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1. Simulation-Based Education for Physicians to Increase Oral Anticoagulants in Hospitalized Elderly Patients with Atrial Fibrillation

Author

Franchi, C, Antoniazzi, S, Ardoino, I, Proietti, M, Marcucci, M, Santalucia, P, Monzani, V, Mannucci, Pm, Nobili, A, Bosari, S, Brignoto, B, Nicolis, E, Fenoglio, Lm, Melchio, R, Fabris, F, Sartori, Mt, Manfredini, R, De Giorgi, A, Fabbian, F, Biolo, G, Zanetti, M, Altamura, N, Sabba, C, Suppressa, P, Bandiera, F, Usai, CINZIA PATRIZIA, Murialdo, G, Fezza, Fabrizio, Marra, A, Castelli, F, Cattaneo, F, Beccati, V, di Minno, G, Tufano, A, Contaldi, P, Lupattelli, G, Bianconi, V, Cappellini, D, Hu, C, Minonzio, F, Fargion, S, Burdick, L, Francione, P, Peyvandi, F, Rossio, R, Colombo, Gherardo, Ceriani, G, Lucchi, T, Brignolo, B, Manfellotto, D, Caridi, I, Corazza, Gr, Miceli, E, Padula, D, Fraternale, G, Guasti, L, Squizzato, A, Maresca, A, Liberato, Nl, Tognin, T, Rozzini, R, Bellucci, Fb, Muscaritoli, M, Molfino, A, Petrillo, E, Dore, M, Raviolo, P, Mete, F, Gino, M, Franceschi, F, Gabrielli, M, Perticone, F, Perticone, M, Bertolotti, M, Mussi, C, Borghi, C, Strocchi, E, Durazzo, M, Fornengo, P, Ruatta, C, Dallegri, F, Ottonello, Lc, Salam, K, Caserza, L, Barbagallo, M, Di Bella, G, Annoni, G, Bruni, Aa, Odetti, P, Nencioni, A, Monacelli, F, Napolitano, A, Brucato, A, Valenti, A, Castellino, P, Zanoli, L, and Mazzeo, M

Subjects
Male, medicine.medical_specialty, Cluster randomized trial, Socio-culturale, Administration, Oral, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine and geriatric wards, Intervention (counseling), Hospital discharge, medicine, Odds Ratio, Cluster Analysis, Humans, 030212 general & internal medicine, Cluster randomised controlled trial, Medical prescription, Simulation based, Simulation Training, Simulation-based education, LS4_7, Aged, Aged, 80 and over, business.industry, Anticoagulants, Atrial fibrillation, General Medicine, Odds ratio, medicine.disease, Older people, Oral anticoagulants, SIM-AF trial, Confidence interval, Atrial fibrillation, Cluster randomized trial, Internal medicine and geriatric wards, Older people, Oral anticoagulants, SIM-AF trial, Simulation-based education, Patient Simulation, Stroke, Geriatrics, Emergency medicine, Education, Medical, Continuing, Female, Clinical Competence, business
Abstract

Purpose This study was intended to determine whether a simulation-based education addressed to physicians was able to increase the proportion of hospitalized elderly with atrial fibrillation prescribed with oral anticoagulants (OACs) compared with the usual practice. Methods We conducted a cluster randomized trial (from April 2015 to September 2018) on 32 Italian internal medicine and geriatric wards randomized 1:1 to intervention or control arms. The physicians of wards randomized to intervention received a computer-based e-learning tool with clinical scenarios (Dr Sim), and those of wards randomized to control received no formal educational intervention. The primary outcome was the OAC prescription rate at hospital discharge in the intervention and control arms. Results Of 452 patients scrutinized, 247 were included in the analysis. Of them, 186 (75.3%) were prescribed with OACs at hospital discharge. No difference was found between the intervention and control arms in the post-intervention phase (odds ratio, 1.46; 95% confidence interval [CI], 0.81-2.64). The differences from the pre- to post-intervention phases in the proportions of patients prescribed with OACs (15.1%; 95% CI, 0%-31.5%) and with direct oral anticoagulants (DOACs) (20%; 95% CI, 0%-39.8%) increased more in the intervention than in the control arm. Conclusions This simulation-based course did not succeed in increasing the rate of elderly patients prescribed with OACs at hospital discharge compared with the usual practice. Notwithstanding, over time there was a greater increase in the intervention than in the control arm in the proportion of patients prescribed with OACs and DOACs. Trial Registration ClinicalTrials.gov identifier: NCT03188211.

