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Hospitalization as an opportunity to correct errors in anticoagulant treatment in patients with atrial fibrillation.

Abstract：

AIMS:To assess whether hospitalization may assist in correcting errors in anticoagulant therapy among patients with atrial fibrillation (AF). METHODS:Our cohort included patients admitted to our institution with a history of AF between 2016 and 2018. We categorized patient's treatment upon admission and discharge as lacking (no treatment despite indication), inadequate (according to individual characteristics) or adequate. We assessed adequacy of treatment upon discharge and determined factors associated with correcting admission errors. RESULTS:Of 4427 patients admitted with a history of AF, the categorization to lacking, inadequate and adequate treatment was 1746 (39.4%), 1237 (27.9%) and 1444 (32.6%) patients, respectively. Of those with inadequate treatment, the most common types of errors were direct oral anticoagulant (DOAC) underdosing (n = 578; 46.7%), vitamin-K antagonists when DOAC was indicated (n = 258; 20.9%), DOAC despite contraindication to DOAC (n = 166; 13.4%) and DOAC overdosing (n = 124; 10%). Upon discharge 688 (18.6%, out of n = 3694) corrections but also 316 (8.6%) new mistakes were found. On multivariate logistic regression, the factors associated with correction of an error on admission were hospitalization due to AF (odds ratio [OR] 2.94 [2.39-3.61]), hospitalization in the neurologic or geriatric wards (OR 2.79 [2.04-3.80]), female sex (OR 1.34 [1.10-1.63]) and a history of stroke (OR 1.47 [1.17-1.86]), while the presence of a contraindication to DOAC decreased the chance of correction (OR 0.10 [0.06-0.18]). CONCLUSION:Hospitalization for any reason may contribute to correction of errors in AC treatment in patients with AF. Unfortunately, a significant portion of patients remains inadequately treated by both outpatient and inpatient providers.

journal_name

Br J Clin Pharmacol

journal_title

British journal of clinical pharmacology

authors

Angel Y,Zeltser D,Berliner S,Ingbir M,Shapira I,Shenhar-Tsarfaty S,Rogowski O

doi

10.1111/bcp.14116

subject

Has Abstract

pub_date

2019-12-01 00:00:00

pages

2838-2847

issue

eissn

0306-5251

issn

1365-2125

journal_volume

pub_type

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Hospitalization as an opportunity to correct errors in anticoagulant treatment in patients with atrial fibrillation.