christoph, Franzosi Maria Grazia, Huber Kurt, Reilly Paul, Varrone Jeanne, Yusuf Salim, Risk of Bleeding With 2 Doses of Dabigatran Compared With Warfarin in Older and Younger Patients With Atrial FibrillationClinical Perspective : An Analysis of the Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) Trial, 10.1161/circulationaha.110.004747
  18. Suárez Fernández Carmen, , Formiga Francesc, Camafort Miguel, Cepeda Rodrigo Jose María, Díez-Manglano Jesús, Pose Reino Antonio, Tiberio Gregorio, Mostaza Jose María, Antithrombotic treatment in elderly patients with atrial fibrillation: a practical approach, 10.1186/s12872-015-0137-7
  19. Sen Souvik, Dahlberg Katherine Willett, Physician's Fear of Anticoagulant Therapy in Nonvalvular Atrial Fibrillation, 10.1097/maj.0000000000000349
  20. Vogel T., Geny B., Kaltenbach G., Lang P.-O., L’anticoagulation dans la fibrillation atriale du sujet âgé : point de vue du gériatre avec un focus sur les anticoagulants oraux directs, 10.1016/j.revmed.2014.08.005
  21. Deschodt Mieke, Flamaing Johan, Rock Goele, Boland Benoit, Boonen Steven, Milisen Koen, Implementation of inpatient geriatric consultation teams and geriatric resource nurses in acute hospitals: A national survey study, 10.1016/j.ijnurstu.2011.11.015
  22. McCusker Jane, Bellavance Francois, Cardin Sylvie, Trepanier Sylvain, Verdon Josee, Ardman Orly, Detection of Older People at Increased Risk of Adverse Health Outcomes After an Emergency Visit: The ISAR Screening Tool, 10.1111/j.1532-5415.1999.tb05204.x
  23. Katz S., Downs T. D., Cash H. R., Grotz R. C., Progress in Development of the Index of ADL, 10.1093/geront/10.1_part_1.20
  24. Folstein Marshal F., The Mini-Mental State Examination, 10.1001/archpsyc.1983.01790060110016
  25. Kaiser M. J., , Bauer J. M., Ramsch C., Uter W., Guigoz Y., Cederholm T., Thomas D. R., Anthony P., Charlton K. E., Maggio M., Tsai A. C., Grathwohl D., Vellas B., Sieber C. C., Validation of the Mini Nutritional Assessment short-form (MNA®-SF): A practical tool for identification of nutritional status, 10.1007/s12603-009-0214-7
  26. Hanon Olivier, Assayag Patrick, Belmin Joel, Collet Jean Philippe, Emeriau Jean Paul, Fauchier Laurent, Forette Françoise, Friocourt Patrick, Gentric Armelle, Leclercq Christophe, Komajda Michel, Le Heuzey Jean Yves, Expert consensus of the French Society of Geriatrics and Gerontology and the French Society of Cardiology on the management of atrial fibrillation in elderly people, 10.1016/j.acvd.2013.04.001
  27. Austin PC. Comparing paired vs non-paired statistical methods of analyses when making inferences about absolute risk reductions in propensity-score matched samples. Stat Med. 2011;30(11):1292–301.
  28. Kim Dae Hyun, Pieper Carl F., Ahmed Ali, Colón-Emeric Cathleen S., Use and Interpretation of Propensity Scores in Aging Research: A Guide for Clinical Researchers, 10.1111/jgs.14253
