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Prescribing, consumption and monitoring of direct oral anticoagulants in elderly patients (>75 years) with atrial fibrillation

Exploring the current methods of prescription and consumption of direct oral anticoagulants in elderly patients diagnosed with Atrial Fibrillation 

Yeyenta Osasu, University of Sheffield 

The Problem

By the age of 75 years, one in five women and one in six men will have had a stroke. Atrial fibrillation (AF) is a condition, which can cause the heart to beat too fast and unevenly. People with AF are five times more likely to have a stroke but taking an anticoagulant can reduce the chances of this happening. Anticoagulants can cause serious harm if not prescribed, taken or monitored properly so this creates a difficult decision making process for doctors, pharmacists and nurses who look after such patients. Anticoagulants are potentially life-saving but the benefit of prescribing these drugs must be balanced with the risk of causing potential harm.

Why is this important?

Historically, warfarin was the anticoagulant of choice but more recently, newer anticoagulants, also known as direct oral anticoagulants (DOACs) have become available. DOACs are promoted as safer alternatives to warfarin and should present less challenges for patients but there is a reluctance to prescribe them. This means an estimated 25% of people are not treated which puts people at a risk of developing a stroke. We need to understand why these drugs are not being prescribed, consumed or monitored correctly. My work will improve decision making processes, improve patient safety, and how patients are managed in the community.

Study design and plan

I will collect information about prescribing DOACs from GP practices to find out which patients are being prescribed these drugs. I will interview 25 patients who are aged over 75 years and have AF, and one or more other long-term condition including high blood pressure and who are currently taking newer anticoagulants. I will interview the patient’s GPs, nurses, and pharmacists. I will discuss the findings with a patient group and GP focus groups to further strengthen the research.

Patient and public involvement (PPI)

The Cardiovascular PPI Group in Sheffield have co-designed this project, will steer the direction of my research and will help me to communicate my findings effectively.

Dissemination

Research findings will be published in academic journals and be presented at conferences. I will feedback results to patients who participated in the study through a project newsletter and develop training materials for health professionals to inform their prescribing practice.

Impact on patients and pharmacy

My work will identify the barriers and benefits of prescribing and taking anticoagulant medication and will build upon the trust that exists already between patients and pharmacists. The  pharmacy profession will take the lead in guiding policy on risk reduction, patient safety, and improving pathways for patient management as a result of this project. Gathering patient experiences is important because I will capture their concerns which, when shared with health professionals, will help them to better communicate anticoagulation benefits and risks. Patients may speak about the benefits of the medication and successful use which will help to reassure other patients who are eligible, yet concerned about taking a high-risk drug. The aim is to increase practitioner and patient confidence in decision making based on more personalised care.

The project was awarded funding in July 2017 and is due to run from November 2017 to October 2019.

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