Multi-morbidity, frailty and self-care: important considerations in treatment with anticoagulation drugs. Outcomes of the AFASTER study
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...
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| Veröffentlicht in: | European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology 2017-02, Vol.16 (2), p.113-124 |
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| container_title | European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology |
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| creator | Ferguson, Caleb Inglis, Sally C Newton, Phillip J Middleton, Sandy Macdonald, Peter S Davidson, Patricia M |
| description | 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. |
| doi_str_mv | 10.1177/1474515116642604 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1875835237</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_1474515116642604</sage_id><sourcerecordid>1875835237</sourcerecordid><originalsourceid>FETCH-LOGICAL-c440t-715970ec96216642e8c96875257c351e6fd73f75265519d1d138508f0cc6f49a3</originalsourceid><addsrcrecordid>eNqNkU1rFTEUhoMotrbuXUnAjQun5jsz7i6lVaFS0HY9pMnJbcrM5JoP5P6C_u2mvVWhILgIOeF9zns4eRF6Q8kRpVp_pEILSSWlSgmmiHiG9mmveUcHyZ-3usndvb6HXuV8QwjV7bxEe0wTrgbJ9tHttzqV0M0xXQUXyvYD9smEqWyxWRzOMPnOmgSfcJg3MRWzFGzjkoODZEpoFQ4LLglMmaFpv0K5bp0l2GjWdXpAsEt1nY_weS02zpBx9LhcA16drn5cnHzHuVS3PUQvvJkyvH68D9Dl6cnF8Zfu7Pzz1-PVWWeFIKXTVA6agB0Ue9gZ-lb2WjKpLZcUlHea-_ZWUtLBUUd5L0nvibXKi8HwA_R-57tJ8WeFXMY5ZAvTZBaINY_t-2TPJeP6P1CmlOa6Hxr67gl6E2ta2iIjE4z3XHDFGkV2lE0x5wR-3KQwm7QdKRnv8xyf5tla3j4a16sZ3J-G3wE2oNsB2azh79R_Gt4BF4amjw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2423834362</pqid></control><display><type>article</type><title>Multi-morbidity, frailty and self-care: important considerations in treatment with anticoagulation drugs. Outcomes of the AFASTER study</title><source>MEDLINE</source><source>SAGE Complete A-Z List</source><source>Oxford University Press Journals All Titles (1996-Current)</source><creator>Ferguson, Caleb ; Inglis, Sally C ; Newton, Phillip J ; Middleton, Sandy ; Macdonald, Peter S ; Davidson, Patricia M</creator><creatorcontrib>Ferguson, Caleb ; Inglis, Sally C ; Newton, Phillip J ; Middleton, Sandy ; Macdonald, Peter S ; Davidson, Patricia M</creatorcontrib><description>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.</description><identifier>ISSN: 1474-5151</identifier><identifier>EISSN: 1873-1953</identifier><identifier>DOI: 10.1177/1474515116642604</identifier><identifier>PMID: 27036952</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Activities of daily living ; Adult ; Aged ; Aged, 80 and over ; Anticoagulants ; Anticoagulants - therapeutic use ; Atrial Fibrillation - drug therapy ; Atrial Fibrillation - mortality ; Cardiac arrhythmia ; Cause of Death ; Chronic Disease - drug therapy ; Cohort Studies ; Female ; Follow-Up Studies ; Frail Elderly ; Heart failure ; Humans ; Ischemic Attack, Transient - drug therapy ; Ischemic Attack, Transient - mortality ; Male ; Middle Aged ; Morbidity ; Mortality ; Prescription drugs ; Prospective Studies ; Risk Factors ; Self Care - mortality</subject><ispartof>European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, 2017-02, Vol.16 (2), p.113-124</ispartof><rights>The European Society of Cardiology 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c440t-715970ec96216642e8c96875257c351e6fd73f75265519d1d138508f0cc6f49a3</citedby><cites>FETCH-LOGICAL-c440t-715970ec96216642e8c96875257c351e6fd73f75265519d1d138508f0cc6f49a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/1474515116642604$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/1474515116642604$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27036952$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ferguson, Caleb</creatorcontrib><creatorcontrib>Inglis, Sally C</creatorcontrib><creatorcontrib>Newton, Phillip J</creatorcontrib><creatorcontrib>Middleton, Sandy</creatorcontrib><creatorcontrib>Macdonald, Peter S</creatorcontrib><creatorcontrib>Davidson, Patricia M</creatorcontrib><title>Multi-morbidity, frailty and self-care: important considerations in treatment with anticoagulation drugs. Outcomes of the AFASTER study</title><title>European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology</title><addtitle>Eur J Cardiovasc Nurs</addtitle><description>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.