- Title
- Using epidemiological evidence to aid tailored joint decision-making in areas of clinical uncertainty in the management of atrial fibrillation in later life
- Creator
- Abbas, Shazia Shehzad
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2023
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Atrial fibrillation (AF) is associated with substantial morbidity and mortality, particularly through the risk of embolic stroke, and is considered an emerging public health epidemic. Management of AF involves a complex decision-making process of balancing the risk of stroke associated with AF and the risk of bleeding associated with its treatment. Literature suggests challenges in the management of AF and indicates that treatment practices do not correlate well with the risk of stroke and bleeding, especially for older patients, and particularly for older women. This research project aimed to i) calculate the prevalence and incidence of AF among older women in Australia, ii) examine medication use among older Australian women with AF, identify distinct patterns of medications for older women over time and factors associated with medication use, iii) assess Quality of Life (QoL) of women with AF by calculating SF-6D (Short-Form Six-Dimension) score using SF-36 (36-Item Short Form Survey), iv) estimate the transition probabilities of women with AF into various health states, and, v) explore a decision analysis model suggesting an optimal treatment of AF for older women. This research was based on longitudinal data collected over 15 years from participants in the Australian Longitudinal Study on Women’s Health (ALSWH), linked with Pharmaceutical Benefits Scheme (PBS) data, state-based hospital admissions data and the National Death Index (NDI). Latent Class Analysis (LCA), Latent Transition Analysis (LTA), multivariable regression, and Markov simulations models were used in various studies to understand the burden of AF among women, medication use, quality of life and optimal treatment for AF among older women. Findings from this research indicate that the prevalence of AF in Australian women was higher than previous estimations from other countries and regions, in that about one in four women over the age of 90 years had AF. While the prevalence increased with age, the incidence remained steady. Combined, these effects suggest “population ageing” that will result in an overall increase in prevalence. Women with AF were found to be at high risk of stroke. Evaluation of medication data, however, suggested inadequate prevention of thromboembolism among older women with AF. There were wide variations in the medication patterns, however, once established, a pattern of medication is often continued over the long term. Quality of life estimated using SF-6D utility scores was lower for women with AF compared to the general population of women in Australia and is further reduced by the presence of various co-morbidities and/or permanent disability. Decision analysis indicated that Oral Anticoagulants (OAC) use is the optimal treatment option for the prevention of stroke and improves survival even in older women. The results of this research indicate that appropriate treatment can not only prevent stroke and mortality but can also improve the quality of life. Therefore, there needs to be a strong justification for withholding anticoagulation medication among women with AF, even if they are very old.
- Subject
- atrial fibrillation; cardiovascular diseases; incidence; medication patterns; thesis by publication; women; geriatrics; medication use; decision analysis; Markov models; quality of Life; SF-36; prevalence
- Identifier
- http://hdl.handle.net/1959.13/1504809
- Identifier
- uon:55577
- Rights
- Copyright 2023 Shazia Shehzad Abbas
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 8 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 638 KB | Adobe Acrobat PDF | View Details Download |