Bo Mario, Sciarrillo Irene, Maggiani Guido, Falcone Yolanda, Iacovino Marina, Grisoglio Enrica, Fonte Gianfranco, Grosjean Simon, Gaita Fiorenzo
SCDU Geriatria e Malattie Metaboliche dell'Osso, Città della Salute e della Scienza-Molinette, Torino, Italia.
SCDU Cardiologia, Città della Salute e della Scienza-Molinette, Torino, Italia.
Geriatr Gerontol Int. 2017 Mar;17(3):416-423. doi: 10.1111/ggi.12730. Epub 2016 Jan 28.
The aim of the present study was to investigate the prevalence of geriatric syndromes among older medical inpatients with atrial fibrillation, and their association with use of vitamin K antagonists.
A retrospective study of patients aged ≥65 years discharged with a diagnosis of atrial fibrillation from the Acute Geriatric Ward was carried out. Stroke and bleeding risk were evaluated according to the CHA DS -VASC and HAS-BLED scores. Comorbidity, cognitive status, functional autonomy and contraindications to vitamin K antagonists were also considered.
Atrial fibrillation was documented in 1078 of 3650 patients (29.5%, mean age 83.4 ± 6.6 years, 60.3% women). Contraindications to vitamin K antagonists were documented in 24.9% of patients. Prescription of vitamin K antagonists at discharge was 37.8% and 47.9%, in the overall sample and in those without contraindications, respectively. In the overall sample, prescription of vitamin K antagonists was associated with younger age, permanent/persistent atrial fibrillation, home discharge, less comorbidity, higher hemoglobin levels, better functional independence, known atrial fibrillation at admission and lower HAS-BLED score. Among patients without contraindications to vitamin K antagonists, their use at discharge was independently associated with younger age, permanent/persistent atrial fibrillation, home discharge, higher hemoglobin levels and CHA2DS2-VASC score, better functional autonomy, and greater number of drugs.
We showed a high prevalence of atrial fibrillation among older medical inpatients, who have a poor health status and a high prevalence of geriatric syndromes. Vitamin K antagonists were prescribed in less than half of the patients; underuse was mainly accounted for by a high prevalence of comorbidities/contraindications, poor health status and limited functional autonomy. Geriatr Gerontol Int 2017; 17: 416-423.
本研究旨在调查老年房颤住院患者中老年综合征的患病率及其与维生素K拮抗剂使用的相关性。
对急性老年病房出院诊断为房颤的≥65岁患者进行回顾性研究。根据CHA₂DS₂-VASc和HAS-BLED评分评估卒中及出血风险。还考虑了合并症、认知状态、功能自主性以及维生素K拮抗剂的禁忌证。
3650例患者中有1078例记录有房颤（29.5%，平均年龄83.4±6.6岁，60.3%为女性）。24.9%的患者记录有维生素K拮抗剂禁忌证。在总体样本和无禁忌证患者中，出院时维生素K拮抗剂的处方率分别为37.8%和47.9%。在总体样本中，维生素K拮抗剂的处方与年龄较轻、永久性/持续性房颤、居家出院、合并症较少、血红蛋白水平较高、功能独立性较好、入院时已知房颤以及较低的HAS-BLED评分相关。在无维生素K拮抗剂禁忌证的患者中，出院时使用该药物与年龄较轻、永久性/持续性房颤、居家出院、较高的血红蛋白水平和CHA₂DS₂-VASc评分、较好的功能自主性以及较多的药物数量独立相关。
我们发现老年内科住院患者中房颤患病率较高，这些患者健康状况较差且老年综合征患病率较高。不到一半的患者使用了维生素K拮抗剂；使用不足主要是由于合并症/禁忌证患病率高、健康状况差和功能自主性有限。《老年医学与老年病学国际杂志》2017年；17：416 - 423。