</description><subject>Activities of daily living</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anticoagulants</subject><subject>Anticoagulants - therapeutic use</subject><subject>Atrial Fibrillation - drug therapy</subject><subject>Atrial Fibrillation - mortality</subject><subject>Cardiac arrhythmia</subject><subject>Cause of Death</subject><subject>Chronic Disease - drug therapy</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Frail Elderly</subject><subject>Heart failure</subject><subject>Humans</subject><subject>Ischemic Attack, Transient - drug therapy</subject><subject>Ischemic Attack, Transient - mortality</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Prescription drugs</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Self Care - mortality</subject><issn>1474-5151</issn><issn>1873-1953</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkU1rFTEUhoMotrbuXUnAjQun5jsz7i6lVaFS0HY9pMnJbcrM5JoP5P6C_u2mvVWhILgIOeF9zns4eRF6Q8kRpVp_pEILSSWlSgmmiHiG9mmveUcHyZ-3usndvb6HXuV8QwjV7bxEe0wTrgbJ9tHttzqV0M0xXQUXyvYD9smEqWyxWRzOMPnOmgSfcJg3MRWzFGzjkoODZEpoFQ4LLglMmaFpv0K5bp0l2GjWdXpAsEt1nY_weS02zpBx9LhcA16drn5cnHzHuVS3PUQvvJkyvH68D9Dl6cnF8Zfu7Pzz1-PVWWeFIKXTVA6agB0Ue9gZ-lb2WjKpLZcUlHea-_ZWUtLBUUd5L0nvibXKi8HwA_R-57tJ8WeFXMY5ZAvTZBaINY_t-2TPJeP6P1CmlOa6Hxr67gl6E2ta2iIjE4z3XHDFGkV2lE0x5wR-3KQwm7QdKRnv8xyf5tla3j4a16sZ3J-G3wE2oNsB2azh79R_Gt4BF4amjw</recordid><startdate>201702</startdate><enddate>201702</enddate><creator>Ferguson, Caleb</creator><creator>Inglis, Sally C</creator><creator>Newton, Phillip J</creator><creator>Middleton, Sandy</creator><creator>Macdonald, Peter S</creator><creator>Davidson, Patricia M</creator><general>SAGE Publications</general><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>201702</creationdate><title>Multi-morbidity, frailty and self-care: important considerations in treatment with anticoagulation drugs. Outcomes of the AFASTER study</title><author>Ferguson, Caleb ; Inglis, Sally C ; Newton, Phillip J ; Middleton, Sandy ; Macdonald, Peter S ; Davidson, Patricia M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c440t-715970ec96216642e8c96875257c351e6fd73f75265519d1d138508f0cc6f49a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Activities of daily living</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anticoagulants</topic><topic>Anticoagulants - therapeutic use</topic><topic>Atrial Fibrillation - drug therapy</topic><topic>Atrial Fibrillation - mortality</topic><topic>Cardiac arrhythmia</topic><topic>Cause of Death</topic><topic>Chronic Disease - drug therapy</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Frail Elderly</topic><topic>Heart failure</topic><topic>Humans</topic><topic>Ischemic Attack, Transient - drug therapy</topic><topic>Ischemic Attack, Transient - mortality</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Prescription drugs</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Self Care - mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ferguson, Caleb</creatorcontrib><creatorcontrib>Inglis, Sally C</creatorcontrib><creatorcontrib>Newton, Phillip J</creatorcontrib><creatorcontrib>Middleton, Sandy</creatorcontrib><creatorcontrib>Macdonald, Peter S</creatorcontrib><creatorcontrib>Davidson, Patricia M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ferguson, Caleb</au><au>Inglis, Sally C</au><au>Newton, Phillip J</au><au>Middleton, Sandy</au><au>Macdonald, Peter S</au><au>Davidson, Patricia M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multi-morbidity, frailty and self-care: important considerations in treatment with anticoagulation drugs. Outcomes of the AFASTER study</atitle><jtitle>European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology</jtitle><addtitle>Eur J Cardiovasc Nurs</addtitle><date>2017-02</date><risdate>2017</risdate><volume>16</volume><issue>2</issue><spage>113</spage><epage>124</epage><pages>113-124</pages><issn>1474-5151</issn><eissn>1873-1953</eissn><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.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>27036952</pmid><doi>10.1177/1474515116642604</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, 2017-02, Vol.16 (2), p.113-124 |
| issn | 1474-5151 1873-1953 |
| language | eng |
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| source | MEDLINE; SAGE Complete A-Z List; Oxford University Press Journals All Titles (1996-Current) |
| subjects | Activities of daily living Adult Aged Aged, 80 and over Anticoagulants Anticoagulants - therapeutic use Atrial Fibrillation - drug therapy Atrial Fibrillation - mortality Cardiac arrhythmia Cause of Death Chronic Disease - drug therapy Cohort Studies Female Follow-Up Studies Frail Elderly Heart failure Humans Ischemic Attack, Transient - drug therapy Ischemic Attack, Transient - mortality Male Middle Aged Morbidity Mortality Prescription drugs Prospective Studies Risk Factors Self Care - mortality |
| title | Multi-morbidity, frailty and self-care: important considerations in treatment with anticoagulation drugs. Outcomes of the AFASTER study |
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