[Anticoagulation in the aged patient with atrial fibrillation: What are prescribing cardiologists, geriatricians and general practitioners?]. / L'anticoagulation du patient âgé en fibrillation atriale: que prescrivent les cardiologues, les gériatres et les médecins généralistes?

ABSTRACT

OBJECTIVE: To assess prescribing of anticoagulants in atrial fibrillation (AF) in the elderly, both a quantitative point of view (rate of anticoagulation) and qualitative (type of anticoagulation). Determinants of prescribing and non-prescribing were also analysed. METHODS: Prospective survey of practice, based on one clinical case and questionnaire conducted in 60 practitioners (20 cardiologists [C], 20 geriatricians [G] and 20 general practitioners [GP]). RESULTS: In reading the clinical case, 88.3% of physicians would have initiated a treatment; three types of treatments would have been chosen AVK (68.3%), ODA (20.0%) and platelet antiaggregant (11.7%). Criteria taken into account to initiate anticoagulation varied according to the specialty. Cardiologists considered more the age criteria (C 95.0%, G 75.0%, MG 60.0%; P<0.05), diabetes (C 90.0%, G 60.0%, MG 55.0%; P<0.05), hypertension (C 85.0%, G 55.0%, MG 60.0%; P<0.05) and female gender (C 80.0%, G 35.0%, MG 25.0%; P<0.05). The quality of renal function was however a more secondary criteria (C 15.0%, G 5.0%, MG 0.0%; P<0.05). General practitioners considered most frequently the presence of underlying heart disease (C 35.0%, G 5.0%, MG 45.0%; P<0.05) as well as usual cardiovascular risk factors (overweight, dyslipidaemia; P<0.05). Risk of bleeding, however, was observed by 76.7% of physicians in the clinical situation presented (C 70.0%, G 75.0%, MG 85.0%; P<0.05). CONCLUSION: This survey confirms that the FA remains under anticoagulated in the elderly and the barriers to the prescription of oral anticoagulation are often without rational basis.