title: The role of comprehensive geriatric assessment and functional status in evaluating the patterns of antithrombotic use among older people with atrial fibrillation.
abstract: Aim of the study is to investigate the use of antithrombotic drugs in older patients with atrial fibrillation (AF) at the time of hospital discharge. We enrolled 399 ≥65 years old patients with AF consecutively admitted to our acute geriatric unit from September 2012 to February 2014. Utilization of antithrombotic drugs, comorbidities, functional, mental and nutritional status were evaluated through a comprehensive geriatric assessment (CGA). A Logistic regression model was used to assess variables associated with antithrombotic use. On admission, 198 patients (49.6%) used oral anticoagulants (OAC), 125 (21.3%) antiplatelets, 32 (8%) low weight molecular heparin (LMWH) and 44 (11%) none of them. At discharge the proportion of patients on OAC increased to 55.7%. Age>90years (OR=2.57, CI=1.28-5.16, p-value=0.008), severe functional impairment (OR=3.38, CI=1.63-7.01, p-value=0.001), polypharmacy (OR=2.07, CI=1.1-3.86, p-value=0.023), HAS-BLED score (OR=1.64, CI=1.09-2.47, p-value=0.019) and ≥1 OAC contraindication (OR=5.01, CI=2.68-9.34, p-value<0.001) were all associated with OAC underuse. In conclusion, OAC is underused in geriatric patients with AF, while antiplatelet, LMWH and no antithrombotic therapy are relatively overused. Factors associated with the decision to not prescribe OAC lie on a mix of clinical and geriatric variables, among which functional status is particularly relevant.
authors.affiliation: School of Medicine and Surgery, University of Milano-Bicocca, Italy; Geriatric Unit, S. Gerardo Hospital, Monza, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Mazzone
authors.affiliation: SCDU Geriatria e Malattie Metaboliche dell'Osso, Città della Salute e della Scienza-Molinette, Torino, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bo
authors.affiliation: School of Medicine and Surgery, University of Milano-Bicocca, Italy; Center of Biostatistics for Clinical Epidemiology, University of Milano-Bicocca, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Lucenti
authors.affiliation: School of Medicine and Surgery, University of Milano-Bicocca, Italy; Center of Biostatistics for Clinical Epidemiology, University of Milano-Bicocca, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Galimberti
authors.affiliation: School of Medicine and Surgery, University of Milano-Bicocca, Italy; Geriatric Unit, S. Gerardo Hospital, Monza, Italy; Milan Center for Neuroscience (Neuro-Mi), Milan, Italy. Electronic address: giuseppe.bellelli@unimib.it.
authors.forename: G
authors.initials: G
authors.lastname: Bellelli
authors.affiliation: School of Medicine and Surgery, University of Milano-Bicocca, Italy; Geriatric Unit, S. Gerardo Hospital, Monza, Italy; Milan Center for Neuroscience (Neuro-Mi), Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Annoni
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D004363:Drug Utilization; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D015577:Geriatric Assessment; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D007558:Italy; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019338:Polypharmacy; D012189:Retrospective Studies; D020521:Stroke / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors
keywords: Antithrombotics; Atrial fibrillation; Comprehensive geriatric assessment; Elderly