|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 2005; 46:1729-1736, doi:10.1016/j.jacc.2005.06.077
(Published online 10 October 2005). © 2005 by the American College of Cardiology Foundation |
* Division of Cardiology, Case Western University/University Hospitals of Cleveland, Cleveland, Ohio
Duke Clinical Research Institute, Durham, North Carolina
Department of Pulmonary Medicine, Duke University Medical Center, Durham, North Carolina
EPI-Q Inc., Oak Brook, Illinois
Manuscript received December 18, 2004; revised manuscript received June 8, 2005, accepted June 28, 2005.
* Reprint requests and correspondence: Dr. Albert L. Waldo, University Hospitals of Cleveland, Division of Cardiology, 11100 Euclid Avenue, Cleveland, Ohio 44106-5038 (Email: albert.waldo{at}case.edu).
OBJECTIVES: The purpose of this study was to determine both treatment gaps and predictors of warfarin use in atrial fibrillation (AF) patients enrolled in a national multicenter study.
BACKGROUND: The National Anticoagulation Benchmark Outcomes Report (NABOR) is a performance improvement program designed to benchmark anticoagulation prophylaxis, treatment, and outcomes among participating hospitals.
METHODS: A retrospective cohort study of inpatients was performed at 21 teaching, 13 community, and 4 Veterans Administration hospitals in the U.S. Patients with an ICD-9-CM code for AF (427.31) were randomly selected.
RESULTS: Among the 945 patients studied, the mean age was 71.5 (± 13.5) years; 43% were >75 years of age, 54.5% were men, and 67% had a history of hypertension. Most (86%) had factors that stratified them as at high risk of stroke, and only 55% of those received warfarin. Neither warfarin nor aspirin were prescribed in 21% of high-risk patients, including 18% of those with a previous stroke, transient ischemic attack, or systemic embolic event. Age >80 years (p = 0.008) and perceived bleeding risk (p = 0.022) were negative predictors of warfarin use. Persistent/permanent AF (p < 0.001) and history of stroke, transient ischemic attack, or systemic embolus (p = 0.014) were positive predictors of warfarin use, whereas high-risk stratification was not.
CONCLUSIONS: This study confirms the under-use of warfarin, but also adds to published reports in several regards. It showed that risk stratification, the guidepost for treatment in international guidelines, had little effect on warfarin use, and that age >80 years and AF classification (permanent/persistent) are factors that influence warfarin use.
| |||||||||||||
This article has been cited by other articles:
|
|
 |
|
  Y. L Bayard, S. H Ostermayer, and H. Sievert Alternatives to warfarin in atrial fibrillation: drugs and devices Heart, September 1, 2008; 94(9): 1113 - 1116. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Meiltz, M. Zimmermann, P. Urban, A. Bloch, and on behalf of the Association of Cardiologists of t Atrial fibrillation management by practice cardiologists: a prospective survey on the adherence to guidelines in the real world Europace, June 1, 2008; 10(6): 674 - 680. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Nieuwlaat, T. Dinh, S. B. Olsson, A. J. Camm, A. Capucci, R. G. Tieleman, G. Y.H. Lip, H. J.G.M. Crijns, and on behalf of the Euro Heart Survey Investigators Should we abandon the common practice of withholding oral anticoagulation in paroxysmal atrial fibrillation? Eur. Heart J., April 1, 2008; 29(7): 915 - 922. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. J. Connolly, J. Eikelboom, M. O'Donnell, J. Pogue, and S. Yusuf Response to Letter Regarding Article, "Challenges of Establishing New Antithrombotic Therapies in Atrial Fibrillation" Circulation, February 5, 2008; 117(5): e150 - e150. [Full Text] [PDF]
|
|
|
|
|
|
S. J. Connolly, J. Eikelboom, M. O'Donnell, J. Pogue, and S. Yusuf Challenges of Establishing New Antithrombotic Therapies in Atrial Fibrillation Circulation, July 24, 2007; 116(4): 449 - 455. [Full Text] [PDF]
|
|
|
|
|
|
E. M. Hylek, C. Evans-Molina, C. Shea, L. E. Henault, and S. Regan Major Hemorrhage and Tolerability of Warfarin in the First Year of Therapy Among Elderly Patients With Atrial Fibrillation Circulation, May 29, 2007; 115(21): 2689 - 2696. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Sconce, P. Avery, H. Wynne, and F. Kamali Vitamin K supplementation can improve stability of anticoagulation for patients with unexplained variability in response to warfarin Blood, March 15, 2007; 109(6): 2419 - 2423. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L Kalra, G Y H Lip, and on behalf of the Guideline Development Group for t Antithrombotic treatment in atrial fibrillation Heart, January 1, 2007; 93(1): 39 - 44. [Full Text] [PDF]
|
|
|
|
|
|
R. Nieuwlaat, A. Capucci, G. Y.H. Lip, S. B. Olsson, M. H. Prins, F. H. Nieman, J. Lopez-Sendon, P. E. Vardas, E. Aliot, M. Santini, et al. Antithrombotic treatment in real-life atrial fibrillation patients: a report from the Euro Heart Survey on Atrial Fibrillation Eur. Heart J., December 2, 2006; 27(24): 3018 - 3026. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Friberg, N. Hammar, M. Ringh, H. Pettersson, and M. Rosenqvist Stroke prophylaxis in atrial fibrillation: who gets it and who does not?: Report from the Stockholm Cohort-study on Atrial Fibrillation (SCAF-study) Eur. Heart J., August 2, 2006; 27(16): 1954 - 1964. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. M. Hylek, J. D'Antonio, C. Evans-Molina, C. Shea, L. E. Henault, and S. Regan Translating the Results of Randomized Trials into Clinical Practice: The Challenge of Warfarin Candidacy Among Hospitalized Elderly Patients With Atrial Fibrillation Stroke, April 1, 2006; 37(4): 1075 - 1080. [Abstract] [Full Text] [PDF]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