Published
2019

2. Use of oral anticoagulant drugs in older patients with atrial fibrillation in internal medicine wards

Author

Proietti, Marco, Antoniazzi, Stefania, Monzani, Valter, Santalucia, Paola, Franchi, Carlotta, SIM-AF, Investigators, Fenoglio, Lm, Melchio, R, Fabris, F, Sartori, Mt, Manfredini, R, De Giorgi, A, Fabbian, F, Biolo, G, Zanetti, M, Altamura, N, Sabbà, C, Suppressa, P, Bandiera, F, Usai, C, Murialdo, G, Fezza, F, Marra, A, Castelli, F, Cattaneo, F, Beccati, V, di Minno, G, Tufano, A, Contaldi, P, Lupattelli, G, Bianconi, V, Cappellini, D, Hu, C, Minonzio, F, Fargion, S, Burdick, L, Francione, P, Peyvandi, F, Rossio, R, Colombo, G, Monzani, V, Ceriani, G, Lucchi, T, Brignolo, B, Manfellotto, D, Caridi, I, Corazza, Gr, Miceli, E, Padula, D, Fraternale, G, Guasti, L, Squizzato, A, Maresca, A, Liberato, Nl, Tognin, T, Rozzini, R, Bellucci, Fb, Muscaritoli, M, Molfino, A, Petrillo, E, Dore, M, Mete, F, Gino, M, Franceschi, F, Gabrielli, M, Perticone, F, Perticone, M, Bertolotti, M, Mussi, C, Borghi, C, Strocchi, E, Durazzo, M, Fornengo, P, Dallegri, F, Ottonello, Lc, Salam, K, Caserza, L, Barbagallo, M, Di Bella, G, Annoni, G, Bruni, Aa, Odetti, P, Nencioni, A, Monacelli, F, Napolitano, A, Brucato, A, Valenti, A, Castellino, P, Zanoli, L, Mazzeo, M, Proietti, Marco, Antoniazzi, Stefania, Monzani, Valter, Santalucia, Paola, Franchi, Carlotta, Fenoglio, Luigi M., Melchio, Remo, Fabris, Fabrizio, Sartori, Maria Teresa, Manfredini, Roberto, De Giorgi, Alfredo, Fabbian, Fabio, Biolo, Gianni, Zanetti, Michela, Altamura, Nicola, Sabbà, Carlo, Suppressa, Patrizia, Bandiera, Francesco, Usai, Carlo, Murialdo, Giovanni, Fezza, Francesca, Marra, Alessio, Castelli, Francesca, Cattaneo, Federico, Beccati, Valentina, di Minno, Giovanni, Tufano, Antonella, Contaldi, Paola, Lupattelli, Graziana, Bianconi, Vanessa, Cappellini, Domenica, Hu, Cinzia, Minonzio, Francesca, Fargion, Silvia, Burdick, Larry, Francione, Paolo, Peyvandi, Flora, Rossio, Raffaella, Colombo, Giulia, Ceriani, Giuliana, Lucchi, Tiziano, Brignolo, Barbara, Manfellotto, Dario, Caridi, Irene, Corazza, Gino Roberto, Miceli, Emanuela, Padula, Donatella, Fraternale, Giacomo, Guasti, Luigina, Squizzato, Alessandro, Maresca, Andrea, Liberato, Nicola Lucio, Tognin, Tiziana, Rozzini, Renzo, Bellucci, Francesco Baffa, Muscaritoli, Maurizio, Molfino, Alessio, Petrillo, Enrico, Dore, Maurizio, Mete, Francesca, Gino, Miriam, Franceschi, Francesco, Gabrielli, Maurizio, Perticone, Francesco, Perticone, Maria, Bertolotti, Marco, Mussi, Chiara, Borghi, Claudio, Strocchi, Enrico, Durazzo, Marilena, Fornengo, Paolo, Dallegri, Franco, Ottonello, Luciano Carlo, Salam, Kassem, Caserza, Lara, Barbagallo, Mario, Di Bella, Giovanna, Annoni, Giorgio, Bruni, Adriana Antonella, Odetti, Patrizio, Nencioni, Alessio, Monacelli, Fiammetta, Napolitano, Armando, Brucato, Antonio, Valenti, Anna, Castellino, Pietro, Zanoli, Luca, Mazzeo, Marco, Proietti, M, Antoniazzi, S, Monzani, V, Santalucia, P, Franchi, C, and Annoni, G

