title: [Adequacy between prescriptions and CHADS(2) score recommendations in geriatric patients].
abstract: Atrial fibrillation (AF) is a major risk factor for stroke. Thromboprophylaxis with anticoagulant reduces the incidence of stroke and is warranted by the CHADS(2) recommendations when score ≥2. But such therapy remains underused particularly among elderly patients. The aim of our study was to evaluate the adequacy between prescriptions and CHADS(2) recommendations in geriatric hospitalised patients with AF.
  
  
  METHODS
  retrospective study set in the Geriatrics Department of the University hospital of Poitiers (France), of patients >75 y with AF, between July and December 2009. The description of the patients taken into the count: epidemiological data, functional daily activities (score GIR), cognitive assessment, antithrombotic treatment, and evaluation of the CHADS(2) and HEMORR(2)HAGES scores.
  
  
  RESULTS
  in this study161 hospitalisations were analysed, mean age of the patients was 87.4 ± 5.4 years. Antithrombotic treatment was prescribed in 84% of cases. The overall conformity to CHADS(2) recommendations was 44%. Most of hospitalisations (88.9%) included patients with CHADS(2) score ≥2. Non-conformity rate was up to 60% in this group with 5 significant variables: MMSE score <26 (OR: 3.17 [95%IC: 1.23-8.17]), high risk of bleeding (2.88 [1.28-6.47]), dementia (2.46 [1.01-5.95]), functional impairment (GIR score ≤4) (2.43 [1.23-4.84]) and history of fall (2.42 [1.13-5.17]). Still, the variables explained only 19% of the non-conform prescriptions and no variable was significantly relevant on multivariate analysis.
  
  
  CONCLUSIONS
  our study show 56% of prescriptions that are non-conform to CHADS(2) recommendations, particularly in the elderly with a predictive embolic score ≥ 2. Antithrombotic treatment seems to be all the less conform as patients appear to be more vunerable. Due to the new score CHA(2)DS(2)-VASc, physicians really have to discuss the benefit-risk balance at an individual level.
authors.affiliation: Département de gériatrie-Pôle médecine. m.paccalin@chu-poitiers.fr
authors.forename: Nolya
authors.initials: N
authors.lastname: Haïda
authors.forename: Marion
authors.initials: M
authors.lastname: Albouy-Llaty
authors.forename: Céline
authors.initials: C
authors.lastname: Baudemont
authors.forename: Fabienne
authors.initials: F
authors.lastname: Bellarbre
authors.forename: Marc
authors.initials: M
authors.lastname: Paccalin
mesh_terms: D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005602:France; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006305:Health Status Indicators; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
chemical_list: D005343:Fibrinolytic Agents