A clinical audit of oral anticoagulant therapy in aged care residents with atrial fibrillation

Abstract

Background Atrial fibrillation (AF) is a risk factor for stroke in older people. Oral anticoagulants can reduce stroke risk but they are commonly under prescribed in the elderly, often due to concerns regarding the risk of bleeding. Prescribing in aged care residents may also be further complicated by associated geriatric conditions such as dementia and risk of falls. Systematic assessment of stroke and bleed risk can help identify people with AF expected to benefit from anticoagulant therapy and optimise prescribing. Objective The aim of this study was to assess the prescribing of anticoagulants in elderly aged care residents in accordance with Australian guideline recommendations. Setting Nineteen aged care facilities across southeast Queensland. Method A clinical audit of anticoagulant therapy in aged care residents was conducted. Main outcome measure Information was collected from the records of residents with non-valvular AF to assess the risk of stroke and bleeding and compare this prescribing to current evidence-based guidelines for anticoagulation in AF. Results A total of 1754 residents were screened with 359 (20.4%) identified to have a diagnosis of non-valvular AF. There were 356 (99.2%) residents with non-valvular AF and a sufficiently high risk of stroke to warrant the use of an anticoagulant. Of these, 172 (48.3%) were prescribed an oral anticoagulant and 40 (11.2%) residents had a documented decision not to prescribe oral anticoagulants in their records. The majority of residents prescribed anticoagulation were receiving non-vitamin K antagonists (76.8%). The prescribed dose was consistent with recommendations for 44.8% of residents prescribed oral anticoagulant therapy. Conclusion Many residents with non-valvular AF and significant risk of stroke were not receiving oral anticoagulation despite a lack of documented reason for non-prescribing. Non-vitamin K antagonists were widely prescribed but dosing of these agents could still be improved. There remains a need to improve anticoagulant prescribing for aged care residents and optimise stroke prevention in this population.