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Despite changes in antiarrhythmic drug (AAD) choice in patients with atrial fibrillation (AF), trends in AAD prescribing remain not investigated. We aimed to examine these changes using a nationwide Australian general practice data from 2009 to 2018. Over the 10 years, AAD prescribing in patients with AF decreased, which was mainly due to a reduction in the use of amiodarone, sotalol and digoxin. In contrast, the use of beta‐blockers and flecainide increased. [ABSTRACT FROM AUTHOR]

Aim: To examine the change in stroke risk over time and determine the proportion of patients with atrial fibrillation (AF) who were initiated on an oral anticoagulant (OAC) as their stroke risk increased from low/moderate to high, using the Australian general practice data set, MedicineInsight. Methods: A total of 2296 patients diagnosed with AF between 1 January 2007 and 31 December 2008, aged 18 years or older and not initiated on an OAC before 2009, were included. We assessed the change in stroke risk and the proportion of patients who had a recorded prescription of an OAC, each year from 1 January 2009 to 31 December 2018. Results: At baseline, 23.9%, 22.9% and 53.2% were categorised as being at low (score = 0), moderate (score = 1) and high stroke risk (score ≥ 2), respectively, using the sexless CHA2DS2‐VASc (CHA2DS2‐VA) score. Overall, the CHA2DS2‐VA score increased by a mean of 1.34 (95% confidence interval, 1.29‐1.39) points over the study period. Nearly two‐thirds of patients (65%, 412/632) whose stroke risk changed from baseline low/moderate to high were subsequently prescribed an OAC. The median (interquartile range) lag time from becoming high stroke risk to having OAC initiation was 2 (5) years. Conclusions: Nearly one‐third of patients reclassified as being at high risk of stroke during the study period were not prescribed OAC therapy. Furthermore, the delay in OAC initiation following classification as being at high risk was a median of 2 years, suggesting that more frequent stroke reassessment is needed. [ABSTRACT FROM AUTHOR]

Background: We investigated factors that influenced oral anticoagulant (OAC) initiation and choice in Australian general practice patients newly diagnosed with AF. Methods: Using an Australian nationally representative general practice dataset, MedicineInsight, we identified patients newly diagnosed with AF between January 2009 and April 2019. Logistic regression analyses were used to examine factors associated with OAC initiation and choice. Results: A total of 63 212 patients with AF (53.7% males, mean age 72.4 years) were identified. Nearly two-thirds of these patients (40 854 [64.6%]) were initiated on an OAC, at a median time of 6 days after the documented diagnosis date. The proportion of patients who were initiated an OAC increased from 44.8% in 2009 to 72.2% in 2019 (P < .001). High risk of stroke (CHA2DS2-VASc, adjusted odds ratio (AOR), 4.39 [95% CI, 3.99-4.83]), low risk of bleeding (ORBIT, AOR, 1.87 [95% CI, 1.72- 2.03]), not having a recorded history of dementia (AOR, 1.81 [95% CI, 1.65-1.98]) and male sex (AOR, 1.29 [95% CI, 1.22-1.35]) were independently associated with OAC initiation. Direct-acting oral anticoagulant (DOAC) use increased from 11.9% in 2011 to 94.0% of all OAC initiations in April 2019 (P < .001). Conclusions: The proportion of newly diagnosed patients with AF initiated on OAC increased markedly following the introduction of the DOACs. Of those initiated, 9 in 10 were receiving a DOAC at the end of the study period. There is potential underuse in women and individuals with dementia. [ABSTRACT FROM AUTHOR]

This study evaluated the effect of pharmacist‐led review on medication appropriateness in 204 older patients with chronic kidney disease (CKD) admitted to an Australian hospital. Medication appropriateness was evaluated using the Medication Appropriateness Index (MAI) prior to medication review, after review (assuming all recommendations were accepted by physicians) and after outcome (acceptance/non‐acceptance) of recommendations. Overall, 95 patients (46%) received a medication review by pharmacists. The median (interquartile range) MAI score decreased significantly from a baseline of 7 (3–12) to 5 (2–10) after medication review (p < 0.001) and to 6 (2–10) after the outcome of recommendations (p < 0.01). The MAI score also decreased in patients with no medication review by a pharmacist from 6 (3–11) at admission to 5 (2–9) at discharge (p < 0.001). MAI scores declined markedly in people with all pharmacist‐conducted medication review recommendations accepted (from 7 to 3; p < 0.05). Reassuringly, hospitalisation alone improved medication appropriateness. However, pharmacist‐led medication review can further optimise medication appropriateness in older CKD patients, particularly when the recommendations are implemented. [ABSTRACT FROM AUTHOR]

Objectives To systematically review clinical outcomes associated with medication regimen complexity in older people. Design Systematic review of EMBASE, MEDLINE, International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane library. Setting Hospitals, home, and long-term care. Participants English-language peer-reviewed original research published before June 2016 was eligible if regimen complexity was quantified using a metric that considered number of medications and at least one other parameter, regimen complexity was calculated for participants' overall regimen, at least 80% of participants were aged 60 and older, and the study investigated a clinical outcome associated with regimen complexity. Measurements Quality assessment was conducted using an adapted version of the Joanna Briggs Institute critical appraisal tool. Results Sixteen observational studies met the inclusion criteria. Regimen complexity was associated with medication nonadherence (2/6 studies) and higher rates of hospitalization (2/4 studies). One study found that participants with less-complex medication administration were more likely to stop medications when feeling worse. One study each identified an association between regimen complexity and higher ability to administer medications as directed, medication self-administration errors, caregiver medication administration hassles, hospital discharge to non-home settings, postdischarge potential adverse drug events, all-cause mortality, and lower patient knowledge of their medication. Regimen complexity had no association with postdischarge medication modification, change in medication- and health-related problems, emergency department visits, or quality of life as rated by nursing staff. Conclusion Research into whether medication regimen complexity is associated with nonadherence and hospitalization has produced inconsistent results. Moderate-quality evidence from four studies (two each for nonadherence and hospitalization) suggests that medication regimen complexity is associated with nonadherence and higher rates of hospitalization. [ABSTRACT FROM AUTHOR]