Does hospitalisation improve oral anticoagulant optimisation in patients with atrial fibrillation?

IF 4.4 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Clinical Investigation Pub Date : 2025-02-14 DOI:10.1111/eci.70011

Belayneh Kefale, Gregory M. Peterson, Corinne Mirkazemi, Nathan B. Dwyer, Mohammed S. Salahudeen, Janette Radford, Camille M. Boland, Woldesellassie M. Bezabhe

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引用次数: 0

Abstract

Background

Hospitalisation offers an opportunity for medication review and correction, yet it has received little attention. We aimed to evaluate oral anticoagulant (OAC) use in patients with atrial fibrillation at hospital admission and discharge and determine whether hospitalisation improves care.

Methods

We conducted an observational study at the Royal Hobart Hospital, Australia, in patients with atrial fibrillation. The appropriateness of stroke-prevention therapy at admission and discharge was evaluated using Australian guidelines. Factors associated with correcting inappropriate OAC therapy were identified using multiple logistic regression.

Results

Among 902 patients, 47.1% (n = 425) were receiving inappropriate OAC therapy at admission. The most common errors included lack of OAC therapy (58.6%, n = 249) and underdosing of direct-acting OACs (15.5%, n = 66). OAC therapy appropriateness at discharge was assessed for 844 patients; 73.8% were receiving appropriate therapy (versus 53.8% at admission (p < .001)). Specifically, 49.0% (n = 191) of the admission therapy errors were corrected. Correction was more likely in patients admitted to the stroke (adjusted odds ratio [aOR]: 16.93, 95% CI: 1.31–218.48) or cardiology wards (aOR: 4.10, 95% CI: 1.94–8.64), and if bleeding occurred during hospitalisation (aOR: 4.01, 95% CI: 1.07–14.99). Conversely, receiving rivaroxaban at admission (aOR: .23, 95% CI: .11–.51) and having a medium or high bleeding risk (ORBIT score ≥3) (aOR: .46, 95% CI: .25–.84) decreased the likelihood of correction.

Conclusion

Hospitalisation improved OAC therapy appropriateness; however, 51.0% of patients admitted with inappropriate therapy continued without correction. An intervention that enhances the hospital care team correcting inappropriate OAC therapy is warranted.

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住院治疗是否能改善房颤患者的口服抗凝药物优化？

背景：住院治疗为药物审查和纠正提供了机会，但很少受到重视。我们的目的是评估口服抗凝剂（OAC）在房颤患者入院和出院时的使用情况，并确定住院治疗是否能改善护理。方法：我们在澳大利亚皇家霍巴特医院对房颤患者进行了一项观察性研究。采用澳大利亚指南评估入院和出院时卒中预防治疗的适宜性。使用多元逻辑回归确定与纠正不适当OAC治疗相关的因素。结果：902例患者中，47.1% （n = 425）患者在入院时接受了不适当的OAC治疗。最常见的错误包括缺乏OAC治疗（58.6%,n = 249）和直接作用OAC剂量不足（15.5%,n = 66）。844例患者出院时评估OAC治疗的适宜性；73.8%的患者接受了适当的治疗（入院时为53.8%）。然而，51.0%接受不适当治疗的患者继续未纠正。加强医院护理团队纠正不适当的OAC治疗的干预是必要的。

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

European Journal of Clinical Investigation 医学-医学：内科

CiteScore

9.50

自引率

3.60%

发文量

192

审稿时长

1 months

期刊介绍： EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.