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April 2, 2016European Journal of Cardiovascular NursingOpen Access

Multi-morbidity, frailty and self-care: important considerations in treatment with anticoagulation drugs. Outcomes of the AFASTER study

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Why the study?

Does the prescription of anticoagulant drugs at discharge improve 12-month mortality and readmission rates in patients hospitalized with chronic heart failure and concomitant atrial fibrillation?

Population

Prospective consecutive participants admitted to hospital with chronic heart failure and concomitant atrial…

Comparison

Anticoagulant drugs prescribed at discharge vs No anticoagulant drugs prescribed at discharge

Design

Cohort

Follow-up

12 months

Key result

Prescription of anticoagulant drugs at discharge in patients with CHF and AF was associated with lower 12-month all-cause mortality (23% vs. 40%; HR 0.506; 95% CI 0.267-0.956; p=0.037).

Authors

CFCaleb FergusonSISally C InglisPNPhillip J. Newton

Discussion

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Overview

May support anticoagulation at discharge in CHF-AF; hypothesis-generating and requires randomized confirmation.

Key Points

  • To evaluate clinical profiles, thromboprophylaxis prescribing patterns, and predictors of 12-month adverse outcomes in patients hospitalized with chronic heart failure and concomitant atrial fibrillation.
  • Prospective cohort study enrolling consecutive hospitalized patients with chronic heart failure and concomitant atrial fibrillation between April and October 2013.
  • Tracked 12-month adverse outcomes, including all-cause hospital readmission, all-cause mortality, stroke or transient ischaemic attack, and bleeding events.
  • Overall 12-month all-cause hospital readmission occurred in 68% of patients, and 12-month all-cause mortality was 29%.
  • Discharge anticoagulation was prescribed to 66% of patients and significantly reduced 12-month mortality (23% vs. 40%; HR 0.506; 95% CI, 0.267–0.956; p=0.037), with no significant effect on readmissions.
  • Self-reported self-care behavior, do-not-resuscitate status, frailty, and higher comorbidity burdens were associated with lower rates of anticoagulant prescription at discharge.

Study Design

Type

Cohort

Structured PICO

Does the prescription of anticoagulant drugs at discharge improve 12-month mortality and readmission rates in patients hospitalized with chronic heart failure and concomitant atrial fibrillation?

P
Population
Prospective consecutive participants admitted to hospital with chronic heart failure (CHF) and concomitant atrial fibrillation (AF)
I
Intervention
Anticoagulant drugs prescribed at discharge
C
Comparator
No anticoagulant drugs prescribed at discharge
O
Outcome
All-cause readmission to hospital, mortality, stroke or transient ischaemic attack, and bleeding at 12 monthshard clinical

Main Result

Effect estimate: HR 0.506 (95% CI 0.267-0.956)

Absolute Event Rate: 23% vs 40%

p-value: p=0.037

In patients hospitalized with CHF and AF, prescription of anticoagulants at discharge is associated with a 50% relative reduction in 12-month mortality, though factors like frailty and self-care limitations often hinder their use.

Cite This Study

Ferguson et al. (2016) conducted a cohort in Chronic heart failure and concomitant atrial fibrillation. Anticoagulant drugs vs. No anticoagulant drugs was evaluated on 12-month all-cause mortality (HR 0.506, 95% CI 0.267-0.956, p=0.037). Prescription of anticoagulant drugs at discharge in patients with CHF and AF was associated with lower 12-month all-cause mortality (23% vs. 40%; HR 0.506; 95% CI 0.267-0.956; p=0.037).

synapsesocial.com/papers/6a10f067660e36c398f3992ahttps://doi.org/10.1177/1474515116642604
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