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

Leona A. Ritchie; Stephanie L. Harrison; Peter E. Penson; Ashley Akbari; Fatemeh Torabi; Joe Hollinghurst; Daniel Harris; Oluwakayode B. Oke; Asangaedem Akpan; Julian P. Halcox; Sarah E. Rodgers; Gregory Y.H. Lip; Deirdre A. Lane

doi:10.3399/BJGP.2022.0156

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

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

Research output: Contribution to journal › Article › peer-review

5 Citations (Scopus)

4 Downloads (Pure)

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 ≥65 years entering a care home between 1^st January 2003 and 31^st 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.

Original language	English
Pages (from-to)	E43-E51
Number of pages	9
Journal	British Journal of General Practice
Volume	73
Issue number	726
DOIs	https://doi.org/10.3399/BJGP.2022.0156
Publication status	Published - Jan 2023
Externally published	Yes

Keywords

anticoagulants
Atrial fibrillation
long-term care
nursing homes
practice patterns (physicians')
primary health care

Access to Document

10.3399/BJGP.2022.0156Licence: CC BY

Final published versionFinal published version, 195 KBLicence: CC BY

Cite this

Ritchie, L. A., Harrison, S. L., Penson, P. E., Akbari, A., Torabi, F., Hollinghurst, J., Harris, D., Oke, O. B., Akpan, A., Halcox, J. P., Rodgers, S. E., Lip, G. Y. H., & Lane, D. A. (2023). Anticoagulation in older people with atrial fibrillation moving to care homes: a data linkage study. British Journal of General Practice, 73(726), E43-E51. https://doi.org/10.3399/BJGP.2022.0156

@article{6caff6ef6c9b4531b47bcc8215e0b12c,

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

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 ≥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.",

keywords = "anticoagulants, Atrial fibrillation, long-term care, nursing homes, practice patterns (physicians'), primary health care",

author = "Ritchie, {Leona A.} and Harrison, {Stephanie L.} and Penson, {Peter E.} and Ashley Akbari and Fatemeh Torabi and Joe Hollinghurst and Daniel Harris and Oke, {Oluwakayode B.} and Asangaedem Akpan and Halcox, {Julian P.} and Rodgers, {Sarah E.} and Lip, {Gregory Y.H.} and Lane, {Deirdre A.}",

year = "2023",

month = jan,

doi = "10.3399/BJGP.2022.0156",

language = "English",

volume = "73",

pages = "E43--E51",

journal = "British Journal of General Practice",

issn = "0960-1643",

publisher = "Royal College of General Practitioners",

number = "726",

}

TY - JOUR

T1 - Anticoagulation in older people with atrial fibrillation moving to care homes

T2 - a data linkage study

AU - Ritchie, Leona A.

AU - Harrison, Stephanie L.

AU - Penson, Peter E.

AU - Akbari, Ashley

AU - Torabi, Fatemeh

AU - Hollinghurst, Joe

AU - Harris, Daniel

AU - Oke, Oluwakayode B.

AU - Akpan, Asangaedem

AU - Halcox, Julian P.

AU - Rodgers, Sarah E.

AU - Lip, Gregory Y.H.

AU - Lane, Deirdre A.

PY - 2023/1

Y1 - 2023/1

N2 - 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.

AB - 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.

KW - anticoagulants

KW - Atrial fibrillation

KW - long-term care

KW - nursing homes

KW - practice patterns (physicians')

KW - primary health care

UR - http://www.scopus.com/inward/record.url?scp=85144595467&partnerID=8YFLogxK

U2 - 10.3399/BJGP.2022.0156

DO - 10.3399/BJGP.2022.0156

M3 - Article

C2 - 36543561

AN - SCOPUS:85144595467

SN - 0960-1643

VL - 73

SP - E43-E51

JO - British Journal of General Practice

JF - British Journal of General Practice

IS - 726

ER -

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

Abstract

Keywords

Access to Document

Other files and links

Fingerprint

Cite this