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Anticoagulation in older people with atrial fibrillation moving to care homes: a data linkage study
British Journal of General Practice, Volume: 73, Issue: 726, Pages: e43 - e51
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Background: Treatment decisions about oral anticoagulants (OAC) for atrial fibrillation (AF) are complex in older care home residents. Aim: To explore factors associated with OAC prescription. Design and Setting: Retrospective cohort study set in care homes in Wales, United Kingdom, listed in the Ca...
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Royal College of General Practitioners
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Background: Treatment decisions about oral anticoagulants (OAC) for atrial fibrillation (AF) are complex in older care home residents. Aim: To explore factors associated with OAC prescription. Design and Setting: Retrospective cohort study set in care homes in Wales, United Kingdom, listed in the Care Inspectorate Wales Registry 2017/18. Method: Analysis of anonymised individual-level electronic health and administrative data on people aged ≥65 years entering a care home between 1st January 2003 and 31st December 2018, provisioned from the Secure Anonymised Information Linkage Databank. Results: Between 2003 and 2018, 14,493 people with AF aged ≥65 years became new residents in care homes in Wales and 7,057 (48.7%) were prescribed OAC (32.7% in 2003 compared to 72.7% in 2018) within six months prior to care entry. Increasing age and prescription of antiplatelet therapy were associated with lower odds of OAC prescription (adjusted odds ratio [aOR] 0.96 per one year age increase [95% confidence interval [CI] 0.95 to 0.96] and aOR 0.91 [0.84 to 0.98], respectively). Conversely, prior venous thromboembolism (aOR 4.06 [3.17 to 5.20]), advancing frailty (mild: aOR 4.61 [3.95 to 5.38]; moderate: aOR 6.69 [5.74 to 7.80]; severe: aOR 8.42 [7.16 to 9.90]) and year of care home entry from 2011 onwards (aOR 1.91 [1.76 to 2.06]) were associated with higher odds of OAC prescription. Conclusions: There has been an increase in OAC prescribing in older people newly admitted to care homes with AF. This study provides an insight into the factors influencing OAC prescribing in this population.
anticoagulants; atrial fibrillation; long-term care; nursing homes; practice patterns, physicians'; primary health care
Faculty of Medicine, Health and Life Sciences
No specific funding was received for this work. This work was supported by Health Data
Research UK [HDR-9006] which receives its funding from the UK Medical Research Council;
Engineering and Physical Sciences Research Council; Economic and Social Research Council;
Department of Health and Social Care (England); Chief Scientist Office of the Scottish
Government Health and Social Care Directorates; Health and Social Care Research and
Development Division (Welsh Government); Public Health Agency (Northern Ireland); British
Heart Foundation (BHF) and the Wellcome Trust and Administrative Data Research UK which
is funded by the Economic and Social Research Council [grant ES/S007393/1]. SER is partfunded by the National Institute for Health Research (NIHR) Applied Research Collaboration
North West Coast (ARC NWC).