  29. Austin Peter C., An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies, 10.1080/00273171.2011.568786
  30. The R Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2016.
  31. Brown Joshua D., Shewale Anand R., Dherange Parinita, Talbert Jeffery C., A Comparison of Oral Anticoagulant Use for Atrial Fibrillation in the Pre- and Post-DOAC Eras, 10.1007/s40266-016-0369-y
  32. Marzec Lucas N., Wang Jingyan, Shah Nilay D., Chan Paul S., Ting Henry H., Gosch Kensey L., Hsu Jonathan C., Maddox Thomas M., Influence of Direct Oral Anticoagulants on Rates of Oral Anticoagulation for Atrial Fibrillation, 10.1016/j.jacc.2017.03.540
  33. Shah Rashmee U., Rupp Austin B., Mowery Danielle, Zhang Mingyuan, Stoddard Greg, Deshmukh Vikrant, Bray Bruce E., Hess Rachel, Rondina Matthew T., Changes in Oral Anticoagulant Treatment Rates in Atrial Fibrillation before and after the Introduction of Direct Oral Anticoagulants, 10.1159/000455012
  34. Staerk Laila, Fosbøl Emil Loldrup, Gadsbøll Kasper, Sindet-Pedersen Caroline, Pallisgaard Jannik Langtved, Lamberts Morten, Lip Gregory Y. H., Torp-Pedersen Christian, Gislason Gunnar Hilmar, Olesen Jonas Bjerring, Non-vitamin K antagonist oral anticoagulation usage according to age among patients with atrial fibrillation: Temporal trends 2011–2015 in Denmark, 10.1038/srep31477
  35. , Camm A. J., Kirchhof P., Lip G. Y. H., Schotten U., Savelieva I., Ernst S., Van Gelder I. C., Al-Attar N., Hindricks G., Prendergast B., Heidbuchel H., Alfieri O., Angelini A., Atar D., Colonna P., De Caterina R., De Sutter J., Goette A., Gorenek B., Heldal M., Hohloser S. H., Kolh P., Le Heuzey J.-Y., Ponikowski P., Rutten F. H., Vahanian A., Auricchio A., Bax J., Ceconi C., Dean V., Filippatos G., Funck-Brentano C., Hobbs R., Kearney P., McDonagh T., Popescu B. A., Reiner Z., Sechtem U., Sirnes P. A., Tendera M., Vardas P. E., Widimsky P., Vardas P. E., Agladze V., Aliot E., Balabanski T., Blomstrom-Lundqvist C., Capucci A., Crijns H., Dahlof B., Folliguet T., Glikson M., Goethals M., Gulba D. C., Ho S. Y., Klautz R. J. M., Kose S., McMurray J., Perrone Filardi P., Raatikainen P., Salvador M. J., Schalij M. J., Shpektor A., Sousa J., Stepinska J., Uuetoa H., Zamorano J. L., Zupan I., , , , , Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC), 10.1093/eurheartj/ehq278
  36. Garkina SV, Vavilova TV, Lebedev DS, Mikhaylov EN. Compliance and adherence to oral anticoagulation therapy in elderly patients with atrial fibrillation in the era of direct oral anticoagulants. J Geriatr Cardiol. 2016;13(9):807–10.
  37. Vrijens B., Heidbuchel H., Non-vitamin K antagonist oral anticoagulants: considerations on once- vs. twice-daily regimens and their potential impact on medication adherence, 10.1093/europace/euu311
  38. Averlant Lorette, Ficheur Grégoire, Ferret Laurie, Boulé Stéphane, Puisieux François, Luyckx Michel, Soula Julien, Georges Alexandre, Beuscart Régis, Chazard Emmanuel, Beuscart Jean-Baptiste, Underuse of Oral Anticoagulants and Inappropriate Prescription of Antiplatelet Therapy in Older Inpatients with Atrial Fibrillation, 10.1007/s40266-017-0477-3
  39. Ali A, Bailey C, Abdelhafiz AH. Stroke prevention with oral anticoagulation in older people with atrial fibrillation—a pragmatic approach. Aging Dis. 2012;3(4):339–51.
  40. Ng Kuan H., Hart Robert G., Eikelboom John W., Anticoagulation in Patients Aged ≥75 years with Atrial Fibrillation: Role of Novel Oral Anticoagulants, 10.1007/s40119-013-0019-y
Bibliographic reference Henrard, Séverine ; Vandenabeele, Caroline ; Marien, Sophie ; Boland, Benoît ; Dalleur, Olivia. Underuse of Anticoagulation in Older Patients with Atrial Fibrillation and CHADS2 Score ≥ 2: Are We Doing Better Since the Marketing of Direct Oral Anticoagulants?. In: Drugs & Aging, Vol. Nov;34(11), p. 841-850 (2017)
Permanent URL http://hdl.handle.net/2078.1/190574