Dementia correlates with anticoagulation underuse in older patients with atrial fibrillation
| Autor: | Evaristo Ettorre, Iulia Maria Chiriac, Giovanni Viscogliosi |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Aging medicine.medical_specialty Health (social science) Clinical Dementia Rating Administration Oral underuse 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Rating scale Internal medicine Atrial Fibrillation Antithrombotic medicine Humans Dementia Medical prescription Geriatric Assessment Aged Retrospective Studies Aged 80 and over business.industry Anticoagulants Retrospective cohort study Atrial fibrillation medicine.disease Mental health Stroke Cross-Sectional Studies Physical therapy anticoagulants atrial fibrillation dementia health (social science) aging gerontology geriatrics and gerontology Female Geriatrics and Gerontology business Gerontology 030217 neurology & neurosurgery |
| Zdroj: | Archives of Gerontology and Geriatrics. 72:108-112 |
| ISSN: | 0167-4943 |
| Popis: | Objectives Stroke prevention in older atrial fibrillation (AF) patients remains a challenge. This study aimed to investigate whether a dementia diagnosis is an independent correlate of lower prescription rate of oral anticoagulant treatment (OAT) in a sample of older AF patients. Methods Cross-sectional retrospective study. Consecutive older community-dwelling AF patients referred for a comprehensive geriatric assessment, were considered. Evaluation of physical, social and mental health, and administration of the Cumulative Illness Rating Scale (CIRS) and Barthel Index were performed. Dementia cases were ascertained by consensus of 2 experienced geriatricians. Dementia severity was assessed using the Clinical Dementia Rating scale (CDR). Results 316 AF patients (ages 74.7 ± 7.0 years, 55.7% women) with high stroke risk (77.5% had a CHA2DS2VASC score ≥3), low bleeding and falling risk, and no neuropsychiatric/behavioral symptoms, were included. 60.1% were prescribed with OAT. Among patients with dementia (n = 86, 27.2%), 22.0% received inadequate antithrombotic prophylaxis (i.e. antiplatelet) and 38.5% no treatment. Proportion of those receiving inadequate or no prophylaxis increased at increasing CDR score. By multiple regression models, either dementia (yes vs no), OR = 1.33, 95%CI = 1.11–1.46, p 1), OR = 2.38, 95%CI = 2.19–2.60, p Conclusions Dementia might be associated with underuse of OAT in older AF patients even in the absence of established contraindications. Future studies are needed to assess the real dimension of the problem and clinician’s barriers to prescribing OAT in demented patients. |
| Databáze: | OpenAIRE |
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