PT  - JOURNAL ARTICLE
AU  - Leona Alexandra Ritchie
AU  - Stephanie L Harrison
AU  - Peter E Penson
AU  - Ashley Akbari
AU  - Fatemeh Torabi
AU  - Joe P Hollinghurst
AU  - Daniel Harris
AU  - Oluwakayode B Oke
AU  - Asan Akpan
AU  - Julian P Halcox
AU  - Sarah Rodgers
AU  - Gregory YH Lip
AU  - Deirdre A Lane
TI  - Anticoagulation in older people with atrial fibrillation moving to care homes: a data linkage study
AID  - 10.3399/BJGP.2022.0156
DP  - 2022 Nov 09
TA  - British Journal of General Practice
PG  - BJGP.2022.0156
4099  - http://bjgp.org/content/early/2022/11/09/BJGP.2022.0156.short
4100  - http://bjgp.org/content/early/2022/11/09/BJGP.2022.0156.full
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.