Objectives: To determine predictors of oral anticoagulation (OAC) for atrial fibrillation (AF) in long-term care (LTC).
Design: Chart review.
Setting: Six LTC facilities in a metropolitan area.
Participants: One hundred seventeen residents with AF identified from 934 total residents.
Measurements: Data was obtained from the medical chart, pharmacy record, and Minimum Data Set (MDS) regarding demographics, medical conditions, falls, fractures, gastrointestinal bleeding (GIB), peptic ulcer disease, dementia, anemia, and physical/cognitive function scales. The recursive partition algorithm was used to construct a model reflecting physician decision patterns that predict prescription of OAC.
Results: Among those 117 residents (12.5% of 934) who had AF (age, 84.6 +/- 8 years), OAC was prescribed for 54 (46%); aspirin or clopidogrel: 47 (40%); neither OAC nor any antithrombotic treatment (ATT): 25 (21%). Prior stroke was the primary determinant of OAC. Residents with prior stroke were less likely to be prescribed OAC if they had prior GIB, were non-Caucasian, or had no history of coronary artery disease (CAD). Those without a stroke were less likely to be prescribed OAC if they were younger, had dementia or lower functional status.
Conclusion: Prior stroke was the primary predictor of OAC use. Our model suggests that physicians may also incorporate concerns of age, bleeding, cognitive and physical function, and ethnicity into the decision-making process. Further study is needed to explore the reasons why 21% of the residents receive neither OAC nor ATT, and why OAC may be less likely to be prescribed to non-Caucasian LTC residents.