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Characteristics of warfarin under-prescription in older adults with atrial fibrillation. IJC HEART & VASCULATURE 2021; 37:100914. [PMID: 34825049 PMCID: PMC8603017 DOI: 10.1016/j.ijcha.2021.100914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/27/2021] [Accepted: 10/31/2021] [Indexed: 12/04/2022]
Abstract
Background The prevalence of atrial fibrillation (AF) and atrial flutter (AFl) increases with age. Under-prescription of anticoagulants in older adults can lead to increased morbidity and mortality. We analyzed warfarin prescription patterns in older adults. Methods In this observational single-center study, we analyzed 2179 consecutive patients with admission diagnosis of AF or AFl. Patients were divided into “older” (≥ 75 years old) and “younger” (<75 years old) groups. Prescription patterns of warfarin were analyzed. Patients discharged from the hospital on a non-warfarin anticoagulation were excluded. Results Of the 1988 patients analyzed, 46.9% were ≥75 years old, of which 50.8% were prescribed warfarin. There was no association between mean CHA2DS2-VASc score and warfarin prescription on discharge (OR = 1.06 (95% CI 0.93–1.21), p = 0.388) in the older group. After adjusting for hypertension, renal function, and Black race, warfarin prescription in older adults was independently associated with lower aspirin prescription rates (OR = 0.57 (95% CI 0.43–0.75), p < 0.001), lower body mass index (OR = 1.03 (95% CI 1.01–1.06), p = 0.018), and lower hemoglobin levels (OR = 1.11 (95% CI 1.04–1.19), p = 0.002). Conclusions In our study, older adults (≥75 years old) with AF and AFl tended to have lower rates of warfarin prescription despite higher CHA2DS2-VASc score and higher risk of thromboembolic events. Anemia, lower body weight, and aspirin use were characteristics associated with warfarin under-prescription.
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Alalwan MA, Al-Ohaid F, Alhajjaj HM, Al Hazeem A, AlJulaih GH, Al-Khedher R, Alshehri A, Jatoi NA. Stroke Prevention Therapy and Prevalence of Risk Factors Among Patients With Atrial Fibrillation at King Fahad University Hospital in Al Khobar: A Retrospective, Single-Center Study. Cureus 2021; 13:e12493. [PMID: 33425559 PMCID: PMC7785493 DOI: 10.7759/cureus.12493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Atrial fibrillation is the most common cardiac arrhythmia in clinical practice. It represents a significant health impact as it is greatly associated with increased risk of mortality and morbidity, most importantly stroke and systemic thromboembolism. Aim This study aims to determine the risk factors of atrial fibrillation, to identify stroke and bleeding risk factors among patients with atrial fibrillation, to assess the trend of stroke prevention management and the influence of CHA2DS2-VASc and HAS-BLED scores on choosing the treatment. Methods This study was performed using all the medical records of 395 patients with Atrial fibrillation who were admitted between 2011-2019 at King Fahd University Hospital, Al-Khobar, Saudi Arabia. The review process included demographic data of the patients and the calculation of stroke and bleeding risk by CHA2DS2-VASc and HAS-BLED scores. Results The median age of the population was 72 years old. Hypertension was the most common risk factor for atrial fibrillation (78.2%), followed by diabetes mellitus (61.0%), dyslipidemia (60.0%), coronary artery disease (41.0%), myocardial infarction (18.7%), and congestive heart failure (29.4%). Regarding the management, (42.5%) of the patients were on a combination of both anticoagulants and antiplatelet therapy, while (33.2%) were on anticoagulant therapy only, (17.5%) were on antiplatelets only, and (5.8%) were not on medication. The increased use of anticoagulants and combined therapy was related to the percentage of a high-risk group of thromboembolic events reaching up to (34.5%) and (45.7%), respectively, which is statistically significant. Moreover, the prescription of warfarin declined in the last five years of our study, while the use of non-vitamin K antagonist oral anticoagulants increased. Conclusion Atrial fibrillation is more prevalent in females, hypertension was the most common risk factor for atrial fibrillation, followed by diabetes mellitus, and dyslipidemia. Most of the studied population was categorized as a high risk of stroke and bleeding according to CHA2DS2-VASc and HAS- BLED scores. The majority of the atrial fibrillation patient were taking anticoagulants and combined treatment as a stroke prevention therapy. Non-vitamin K antagonist oral anticoagulant prescription increased over warfarin in recent years.
