Key result
Inappropriate DOAC prescribing is linked to ~117% higher major bleeding risk but not mortality or stroke.
Why the study?
Polypharmacy in multimorbid older patients with AF is a risk factor for potentially inappropriate prescribing (PIP), but evidence on its prevalence and impact on adverse health outcomes needed systematic assessment.
Does potentially inappropriate prescribing of (D)OACs increase adverse health outcomes in multimorbid, polymedicated older adults with atrial fibrillation?
Meta-Analysis
Does potentially inappropriate prescribing of (D)OACs increase adverse health outcomes in multimorbid, polymedicated older adults with atrial fibrillation?
Effect estimate: OR 2.17 (95% CI 1.14-4.12)
Potentially inappropriate prescribing of (D)OACs is highly prevalent (35.2%) in multimorbid older adults with atrial fibrillation, though evidence linking it to adverse clinical outcomes remains scarce and heterogeneous.
Evidence on outcomes with potentially inappropriate (D)OAC use in older adults remains insufficient to alter practice; leaves open need for dedicated prospective research.
AIM: Polypharmacy in multimorbid older patients with atrial fibrillation (AF) is a risk factor for potentially inappropriate prescribing (PIP). We aimed to systematically assess the evidence on the prevalence of PIP and its impact on adverse health outcomes in this patient group. METHODS: A systematic search of the published peer-reviewed literature describing the prevalence of PIP and/or its association with adverse health outcomes in multimorbid (AF plus one comorbidity) and polymedicated (≥ 2 drugs) adults ≥ 65 years was done up to March 2023. A meta-analysis of the prevalence of PIP of (direct) oral anticoagulants ((D)OACs) was conducted using a random-effects model. Leave-one-out analysis was performed with R (version 4.2.2) and RStudio (version 2022.12.0+353). RESULTS: 95%). No statistically significant association was reported in three studies between PIP of (D)OACs, cardiovascular (CV) and all-cause mortality, hospital readmission, CV hospitalisation and stroke. Reported associations between PIP and major bleeding differed, with one study demonstrating a significant association (odds ratio 2.17; 95% CI 1.14-4.12) and the other study not showing such association. CONCLUSION: This systematic review highlights the scarce evidence regarding the prevalence of PIP and its association with adverse health outcomes in multimorbid older adults with AF. Large, prospective and better-designed studies are needed.
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Amrouch et al. (2023) conducted a meta-analysis in Atrial fibrillation. Potentially inappropriate prescribing (PIP) of (D)OACs was evaluated on Adverse health outcomes (mortality, hospital readmission, CV hospitalisation, stroke, major bleeding) (OR 2.17, 95% CI 1.14-4.12). Potentially inappropriate prescribing of (D)OACs showed no significant association with mortality or stroke, but had mixed associations with major bleeding (OR 2.17; 95% CI 1.14-4.12 in one study).
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