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Adherence to recommendations of the Therapeutic Positioning Report about treatment with oral anticoagulants in elderly patients with atrial fibrillation. The ESPARTA study.

Abstract：

BACKGROUND AND OBJECTIVE:To evaluate the adherence to the recommendations in clinical practice performed by the Therapeutic Positioning Report (TPR) of the Spanish Agency of Medicines and Sanitary Products about the treatment with oral anticoagulants in patients aged≥75 years old with nonvalvular atrial fibrillation (NVAF) treated in Internal Medicine departments in Spain. PATIENTS AND METHODS:Observational, cross-sectional and multicenter study in which 837 patients aged≥75 years old with NVAF, with stable treatment with oral anticoagulants at least 3 months before inclusion, and that had started treatment with oral anticoagulants before the inclusion period were included. RESULTS:Mean age was 83.0±5.0 years old, mean CHADS2 score 3.2±1.2, mean CHA2DS2-VASc score 5.0±1.4, and mean HAS-BLED score 2.1±0.9. A percentage of 70.8 of patients were treated with vitamin K antagonists (VKA) and the rest of patients with direct oral anticoagulants (DOACs). A percentage of 65.6 of patients treated with VKA did not follow the recommendations made by the TPR compared with 43.0% of patients treated with DOACs (P<.0001). In the case of VKA, the main reason for being considered as not appropriate according to the TPR was having poor control of anticoagulation and not switching to DOACs, whereas in the case of DOACs, it was not receiving the adequate dose according to the TPR. CONCLUSIONS:In a high proportion of anticoagulated elderly patients with NVAF in Spain, the recommendations performed by the TPR are not followed, particularly with VKA, since patients are not switched to DOACs despite time in therapeutic range.

journal_name

Med Clin (Barc)

journal_title

Medicina clinica

authors

Suárez Fernández C,Mostaza JM,Castilla Guerra L,Cantero Hinojosa J,Suriñach JM,Acosta de Bilbao F,Tamarit JJ,Diaz Diaz JL,Hernandez JL,Cazorla D,Ràfols C,en nombre de los Investigadores del Estudio ESPARTA.

doi

10.1016/j.medcli.2017.07.025

subject

Has Abstract

pub_date

2018-07-13 00:00:00

pages

8-15

issue

eissn

0025-7753

issn

1578-8989

pii

S0025-7753(17)30653-X

journal_volume

151

pub_type

杂志文章,多中心研究

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Adherence to recommendations of the Therapeutic Positioning Report about treatment with oral anticoagulants in elderly patients with atrial fibrillation. The ESPARTA study.