Subjects
Male, Administration, Oral, 030204 cardiovascular system & hematology, Body Mass Index, Oral anticoagulant drug, 0302 clinical medicine, Elderly, Drug Prescription, Older patients, Retrospective Studie, 80 and over, Medicine, 030212 general & internal medicine, Stroke, Randomized Controlled Trials as Topic, Aged, 80 and over, Atrial fibrillation, Oral anticoagulant drugs, Prescription rate, Internal Medicine, Observational Studies as Topic, Atrial fibrillation, Elderly, Oral anticoagulant drugs, Prescription rate, Internal Medicine, Administration, Oral anticoagulant, Female, Human, Oral, medicine.medical_specialty, Socio-culturale, Drug Prescriptions, 03 medical and health sciences, Internal medicine, Humans, Aged, Retrospective Studies, business.industry, Settore MED/09 - MEDICINA INTERNA, Anticoagulant, Anticoagulants, Retrospective cohort study, medicine.disease, Atrial Fibrillation, business, Body mass index, Atrial fibrillation, Elderly, Oral anticoagulant drugs, Prescription rate
Abstract

no abstract available

Published
2018

3. Appropriateness of oral anticoagulant therapy prescription and its associated factors in hospitalized older people with atrial fibrillation

Author

Franchi, Carlotta, Antoniazzi, Stefania, Proietti, Marco, Nobili, Alessandro, Mannucci, Pier Mannuccio, Santalucia, Paola, Monzani, Valter, Marcucci, Maura, Bosari, Silvano, Brignolo, Barbara, Nicolis, Enrico, Ardoino, Ilaria, Fenoglio, Luigi M., Melchio, Remo, Fabris, Fabrizio, Sartori, Maria Teresa, Manfredini, Roberto, De Giorgi, Alfredo, Fabbian, Fabio, Biolo, Gianni, Zanetti, Michela, Altamura, Nicola, Sabbà, Carlo, Suppressa, Patrizia, Bandiera, Francesco, Usai, Carlo, Murialdo, Giovanni, Fezza, Francesca, Marra, Alessio, Castelli, Francesca, Cattaneo, Federico, Beccati, Valentina, di Minno, Giovanni, Tufano, Antonella, Contaldi, Paola, Lupattelli, Graziana, Bianconi, Vanessa, Cappellini, Domenica, Cinzia, Hu, Minonzio, Francesca, Fargion, Silvia, Burdick, Larry, Francione, Paolo, Peyvandi, Flora, Rossio, Raffaella, Colombo, Giulia, Ceriani, Giuliana, Lucchi, Tiziano, Manfellotto, Dario, Caridi, Irene, Corazza, Gino Roberto, Miceli, Emanuela, Padula, Donatella, Fraternale, Giacomo, Guasti, Luigina, Squizzato, Alessandro, Maresca, Andrea, Liberato, Nicola Lucio, Tognin, Tiziana, Rozzini, Renzo, Bellucci, Francesco Baffa, Muscaritoli, Maurizio, Molfino, Alessio, Petrillo, Enrico, Dore, Maurizio, Mete, Francesca, Gino, Miriam, Franceschi, Francesco, Gabrielli, Maurizio, Perticone, Francesco, Perticone, Maria, Bertolotti, Marco, Mussi, Chiara, Borghi, Claudio, Strocchi, Enrico, Durazzo, Marilena, Fornengo, Paolo, Dallegri, Franco, Ottonello, Luciano Carlo, Salam, Kassem, Caserza, Lara, Barbagallo, Mario, Di Bella, Giovanna, Annoni, Giorgio, Bruni, Adriana Antonella, Odetti, Patrizio, Nencioni, Alessio, Monacelli, Fiammetta, Napolitano, Armando, Brucato, Antonio, Valenti, Anna, Castellino, Pietro, Zanoli, Luca, Mazzeo, Marco, Franchi, Carlotta, Antoniazzi, Stefania, Proietti, Marco, Nobili, Alessandro, Mannucci, Pier