TY - JOUR
T1 - Effect of New Oral Anticoagulants on Prescribing Practices for Atrial Fibrillation in Older Adults
AU - Fohtung, Raymond B.
AU - Novak, Eric
AU - Rich, Michael W.
N1 - Funding Information:
Financial Disclosure: This research was supported by the Mentors in Medicine program of the Department of Medicine and Division of Medical Education at the Washington University School of Medicine and Just-in-Time Grant ID# CI044 from the Washington University Institute of Clinical and Translation Sciences Grant UL1 TR000448 from the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official view of NIH.
Publisher Copyright:
© 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society
PY - 2017/11
Y1 - 2017/11
N2 - Objectives: To determine the effect of new oral anticoagulants (NOACs) on prescribing practices in older adults with atrial fibrillation (AF). Design: Retrospective observational cohort study. Setting: Academic medical center in St. Louis, Missouri. Participants: Individuals aged 75 and older with AF admitted to the hospital from October 2010 through September 2015 (N = 6,568, 50% female, 15% non-white). Measurements: Information on NOACs and warfarin prescribed at discharge was obtained from hospital discharge summaries, and linear regression was used to examine quarterly trends in their use. Multivariable logistic regression was used to assess independent predictors of anticoagulant use. Results: NOAC use increased over time (correlation coefficient (r) = 0.87, P <.001), warfarin use did not change (r = −0.16, P =.50), and overall anticoagulant use (NOACs and warfarin) increased (r = 0.68, P =.001). NOAC use increased over time in all age groups (75–79, 80–84, 85–89) except aged 90 and older, but increasing age attenuated the rate of NOAC uptake. There was no consistent relationship between age and warfarin or overall anticoagulant use, except that individuals aged 90 and older had consistently lower use. Overall, fewer than 45% of participants were prescribed an anticoagulant. In multivariable analysis, younger age, white race, female sex, higher hemoglobin, higher creatinine clearance, being on a medical service, hypertension, stroke or transient ischemic attack, no history of intracranial hemorrhage, and a modified HAS-BLED score of less than 3 increased the likelihood of receiving NOACs. Conclusion: Prescription of anticoagulants for AF increased in older adults primarily because of an increase in the use of NOACs. Nonetheless, fewer than 45% of participants were prescribed an anticoagulant. Additional research is needed to optimize prescribing practices for older adults with AF.
AB - Objectives: To determine the effect of new oral anticoagulants (NOACs) on prescribing practices in older adults with atrial fibrillation (AF). Design: Retrospective observational cohort study. Setting: Academic medical center in St. Louis, Missouri. Participants: Individuals aged 75 and older with AF admitted to the hospital from October 2010 through September 2015 (N = 6,568, 50% female, 15% non-white). Measurements: Information on NOACs and warfarin prescribed at discharge was obtained from hospital discharge summaries, and linear regression was used to examine quarterly trends in their use. Multivariable logistic regression was used to assess independent predictors of anticoagulant use. Results: NOAC use increased over time (correlation coefficient (r) = 0.87, P <.001), warfarin use did not change (r = −0.16, P =.50), and overall anticoagulant use (NOACs and warfarin) increased (r = 0.68, P =.001). NOAC use increased over time in all age groups (75–79, 80–84, 85–89) except aged 90 and older, but increasing age attenuated the rate of NOAC uptake. There was no consistent relationship between age and warfarin or overall anticoagulant use, except that individuals aged 90 and older had consistently lower use. Overall, fewer than 45% of participants were prescribed an anticoagulant. In multivariable analysis, younger age, white race, female sex, higher hemoglobin, higher creatinine clearance, being on a medical service, hypertension, stroke or transient ischemic attack, no history of intracranial hemorrhage, and a modified HAS-BLED score of less than 3 increased the likelihood of receiving NOACs. Conclusion: Prescription of anticoagulants for AF increased in older adults primarily because of an increase in the use of NOACs. Nonetheless, fewer than 45% of participants were prescribed an anticoagulant. Additional research is needed to optimize prescribing practices for older adults with AF.
KW - CHADS-VASc score
KW - atrial fibrillation
KW - creatinine clearance
KW - dementia
KW - new oral anticoagulants
KW - oral anticoagulants
KW - race
KW - warfarin
UR - http://www.scopus.com/inward/record.url?scp=85034103150&partnerID=8YFLogxK
U2 - 10.1111/jgs.15058
DO - 10.1111/jgs.15058
M3 - Article
C2 - 28832920
AN - SCOPUS:85034103150
SN - 0002-8614
VL - 65
SP - 2405
EP - 2412
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 11
ER -