Potentially inappropriate prescribing and polypharmacy in older adults with atrial fibrillation: a retrospective observational study

OBJECTIVES: To describe and assess the appropriateness of prescribing for older adults with atrial fibrillation (AF) presenting to a multidisciplinary outpatient clinic. METHODS: Retrospective observational study of medical records of patients who attended a specialist AF outpatient clinic over a 1-year period. Prescribing was assessed using the STOPP/START Criteria (Version 2). Direct oral anticoagulant prescribing was assessed separately. Risk factors for Potentially Inappropriate Medications (PIM) and Potential Prescribing Omissions (PPO) were assessed through multivariable logistic regression. KEY FINDINGS: One hundred and sixty-eight patients (median age: 74 years; range: 65-94 years; 59.4% male) were included. Patients had a median of six comorbidities (IQR 4-9) and were prescribed a median of six medications (IQR 4-9). Minor polypharmacy (5-9 medications) was found in 53.0% (n = 89), and major polypharmacy (>9 medications) was found in 21.4% (n = 36). Potentially inappropriate prescribing was present in 75.6% (n = 127). The majority (60.1%, n = 101) had at least one potentially inappropriate medication, and 46.4% (n = 78) had a potential prescribing omission. Anticoagulants were inappropriately dosed in 11.6% (n = 13) of patients. There were positive associations between number of medications prescribed and PIM (P = < .001), and number of comorbidities and PPO (P = < .001). CONCLUSIONS: Polypharmacy and potentially inappropriate prescribing were prevalent in this population of older adults with AF. Interventions are needed to optimize prescribing in this cohort.