Mannuccio, Santalucia, Paola, Monzani, Valter, Marcucci, Maura, Bosari, Silvano, Brignolo, Barbara, Nicolis, Enrico, Ardoino, Ilaria, Fenoglio, Luigi M., Melchio, Remo, Fabris, Fabrizio, Sartori, Maria Teresa, Manfredini, Roberto, De Giorgi, Alfredo, Fabbian, Fabio, Biolo, Gianni, Zanetti, Michela, Altamura, Nicola, Sabbà, Carlo, Suppressa, Patrizia, Bandiera, Francesco, Usai, Carlo, Murialdo, Giovanni, Fezza, Francesca, Marra, Alessio, Castelli, Francesca, Cattaneo, Federico, Beccati, Valentina, di Minno, Giovanni, Tufano, Antonella, Contaldi, Paola, Lupattelli, Graziana, Bianconi, Vanessa, Cappellini, Domenica, Hu, Cinzia, Minonzio, Francesca, Fargion, Silvia, Burdick, Larry, Francione, Paolo, Peyvandi, Flora, Rossio, Raffaella, Colombo, Giulia, Ceriani, Giuliana, Lucchi, Tiziano, Manfellotto, Dario, Caridi, Irene, Corazza, Gino Roberto, Miceli, Emanuela, Padula, Donatella, Fraternale, Giacomo, Guasti, Luigina, Squizzato, Alessandro, Maresca, Andrea, Liberato, Nicola Lucio, Tognin, Tiziana, Rozzini, Renzo, Bellucci, Francesco Baffa, Muscaritoli, Maurizio, Molfino, Alessio, Petrillo, Enrico, Dore, Maurizio, Mete, Francesca, Gino, Miriam, Franceschi, Francesco, Gabrielli, Maurizio, Perticone, Francesco, Perticone, Maria, Bertolotti, Marco, Mussi, Chiara, Borghi, Claudio, Strocchi, Enrico, Durazzo, Marilena, Fornengo, Paolo, Dallegri, Franco, Ottonello, Luciano Carlo, Salam, Kassem, Caserza, Lara, Barbagallo, Mario, Di Bella, Giovanna, Annoni, Giorgio, Bruni, Adriana Antonella, Odetti, Patrizio, Nencioni, Alessio, Monacelli, Fiammetta, Napolitano, Armando, Brucato, Antonio, Valenti, Anna, Castellino, Pietro, Zanoli, Luca, Mazzeo, Marco, Franchi, C, Antoniazzi, S, Proietti, M, Nobili, A, Mannucci, P, Santalucia, P, Monzani, V, Marcucci, M, Bosari, S, Brignolo, B, Nicolis, E, Ardoino, I, Fenoglio, L, Melchio, R, Fabris, F, Sartori, M, Manfredini, R, De Giorgi, A, Fabbian, F, Biolo, G, Zanetti, M, Altamura, N, Sabbà, C, Suppressa, P, Bandiera, F, Usai, C, Murialdo, G, Fezza, F, Marra, A, Castelli, F, Cattaneo, F, Beccati, V, di Minno, G, Tufano, A, Contaldi, P, Lupattelli, G, Bianconi, V, Cappellini, D, Hu, C, Minonzio, F, Fargion, S, Burdick, L, Francione, P, Peyvandi, F, Rossio, R, Colombo, G, Ceriani, G, Lucchi, T, Manfellotto, D, Caridi, I, Corazza, G, Miceli, E, Padula, D, Fraternale, G, Guasti, L, Squizzato, A, Maresca, A, Liberato, N, Tognin, T, Rozzini, R, Bellucci, F, Muscaritoli, M, Molfino, A, Petrillo, E, Dore, M, Mete, F, Gino, M, Franceschi, F, Gabrielli, M, Perticone, F, Perticone, M, Bertolotti, M, Mussi, C, Borghi, C, Strocchi, E, Durazzo, M, Fornengo, P, Dallegri, F, Ottonello, L, Salam, K, Caserza, L, Barbagallo, M, Di Bella, G, Annoni, G, Bruni, A, Odetti, P, Nencioni, A, Monacelli, F, Napolitano, A, Brucato, A, Valenti, A, Castellino, P, Zanoli, L, and Mazzeo, M

