Atrial fibrillation management in older hospitalized patients: Evidence of a poor oral anticoagulants prescriptive attitude from the Italian REPOSI registry

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics Pub Date : 2024-08-12 DOI:10.1016/j.archger.2024.105602

Vincenzo Arcoraci , Michelangelo Rottura , Viviana Maria Gianguzzo , Giovanni Pallio , Egidio Imbalzano , Alessandro Nobili , Giuseppe Natoli , Christiano Argano , Giovanni Squadrito , Natasha Irrera , Salvatore Corrao , REPOSI investigators

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引用次数: 0

Abstract

Atrial fibrillation (AF) prevalence increases in older patients which also show a high thromboembolic risk. Oral anticoagulants (OACs) are recommended to prevent cardioembolic events and direct oral anticoagulants (DOACs) improved anti-thrombotic treatment. However, the benefits/risks of anticoagulant in older patients still need to be completely defined.

This retrospective observational study aimed to describe the treatment with OACs in older AF hospitalized patients, and to identify factors influencing OAC therapy or discontinuation using the REgistro Politerapie SIMI.

Univariate and multivariate logistic regression models were applied to identify predictors of OACs treatment and discontinuation. Cox proportional hazards models were performed to evaluate one-year mortality by treatment groups.

AF patients were 1,128(26.5 %) at discharge and 1,098(97.3 %) required OAC treatment; about half of them (N = 528;48.1 %) were no-OACs users; 236(21.5 %) and 334(30.4 %) used DOACs and VKA, respectively.

Increasing DOACs use was observed during the study period. Predictors of OACs treatment were: BMI (OR:1.04; 95 %CI:1.01–1.07), Barthel index (OR:1.01; 95 %CI:1.01–1.02), medications number (OR:1.07; 95 %CI:1.01–1.13). Conversely, a lower probability was found in patients with a high CIR.S (OR:0.59; 95 %CI:0.36–0.97) and neoplasm (OR:0.57; 95 %CI:0.37–0.88). Hospital stay (OR:1.02; 95 %CI:1.01–1.05), neoplasm (OR:2.25; 95 %CI:1.07–4.70) and INR (OR:1.21; 95 %CI:1.05–1.40) increased OACs discontinuation. A lower discontinuation was observed in dyslipidemic patients (OR:0.18; 95 %CI:0.04–0.82) and heart failure (OR:0.38; 95 %CI:0.21–0.70). Among AF patients, 157(14.3 %) died during the follow-up year. Age (HR = 1.05; 95 %CI = 1.03–1.08) and CIR.S (HR = 2.54; 95 %CI = 1.53–4.21) were associated with a greater mortality risk. In conclusion, critical issues related to the underuse and discontinuation of OACs therapy in hospitalized older patients were highlighted.

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老年住院患者的心房颤动管理：来自意大利 REPOSI 登记处的证据表明，口服抗凝剂的处方态度不佳。

心房颤动（房颤）在老年患者中的发病率越来越高，而老年患者的血栓栓塞风险也很高。建议使用口服抗凝剂（OAC）来预防心栓塞事件，而直接口服抗凝剂（DOAC）可改善抗血栓治疗。然而，抗凝剂对老年患者的益处/风险仍有待完全明确。这项回顾性观察研究旨在描述老年房颤住院患者使用 OACs 治疗的情况，并使用 REgistro Politerapie SIMI 确定影响 OAC 治疗或停药的因素。采用单变量和多变量逻辑回归模型来确定OACs治疗和停药的预测因素。采用 Cox 比例危险度模型评估各治疗组的一年死亡率。心房颤动患者中有 1,128 人（26.5%）在出院时需要接受 OAC 治疗，1,098 人（97.3%）需要接受 OAC 治疗；其中约半数患者（N = 528；48.1%）未使用 OACs；236 人（21.5%）和 334 人（30.4%）分别使用 DOACs 和 VKA。在研究期间，观察到 DOACs 的使用量不断增加。OACs治疗的预测因素包括体重指数（OR：1.04；95 %CI：1.01-1.07）、巴特尔指数（OR：1.01；95 %CI：1.01-1.02）、用药次数（OR：1.07；95 %CI：1.01-1.13）。相反，CIR.S高（OR：0.59；95 %CI：0.36-0.97）和肿瘤（OR：0.57；95 %CI：0.37-0.88）患者的概率较低。住院时间（OR：1.02；95 %CI：1.01-1.05）、肿瘤（OR：2.25；95 %CI：1.07-4.70）和 INR（OR：1.21；95 %CI：1.05-1.40）会增加 OACs 的停药率。血脂异常患者（OR：0.18；95 %CI：0.04-0.82）和心力衰竭患者（OR：0.38；95 %CI：0.21-0.70）的停药率较低。心房颤动患者中有 157 人（14.3%）在随访期间死亡。年龄（HR = 1.05; 95 %CI = 1.03-1.08）和CIR.S（HR = 2.54; 95 %CI = 1.53-4.21）与更高的死亡风险相关。总之，与住院老年患者OACs使用不足和停药有关的关键问题得到了强调。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Archives of gerontology and geriatrics 医学-老年医学

CiteScore

7.30

自引率

5.00%

发文量

198

审稿时长

16 days

期刊介绍： Archives of Gerontology and Geriatrics provides a medium for the publication of papers from the fields of experimental gerontology and clinical and social geriatrics. The principal aim of the journal is to facilitate the exchange of information between specialists in these three fields of gerontological research. Experimental papers dealing with the basic mechanisms of aging at molecular, cellular, tissue or organ levels will be published. Clinical papers will be accepted if they provide sufficiently new information or are of fundamental importance for the knowledge of human aging. Purely descriptive clinical papers will be accepted only if the results permit further interpretation. Papers dealing with anti-aging pharmacological preparations in humans are welcome. Papers on the social aspects of geriatrics will be accepted if they are of general interest regarding the epidemiology of aging and the efficiency and working methods of the social organizations for the health care of the elderly.