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Multi-morbidity, frailty and self-care : Important considerations in treatment with anticoagulation drugs. Outcomes of the AFASTER study
Ferguson, Caleb Inglis, Sally C. Newton, Phillip J. Middleton, Sandy Macdonald, Peter S. Davidson, Patricia M.
Ferguson, Caleb
Inglis, Sally C.
Newton, Phillip J.
Middleton, Sandy
Macdonald, Peter S.
Davidson, Patricia M.
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.
Keywords
chronic heart failure, atrial fibrillation, anticoagulation drugs, readmission to hospital, mortality, multi-morbidity, frailty, self-care
Date
2017
Type
Journal article
Journal
European Journal of Cardiovascular Nursing
Book
Volume
16
Issue
2
Page Range
113-124
Article Number
ACU Department
Nursing Research Institute
Faculty of Health Sciences
Faculty of Health Sciences
Collections
Relation URI
Source URL
Event URL
Open Access Status
License
All rights reserved
File Access
Controlled