Subjects
Male, Oral, appropriateness of prescription, appropriateness of prescription, atrial fibrillation, internal medicine, geriatric wards, older patients, oral anticoagulant, Socio-culturale, Administration, Oral, Hemorrhage, Inappropriate Prescribing, Drug Prescriptions, internal medicine and geriatric ward, Dose-Response Relationship, older patient, Risk Factors, oral anticoagulant, 80 and over, Humans, atrial fibrillation, Pharmacology (medical), Prospective Studies, Aged, Retrospective Studies, Aged, 80 and over, Pharmacology, geriatric wards, Dose-Response Relationship, Drug, Settore MED/09 - MEDICINA INTERNA, Age Factors, Anticoagulants, internal medicine and geriatric wards, Original Articles, older patients, Stroke, internal medicine, Administration, Female, Drug
Abstract

Aims: Although oral anticoagulants (OACs) are effective in preventing stroke in older people with atrial fibrillation (AF), they are often underused in this particularly high-risk population. The aim of the present study was to assess the appropriateness of OAC prescription and its associated factors in hospitalized patients aged 65years or older. Methods: Data were obtained from the retrospective phase of Simulation-based Technologies to Improve the Appropriate Use of Oral Anticoagulants in Hospitalized Elderly Patients With Atrial Fibrillation (SIM-AF) study, held in 32 Italian internal medicine and geriatric wards. The appropriateness of OAC prescription was assessed, grouping patients in those who were and were not prescribed OACs at hospital discharge. Multivariable logistic regression was used to establish factors independently associated with the appropriateness of OAC prescription. Results: A total of 328 patients were included in the retrospective phase of the study. Of these, almost 44% (N = 143) were inappropriately prescribed OACs, being mainly underprescribed or prescribed an inappropriate antithrombotic drug (N = 88). Among the patients prescribed OACs (N=221), errors in the prescribed doses were the most frequent cause of inappropriate use (N=55). Factors associated with a higher degree of patient frailty were inversely associated with the appropriateness of OAC prescription. Conclusions: In hospitalized older patients with AF, there is still a high prevalence of inappropriate OAC prescribing. Characteristics usually related to frailty are associated with the inappropriate prescribing. These findings point to the need for targeted interventions designed for internists and geriatricians, aimed at improving the appropriate prescribing of OACs in this complex and high-risk population.

Published
2018

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