Réunion de concertation pluridisciplinaire a propos de l’anticoagulation du sujet âgé en fibrillation atriale : état des lieux après deux ans de fonctionnement

Abstract : In the cases of aged patients with atrial fibrillation, treatment with anticoagulant might be hard to prescribe. To help with the decision making process and discuss difficult cases, geriatricians, cardiologists and neurologists decided to create a Multidisciplinary team meeting (MDT). The main purpose of this study was to analyze patients’ characteristics, questions asked about each patient to the MDT and answers from the MDT. The secondary aims of the study were to distinguish different types of patients, to search for predictive factors of the decision to start or keep an anticoagulation, and to know the general practitioners’ perception of the MDT. In this descriptive and case-control study, we used univariate and adjusted analysis. The patients were more than 75 years old, suffered from atrial fibrillation and had been examined by the MDT between January 2016 and January 2018. We included 86 patients, the mean age was 87, 46% of the participants had a history of stroke, and 42% a history of vascular disease. We identified 4 reasons why patients were introduced to the MDT: hemorrhagic risk, embolic risk, diagnosis issue, other reason. The predictive factors of the decision to start or keep an anticoagulation were history of stroke (adjusted OR (95 % CI): 3,777 (1,329-10,738); p=0,013) and having an anticoagulant treatment before the MDT (adjusted OR (95 % CI): 3,820 (1,035-14,098); p=0,044). The general practitioners were enthusiastic about the MDT, however the quality of communication was found poor and the MDT should work on that to have more impact.
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Master Thesis
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Héloïse Camus. Réunion de concertation pluridisciplinaire a propos de l’anticoagulation du sujet âgé en fibrillation atriale : état des lieux après deux ans de fonctionnement. Médecine humaine et pathologie. 2018. ⟨dumas-02173212⟩

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