VALFORTA: a randomised trial to validate the FORTA (Fit fOR The Aged) classification

Wehling, Martin; Burkhardt, Heinrich; Kuhn-Thiel, Alexandra; Pazan, Farhad; Throm, Christina; Weiß, Christel; Frohnhofen, Helmut

doi:10.1093/ageing/afv200

Cited by 136 publications

(134 citation statements)

References 22 publications

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“…In a randomized, controlled trial (VALFORTA) FORTA significantly improved medication quality as measured by the FORTA-score that adds over-and undertreatment errors. FORTA also reduced adverse drug effects at a number needed to treat of only 5 [11].…”

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confidence: 99%

Appropriateness of Oral Anticoagulants for the Long-Term Treatment of Atrial Fibrillation in Older People: Results of an Evidence-Based Review and International Consensus Validation Process (OAC-FORTA 2016)

et al. 2017

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Importance: Age appropriateness of anticoagulants for stroke prevention in atrial fibrillation (AF) is uncertain.Objective: To review oral anticoagulants (OAC) for AF in older (age >65y) people, to classify appropriate and inappropriate drugs based on efficacy, safety and tolerability using the Fit-fOR-The-Aged (FORTA) classification.Evidence: We performed a structured comprehensive review of controlled clinical trials and summaries of individual product characteristics to assess study and total patient numbers, quality of major outcome data and data of geriatric relevance. The resulting evidence was discussed in a round table with an interdisciplinary panel of ten European experts. Decisions on age appropriateness were made using a Delphi process.Findings: For the 8 drugs included, 380 citations were identified. The primary outcome results were reported in 32 clinical trials with explicit and relevant data on older people. Though over 24000 patients aged >75/80 were studied for warfarin, data on geriatric syndromes were rare (2 studies reporting on frailty/falls/mental status), and missing for all other compounds. Apixaban was rated FORTA-A (highly beneficial). Other non-vitamin K antagonist OACs [NOACs] (including low/high-intensity dabigatran and high-intensity edoxaban) and warfarin were assigned to FORTA-B (beneficial). Phenprocoumon, acenocoumarol and fluindione were rated FORTA-C (questionable) mainly reflecting the absence of data. Conclusions: All NOACs and warfarin were classified as beneficial or very beneficial in older persons (FORTA-A or-B) underlining the overall positive assessment of the risk/benefit ratio for these drugs. For other vitamin-Kantagonists regionally used in Europe the lack of evidence should challenge current practice. KEY WORDSOlder people; Oral Anticoagulants; Atrial fibrillation; Effectiveness; Tolerability; FORTA Fit For The Aged. KEY POINTS Age appropriateness of chronically used anticoagulants to treat atrial fibrillation is still uncertain. Using a structured comprehensive approach including a literature search and subsequent Delphi process, an interdisciplinary expert group rated the appropriateness of oral anticoagulants for long-term treatment of atrial fibrillation in older people with regard to efficacy, tolerability, and safety. In older people the majority of these drugs, the non-vitamin K oral anticoagulants and warfarin, are seen to be beneficial or very beneficial while regionally used older vitamin K antagonists should be used with caution as evidence is missing. The evidence basis for the use of these drugs in older people regarding geriatric syndromes is very limited. 41.

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confidence: 99%

Appropriateness of Oral Anticoagulants for the Long-Term Treatment of Atrial Fibrillation in Older People: Results of an Evidence-Based Review and International Consensus Validation Process (OAC-FORTA 2016)

et al. 2017

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“…The updates of already existing lists and new lists of PIM are creating a need for constant updates of the content of this repository. For example, between the creation of the repository and the publication of this paper, an update of the FORTA list was published along with a number of validation studies . Although the author of the list describes the FORTA list as an implicit tool, we consider that this list contains valuable information and it needs to be considered for inclusion in the next updated more searchable version of this repository.…”

Section: Discussionmentioning

confidence: 99%

European repository of explicit criteria of potentially inappropriate medications in old age

Ivanova

Elseviers

Wauters

et al. 2018

Geriatrics Gerontology Int

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“…It should be noted that listing approaches such as START/STOPP or FORTA include aspects of fall risk reduction, as FRIDs are mostly highlighted as causative factors. Interventional trials have shown that these systematic drug-optimization strategies can reduce drug side effects [31, 32], including falls [20]. However, no single ideal tool exists currently, and the choice of tool may rely on the purpose of use and availability of data [30, 33].…”

Section: How To Reduce the Use Of Fall-risk-increasing Drugs (Frids)?mentioning

confidence: 99%

EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research

et al. 2019

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Falls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor. In the present statement, the European Geriatric Medicine Society (EuGMS) Task and Finish group on fall-risk-increasing drugs (FRIDs), in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge dissemination on medication-related falls in older people across Europe. The EuGMS Task and Finish group is developing educational materials to facilitate knowledge dissemination for healthcare professionals and older people. In addition, steps in primary prevention through judicious prescribing, deprescribing of FRIDs (withdrawal and dose reduction), and gaps in current research are outlined in this position paper.

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VALFORTA: a randomised trial to validate the FORTA (Fit fOR The Aged) classification

Abstract: DFG-German Research Foundation (WE 1184/15-1).

Cited by 136 publications

References 22 publications

Appropriateness of Oral Anticoagulants for the Long-Term Treatment of Atrial Fibrillation in Older People: Results of an Evidence-Based Review and International Consensus Validation Process (OAC-FORTA 2016)

Appropriateness of Oral Anticoagulants for the Long-Term Treatment of Atrial Fibrillation in Older People: Results of an Evidence-Based Review and International Consensus Validation Process (OAC-FORTA 2016)

European repository of explicit criteria of potentially inappropriate medications in old age

EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research

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