Characterization of Patients with Atrial Fibrillation Treated Inadequately with Anticoagulants: Why Hospitalization Is Not an Opportunity to Correct Errors.
Mreisat L, Rubinstein Levy S, Ben-Shabat N, Amital H • The Israel Medical Association journal : IMAJ • 2026
Hospitalization fails to correct inappropriate anticoagulation therapy in atrial fibrillation patients, with older patients receiving less standardized care and no statistically significant differences found between patients with and without DOAC contraindications regarding rates of missing therapy.
Key Findings
Methods
A substantial proportion of AF patients were discharged from internal medicine wards without appropriate DOAC therapy despite hospitalization representing a potential opportunity to correct management errors.
Retrospective cohort study of 222 patients at Sheba Medical Center
Data gathered from electronic medical records of patients hospitalized in internal medicine departments for any reason
Patients were discharged without receiving DOAC therapy
The study explicitly investigated 'the effectiveness of hospitalization in correcting inappropriate therapy for AF'
Results
The study population was predominantly elderly with a mean age of 77.1 years and had multiple comorbidities relevant to anticoagulation decisions.
Mean age of 77.1 years
42.3% were male
21.6% presented with cognitive impairment
Renal disease was present in 24.3% of patients
Mechanical valves were present in 14.4% of patients
Results
Patients were divided into three groups based on anticoagulation therapy received, with 134 patients not receiving DOACs due to contraindications and 88 patients not receiving DOACs mistakenly.
Total cohort of 222 patients divided into three groups based on anticoagulation therapy
134 patients did not receive DOACs due to identified contraindications
88 patients did not receive DOACs mistakenly (i.e., without valid contraindications)
Potential contraindications identified included renal disease (24.3%) and mechanical valves (14.4%)
Results
There were no statistically significant differences in baseline factors between patients who lacked DOACs due to contraindications versus those who lacked DOACs mistakenly.
Comparison made between the 134 patients with contraindications and the 88 patients mistakenly without DOACs
Baseline factors showed 'no statistically significant differences' between these two groups
This finding suggests clinicians may not be systematically distinguishing between patients with and without valid contraindications
No statistically significant differences were found regarding cognitive impairment rates or the lack of anticoagulation therapy when comparing patients with and without DOAC contraindications
Results
Older patients received less standardized care in terms of anticoagulation management for atrial fibrillation.
The study found that 'older patients received less standardized care'
Mean age of the cohort was 77.1 years, indicating a generally elderly population
This age-related disparity in care quality was identified as a key finding
The finding highlights a potential age-based inequity in adherence to guideline-recommended DOAC therapy
Discussion
Hospitalization in internal medicine wards did not serve as an effective opportunity to identify and correct inappropriate anticoagulation management in AF patients.
The study title explicitly frames hospitalization as a missed opportunity: 'Why Hospitalization Is Not an Opportunity to Correct Errors'
Patients were discharged without appropriate DOAC therapy despite being hospitalized
Findings 'emphasize the need to consider individual patient characteristics and co-morbidities to eliminate management errors'
DOACs 'have been shown to have improved safety and efficacy profiles and are the preferred therapy in all recent guidelines,' yet were still not prescribed appropriately
What This Means
This research suggests that when patients with atrial fibrillation (an irregular heart rhythm that raises stroke risk) are admitted to hospital internal medicine wards, their stays frequently fail to correct pre-existing problems with their blood thinner prescriptions. In a study of 222 patients at Sheba Medical Center in Israel, researchers found that many patients were sent home without the recommended type of blood thinners (called direct oral anticoagulants, or DOACs), even though current medical guidelines strongly favor these medications. Of those not receiving DOACs, 88 patients had no valid medical reason to avoid them — meaning their lack of treatment appeared to be a medical error rather than an intentional clinical decision.
A particularly concerning finding was that there were no meaningful statistical differences in patient characteristics between those who had legitimate reasons to avoid DOACs and those who were mistakenly left without them. This suggests that clinicians may not be reliably distinguishing between patients who truly cannot take these medications and those who simply were not prescribed them correctly. Additionally, older patients were found to receive less standardized care, raising concerns about age-related gaps in treatment quality for a condition that becomes more common and more dangerous with advancing age.
This research suggests that hospital admissions represent a missed opportunity to review and correct long-term medication management for atrial fibrillation. The findings point to a need for more systematic processes — such as medication reviews during hospitalization — to ensure that patients with atrial fibrillation leave the hospital on guideline-recommended therapy unless there is a clear, documented reason they cannot take it.
Mreisat L, Rubinstein Levy S, Ben-Shabat N, Amital H. (2026). Characterization of Patients with Atrial Fibrillation Treated Inadequately with Anticoagulants: Why Hospitalization Is Not an Opportunity to Correct Errors.. The Israel Medical Association journal : IMAJ. https://pubmed.ncbi.nlm.nih.gov/42867099/