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Anticoagulation in older people with atrial fibrillation moving to care homes: a data linkage study

Leona A Ritchie Orcid Logo, Stephanie L Harrison Orcid Logo, Peter E Penson Orcid Logo, Ashley Akbari Orcid Logo, Fatemeh Torabi Orcid Logo, Joe Hollinghurst, Daniel Harris, Oluwakayode B Oke Orcid Logo, Asangaedem Akpan Orcid Logo, Julian Halcox Orcid Logo, Sarah Rodgers Orcid Logo, Gregory YH Lip Orcid Logo, Deirdre A Lane Orcid Logo

British Journal of General Practice, Volume: 73, Issue: 726, Pages: e43 - e51

Swansea University Authors: Ashley Akbari Orcid Logo, Fatemeh Torabi Orcid Logo, Joe Hollinghurst, Daniel Harris, Julian Halcox Orcid Logo, Sarah Rodgers Orcid Logo

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DOI (Published version): 10.3399/bjgp.2022.0156

Abstract

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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Published in: British Journal of General Practice
ISSN: 0960-1643 1478-5242
Published: Royal College of General Practitioners 2023
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URI: https://cronfa.swan.ac.uk/Record/cronfa61934
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2023-01-12T11:44:54.1408243</datestamp><bib-version>v2</bib-version><id>61934</id><entry>2022-11-15</entry><title>Anticoagulation in older people with atrial fibrillation moving to care homes: a data linkage study</title><swanseaauthors><author><sid>aa1b025ec0243f708bb5eb0a93d6fb52</sid><ORCID>0000-0003-0814-0801</ORCID><firstname>Ashley</firstname><surname>Akbari</surname><name>Ashley Akbari</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>f569591e1bfb0e405b8091f99fec45d3</sid><ORCID>0000-0002-5853-4625</ORCID><firstname>Fatemeh</firstname><surname>Torabi</surname><name>Fatemeh Torabi</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>d7c51b69270b644a11b904629fe56ab0</sid><firstname>Joe</firstname><surname>Hollinghurst</surname><name>Joe Hollinghurst</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>e60c9c73b645f0e8033ae26fa8e634b8</sid><firstname>Daniel</firstname><surname>Harris</surname><name>Daniel Harris</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>3676f695eeda169d0f8c618adf27c04b</sid><ORCID>0000-0001-6926-2947</ORCID><firstname>Julian</firstname><surname>Halcox</surname><name>Julian Halcox</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>e81e94dea293640575619d15baf34a35</sid><ORCID>0000-0002-4483-0845</ORCID><firstname>Sarah</firstname><surname>Rodgers</surname><name>Sarah Rodgers</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2022-11-15</date><deptcode>HDAT</deptcode><abstract>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 &#x2265;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 &#x2265;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.</abstract><type>Journal Article</type><journal>British Journal of General Practice</journal><volume>73</volume><journalNumber>726</journalNumber><paginationStart>e43</paginationStart><paginationEnd>e51</paginationEnd><publisher>Royal College of General Practitioners</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0960-1643</issnPrint><issnElectronic>1478-5242</issnElectronic><keywords>anticoagulants; atrial fibrillation; long-term care; nursing homes; practice patterns, physicians&amp;apos;; primary health care</keywords><publishedDay>1</publishedDay><publishedMonth>1</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-01-01</publishedDate><doi>10.3399/bjgp.2022.0156</doi><url/><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm/><funders>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).</funders><projectreference/><lastEdited>2023-01-12T11:44:54.1408243</lastEdited><Created>2022-11-15T22:55:45.4844404</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Leona A</firstname><surname>Ritchie</surname><orcid>0000-0002-0392-1767</orcid><order>1</order></author><author><firstname>Stephanie L</firstname><surname>Harrison</surname><orcid>0000-0002-8846-0946</orcid><order>2</order></author><author><firstname>Peter E</firstname><surname>Penson</surname><orcid>0000-0001-6763-1489</orcid><order>3</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>4</order></author><author><firstname>Fatemeh</firstname><surname>Torabi</surname><orcid>0000-0002-5853-4625</orcid><order>5</order></author><author><firstname>Joe</firstname><surname>Hollinghurst</surname><order>6</order></author><author><firstname>Daniel</firstname><surname>Harris</surname><order>7</order></author><author><firstname>Oluwakayode B</firstname><surname>Oke</surname><orcid>0000-0003-3964-8667</orcid><order>8</order></author><author><firstname>Asangaedem</firstname><surname>Akpan</surname><orcid>0000-0002-1764-8669</orcid><order>9</order></author><author><firstname>Julian</firstname><surname>Halcox</surname><orcid>0000-0001-6926-2947</orcid><order>10</order></author><author><firstname>Sarah</firstname><surname>Rodgers</surname><orcid>0000-0002-4483-0845</orcid><order>11</order></author><author><firstname>Gregory