Abstract
BackgroundThe global burden of cardiovascular disease (CVD) is forecast to increase, and anticoagulants will remain important medicines for its management. Coroners' Prevention of Future Death reports (PFDs) provide valuable insights that may enable safer and more effective use of these agents.AimTo identify CVD-related PFDs involving anticoagulants.Design & settingCase series of coronial reports in England and Wales between 2013 and 2019.MethodA total of 3037 PFDs were screened for eligibility. PFDs were included where CVD and an anticoagulant caused or contributed to the death. Included cases were descriptively analysed and content analysis was used to assess concerns raised by coroners and who had responded to them.ResultsThe study identified 113 CVD-related PFDs involving anticoagulants. Warfarin (36%, n = 41), enoxaparin (11%, n = 12), and rivaroxaban (11%, n = 12) were the most common anticoagulants reported. Concerns most frequently raised by coroners included poor systems (31%), poor communication (25%), and failures to keep accurate medical records (25%). These concerns were most often directed to NHS trusts (29%), hospitals (10%), and general practices (8%). Nearly two-thirds (60%) of PFDs had not received responses from such organisations, which are mandatory under regulation 28 of the Coroners' (Investigations) Regulations 2013. A publicly available tool has been created by the authors (https://preventabledeathstracker.net), which displays coroners’ reports in England and Wales to streamline access, and identify important lessons to prevent future deaths.ConclusionNational organisations, healthcare professionals, and prescribers should take actions to address the concerns of coroners in PFDs to improve the safe use of anticoagulants in patients with CVD.
Highlights
cardiovascular disease (CVD) is the leading cause of mortality worldwide.[1,2] In 2019, 18.6 million deaths (33% of all deaths) were due to CVD,[3] with a projection of 24 million annual deaths by 2030.4 In England and Wales, CVD was responsible for almost a quarter of all deaths in 2019.5,6 Premature mortality from CVD in England has been attributed to greater socioeconomic inequalities in people aged
Concerns most frequently raised by coroners included poor systems (31%), poor communication (25%), and failures to keep accurate medical records (25%)
National organisations, healthcare professionals, and prescribers should take actions to address the concerns of coroners in Prevention of Future Death reports (PFDs) to improve the safe use of anticoagulants in patients with CVD
Summary
In patients at high risk of strokes, heart attacks, deep vein thrombosis, or pulmonary embolism, anticoagulation is one possible prophylactic intervention.[8] Anticoagulants target different points of the coagulation cascade, helping to prevent blood-clot formation and the adverse effects of excessive clotting. The effectiveness of anticoagulants for CVD is well established. Adjusted-d ose warfarin reduced stroke by 62% (95% confidence interval [CI] = 48% to 72%) in patients with atrial fibrillation.[10] the narrow therapeutic index and frequent laboratory monitoring needed with warfarin administration have led to the development of DOACs.[11] Bleeding associated with warfarin therapy is among the top three adverse drug reactions that cause hospital admissions in England.[12]. The global burden of cardiovascular disease (CVD) is forecast to increase, and anticoagulants will remain important medicines for its management. Coroners' Prevention of Future Death reports (PFDs) provide valuable insights that may enable safer and more effective use of these agents
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