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 Printable version |
Adequacy between prescriptions and CHADS
2 score recommendations in geriatric patients |
Gériatrie et Psychologie Neuropsychiatrie du Vieillissement. Volume 9, Number 1, 39-44, Mars 2011, Article original
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 Résumé
Article gratuit
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Author(s) : Nolya Haïda, Marion Albouy-Llaty, Céline Baudemont, Fabienne Bellarbre, Marc Paccalin |
Summary : Atrial fibrillation (AF) is a major risk factor for stroke. Thromboprophylaxis with anticoagulant reduces the incidence of stroke and is warranted by the CHADS
2 recommendations when score ≥2. But such therapy remains underused particularly among elderly patients. The aim of our study was to evaluate the adequacy between prescriptions and CHADS
2 recommendations in geriatric hospitalised patients with AF.
Method: retrospective study set in the Geriatrics Department of the University hospital of Poitiers (France), of patients >75 y with AF, between July and December 2009. The description of the patients taken into the count: epidemiological data, functional daily activities (score GIR), cognitive assessment, antithrombotic treatment, and evaluation of the CHADS
2 and HEMORR
2HAGES scores.
Results: in this study161 hospitalisations were analysed, mean age of the patients was 87.4 ± 5.4 years. Antithrombotic treatment was prescribed in 84% of cases. The overall conformity to CHADS
2 recommendations was 44%. Most of hospitalisations (88.9%) included patients with CHADS
2 score ≥2. Non-conformity rate was up to 60% in this group with 5 significant variables: MMSE score <\;26 (OR: 3.17 [95%IC: 1.23-8.17]), high risk of bleeding (2.88 [1.28-6.47]), dementia (2.46 [1.01-5.95]), functional impairment (GIR score ≤4) (2.43 [1.23-4.84]) and history of fall (2.42 [1.13-5.17]). Still, the variables explained only 19% of the non-conform prescriptions and no variable was significantly relevant on multivariate analysis.
Discussion: our study show 56% of prescriptions that are non-conform to CHADS
2 recommendations, particularly in the elderly with a predictive embolic score ≥ 2. Antithrombotic treatment seems to be all the less conform as patients appear to be more vunerable. Due to the new score CHA
2DS
2-VASc, physicians really have to discuss the benefit-risk balance at an individual level. |
Keywords : atrial fibrillation, geriatrics, antithrombotic treatment, CHADS
2 score |
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