Ferguson, Caleb and Inglis, Sally C and Newton, Phillip J and Middleton, Sandy and Macdonald, Peter S and Davidson, Patricia M (2017) Multi-morbidity, frailty and self-care: important considerations in treatment with anticoagulation drugs. Outcomes of the AFASTER study. European Journal of Cardiovascular Nursing, 16 (2). pp.113-124. ISSN 1873-1953 (OA)
Full text not available from this repository.Abstract
BACKGROUND
Chronic heart failure (CHF) and atrial fibrillation (AF) are complex cardiogeriatric syndromes mediated by physical, psychological and social factors. Thromboprophylaxis is an important part of avoiding adverse events in these syndromes, particularly stroke.
PURPOSE
This study sought to describe the clinical characteristics of a cohort of patients admitted to hospital with CHF and concomitant AF and to document the rate and type of thromboprophylaxis. We examined the practice patterns of the prescription of treatment and determined the predictors of adverse events.
METHODS
Prospective consecutive participants with CHF and concomitant AF were enrolled during the period April to October 2013. Outcomes were assessed at 12 months, including all-cause readmission to hospital and mortality, stroke or transient ischaemic attack, and bleeding.
RESULTS
All-cause readmission to hospital was frequent (68%) and the 12-month all-cause mortality was high (29%). The prescription of anticoagulant drugs at discharge was statistically significantly associated with a lower mortality at 12 months (23 vs. 40%; p=0.037; hazards ratio 0.506; 95% confidence interval 0.267-0.956), but was not associated with lower rates of readmission to hospital among patients with CHF and AF. Sixty-six per cent of participants were prescribed anticoagulant drugs on discharge from hospital. Self-reported self-care behaviour and 'not for cardiopulmonary resuscitation' were associated with not receiving anticoagulant drugs at discharge. Although statistical significance was not achieved, those patients who were assessed as frail or having greater comorbidity were less likely to receive anticoagulant drugs at discharge.
CONCLUSION
This study highlights multi-morbidity, frailty and self-care to be important considerations in thromboprophylaxis. Shared decision-making with patients and caregivers offers the potential to improve treatment knowledge, adherence and outcomes in this group of patients with complex care needs.
| Item Type: | Article |
|---|---|
| Additional Information: | Article available for free from publisher's website. Epub: April 2016 |
| Subjects: | R Medicine > R Medicine (General) |
| Depositing User: | Repository Administrator |
| Date Deposited: | 17 Jun 2016 04:19 |
| Last Modified: | 28 Sep 2017 03:47 |
| URI: | https://eprints.victorchang.edu.au/id/eprint/452 |
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