title: Evaluation of compliance with recommendations of prevention of thromboembolism in atrial fibrillation in the elderly, by data reuse of electronic health records.
abstract: Under-prescription of anticoagulants in the elderly with atrial fibrillation (AF) has been described in several studies, showing that only 15 to 44% of them receive anticoagulants. However, the European Society of Cardiology recommendations state that anticoagulants should be systematically prescribed. In case of refusal of the treatment by the patient, a platelet aggregation inhibitor should be prescribed in monotherapy or bitherapy according to the HAS-BLED bleeding risk score. In all the cases the patient should receive an antithrombotic treatment. In this work we observe the adequacy of prescription practices to the recommendations for AF in the elderly by data reuse on a monocentric observational retrospective cohort. Data of a 222 beds French community hospital were extracted for the year 2013. The patients aged over 75 years and presenting AF were selected. The HAS-BLED score was calculated and the consistency of the prescriptions with the recommendations of the European Society of Cardiology was verified. Then the compliance rate to the recommendations was calculated. The rules detected 433 patients with AF and aged over 75 years. From those patients, 45% received an anticoagulant, 32.1% received platelet aggregation inhibitors and 22.9% did not receive any antithrombotic treatment. When a platelet aggregation inhibitor was prescribed the recommendation for bitherapy was not followed in 97% of the cases. The compliance rate to the recommendations was 47.8%. This work highlights a major problem of quality of the prescriptions in the hospital field and shows how data reuse can help describing this type of issues.
authors.affiliation: Pharmacology and clinical pharmacy laboratory, EA 4481; University of Lille; F-59000 Lille, France.
authors.forename: Laurie
authors.initials: L
authors.lastname: Ferret
authors.affiliation: Geriatric department, Lille University Hospital; F-59000 Lille, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Beuscart
authors.affiliation: Public Health Department, Lille University Hospital; EA 2694; University of Lille; F-59000 Lille, France.
authors.forename: Grégoire
authors.initials: G
authors.lastname: Ficheur
authors.affiliation: Public Health Department, Lille University Hospital; EA 2694; University of Lille; F-59000 Lille, France.
authors.forename: Régis
authors.initials: R
authors.lastname: Beuscart
authors.affiliation: Pharmacology and clinical pharmacy laboratory, EA 4481; University of Lille; F-59000 Lille, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Luyckx
authors.affiliation: Public Health Department, Lille University Hospital; EA 2694; University of Lille; F-59000 Lille, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chazard
mesh_terms: D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology; D002309:Cardiology / Q000592:standards; D015984:Causality; D015897:Comorbidity; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D017723:Drug Utilization Review; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005602:France / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control / Q000706:statistics & numerical data*; D015994:Incidence; D008297:Male; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D013923:Thromboembolism / Q000453:epidemiology / Q000517:prevention & control*; D014600:Utilization Review
chemical_list: D005343:Fibrinolytic Agents