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Affiliation(s)
- Maryam A Alalwan
- Internal Medicine, Imam Abdulrahman Bin Faisal University, Al Khobar, SAU
| | - Fatimah Al-Ohaid
- Internal Medicine, Imam Abdulrahman Bin Faisal University, Al Khobar, SAU
| | - Huda M Alhajjaj
- Internal Medicine, Imam Abdulrahman Bin Faisal University, Al Khobar, SAU
| | - Ahlam Al Hazeem
- Internal Medicine, Imam Abdulrahman Bin Faisal University, Al Khobar, SAU
| | - Ghadeer H AlJulaih
- Internal Medicine, Imam Abdulrahman Bin Faisal University, Al Khobar, SAU
| | - Rabab Al-Khedher
- Internal Medicine, Imam Abdulrahman Bin Faisal University, Al Khobar, SAU
| | - Abdullah Alshehri
- Internal Medicine, Imam Abdulrahman Bin Faisal University, King Fahad University Hospital, Al Khobar, SAU
| | - Noor-Ahmed Jatoi
- Internal Medicine, Imam Abdulrahman Bin Faisal University, King Fahad University Hospital, Al Khobar, SAU
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Mizokami Y, Yamamoto T, Atarashi H, Yamashita T, Akao M, Ikeda T, Koretsune Y, Okumura K, Shimizu W, Tsutsui H, Toyoda K, Hirayama A, Yasaka M, Yamaguchi T, Teramukai S, Kimura T, Kaburagi J, Takita A, Inoue H. Current status of proton pump inhibitor use in Japanese elderly patients with non-valvular atrial fibrillation: A subanalysis of the ANAFIE Registry. PLoS One 2020; 15:e0240859. [PMID: 33151969 PMCID: PMC7644054 DOI: 10.1371/journal.pone.0240859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/04/2020] [Indexed: 01/16/2023] Open
Abstract
The real-world status of proton pump inhibitor (PPI) use in patients with atrial fibrillation (AF) receiving antithrombotic treatment is largely unknown. The All Nippon AF In the Elderly (ANAFIE) Registry, a prospective, multicenter, observational study, aimed to determine treatment patterns, risk factors, and outcomes among elderly (aged ≥75 years) Japanese non-valvular AF (NVAF) patients in the real-world clinical setting. The present subanalysis of the ANAFIE Registry determined the PPI prescription status of 32,490 elderly Japanese NVAF patients. Patients were stratified by PPI use (PPI+) or no PPI use (PPI−). Risk scores for stroke (CHADS2, CHA2DS2-VASc) and bleeding (HAS-BLED), anticoagulant use, time in therapeutic range (TTR) for warfarin, and anticoagulant/antiplatelet combination use were evaluated. PPIs were used in 11,981 (36.9%) patients. Compared with the PPI− group, the PPI+ group included a greater proportion of female patients (45.2% vs 41.3%; P <0.0001) and had significantly higher CHADS2, CHA2DS2-VASc, and HAS-BLED scores (P <0.0001 for each) as well as higher prevalences of several comorbidities. In the PPI+ group, 54.6% of patients did not have gastrointestinal (GI) disorders and were likely prescribed a PPI to prevent GI bleeding events. Most of the patients with a GI disorder in the PPI+ group had reflux esophagitis. Compared with patients not receiving anticoagulants, a significantly higher proportion of patients receiving anticoagulants received PPIs. For patients receiving anticoagulants, antiplatelet drugs, and both drugs, rates of PPI use were 34.1%, 44.1%, and 53.5%, respectively (P <0.01). Although the rate of PPI use was the highest for NVAF patients receiving both antiplatelet and anticoagulants, no clear differences were observed in the anticoagulants used. These data suggest that PPIs were actively prescribed in high-risk cases and may have been used to prevent GI bleeding among elderly NVAF patients receiving antithrombotic drugs. Trial registration:UMIN000024006
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Affiliation(s)
- Yuji Mizokami
- Department of Gastroenterology, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Takatsugu Yamamoto
- Department of Medicine, Teikyo University, Itabashi City, Tokyo, Japan
- * E-mail:
| | | | | | - Masaharu Akao
- National Hospital Organization Kyoto Medical Center, Fushimi Ward, Kyoto, Japan
| | - Takanori Ikeda
- Toho University Omori Medical Center, Ota City, Tokyo, Japan
| | - Yukihiro Koretsune
- National Hospital Organization Osaka National Hospital, Chuo Ward, Osaka, Japan
| | - Ken Okumura
- Saiseikai Kumamoto Hospital, Minami Ward, Kumamoto, Japan
| | | | | | - Kazunori Toyoda
- National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | | | - Masahiro Yasaka
- National Hospital Organization Kyushu Medical Center, Chuo Ward, Fukuoka, Japan
| | | | - Satoshi Teramukai
- Kyoto Prefectural University of Medicine, Kamigyo Ward, Kyoto, Japan
| | - Tetsuya Kimura
- Medical Science Department, Daiichi Sankyo Co., Ltd., Chuo City, Tokyo, Japan
| | - Jumpei Kaburagi
- Medical Science Department, Daiichi Sankyo Co., Ltd., Chuo City, Tokyo, Japan
| | - Atsushi Takita
- Biostatistics and Data Management Department, Daiichi Sankyo Co., Ltd., Shinagawa-ku, Tokyo, Japan
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