YH</firstname><surname>Lip</surname><orcid>0000-0002-7566-1626</orcid><order>12</order></author><author><firstname>Deirdre A</firstname><surname>Lane</surname><orcid>0000-0002-5604-9378</orcid><order>13</order></author></authors><documents><document><filename>61934__26269__39970157ad414194986b226f11b69d1d.pdf</filename><originalFilename>61934.pdf</originalFilename><uploaded>2023-01-12T11:41:57.3856789</uploaded><type>Output</type><contentLength>199729</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9;The Authors. This article is Open Access: CC BY 4.0 licence</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>http://creativecommons.org/licences/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling 2023-01-12T11:44:54.1408243 v2 61934 2022-11-15 Anticoagulation in older people with atrial fibrillation moving to care homes: a data linkage study aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false f569591e1bfb0e405b8091f99fec45d3 0000-0002-5853-4625 Fatemeh Torabi Fatemeh Torabi true false d7c51b69270b644a11b904629fe56ab0 Joe Hollinghurst Joe Hollinghurst true false e60c9c73b645f0e8033ae26fa8e634b8 Daniel Harris Daniel Harris true false 3676f695eeda169d0f8c618adf27c04b 0000-0001-6926-2947 Julian Halcox Julian Halcox true false e81e94dea293640575619d15baf34a35 0000-0002-4483-0845 Sarah Rodgers Sarah Rodgers true false 2022-11-15 HDAT 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. Journal Article British Journal of General Practice 73 726 e43 e51 Royal College of General Practitioners 0960-1643 1478-5242 anticoagulants; atrial fibrillation; long-term care; nursing homes; practice patterns, physicians&apos;; primary health care 1 1 2023 2023-01-01 10.3399/bjgp.2022.0156 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University 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). 2023-01-12T11:44:54.1408243 2022-11-15T22:55:45.4844404 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Leona A Ritchie 0000-0002-0392-1767 1 Stephanie L Harrison 0000-0002-8846-0946 2 Peter E Penson 0000-0001-6763-1489 3 Ashley Akbari 0000-0003-0814-0801 4 Fatemeh Torabi 0000-0002-5853-4625 5 Joe Hollinghurst 6 Daniel Harris 7 Oluwakayode B Oke 0000-0003-3964-8667 8 Asangaedem Akpan 0000-0002-1764-8669 9 Julian Halcox 0000-0001-6926-2947 10 Sarah Rodgers 0000-0002-4483-0845 11 Gregory YH Lip 0000-0002-7566-1626 12 Deirdre A Lane 0000-0002-5604-9378 13 61934__26269__39970157ad414194986b226f11b69d1d.pdf 61934.pdf 2023-01-12T11:41:57.3856789 Output 199729 application/pdf Version of Record true ©The Authors. This article is Open Access: CC BY 4.0 licence true eng http://creativecommons.org/licences/by/4.0/
title Anticoagulation in older people with atrial fibrillation moving to care homes: a data linkage study
spellingShingle Anticoagulation in older people with atrial fibrillation moving to care homes: a data linkage study
Ashley Akbari
Fatemeh Torabi
Joe Hollinghurst
Daniel Harris
Julian Halcox
Sarah Rodgers
title_short Anticoagulation in older people with atrial fibrillation moving to care homes: a data linkage study
title_full Anticoagulation in older people with atrial fibrillation moving to care homes: a data linkage study
title_fullStr Anticoagulation in older people with atrial fibrillation moving to care homes: a data linkage study
title_full_unstemmed Anticoagulation in older people with atrial fibrillation moving to care homes: a data linkage study
title_sort Anticoagulation in older people with atrial fibrillation moving to care homes: a data linkage study
author_id_str_mv aa1b025ec0243f708bb5eb0a93d6fb52
f569591e1bfb0e405b8091f99fec45d3
d7c51b69270b644a11b904629fe56ab0
e60c9c73b645f0e8033ae26fa8e634b8
3676f695eeda169d0f8c618adf27c04b
e81e94dea293640575619d15baf34a35
author_id_fullname_str_mv aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
f569591e1bfb0e405b8091f99fec45d3_***_Fatemeh Torabi
d7c51b69270b644a11b904629fe56ab0_***_Joe Hollinghurst
e60c9c73b645f0e8033ae26fa8e634b8_***_Daniel Harris
3676f695eeda169d0f8c618adf27c04b_***_Julian Halcox
e81e94dea293640575619d15baf34a35_***_Sarah Rodgers
author Ashley Akbari
Fatemeh Torabi
Joe Hollinghurst
Daniel Harris
Julian Halcox
Sarah Rodgers
author2 Leona A Ritchie
Stephanie L Harrison
Peter E Penson
Ashley Akbari
Fatemeh Torabi
Joe Hollinghurst
Daniel Harris
Oluwakayode B Oke
Asangaedem Akpan
Julian Halcox
Sarah Rodgers
Gregory YH Lip
Deirdre A Lane
format Journal article
container_title British Journal of General Practice
container_volume 73
container_issue 726
container_start_page e43
publishDate 2023
institution Swansea University
issn 0960-1643
1478-5242
doi_str_mv 10.3399/bjgp.2022.0156
publisher Royal College of General Practitioners
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description 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.
published_date 2023-01-01T04:13:21Z
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