This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Gregory W. Albers, MD; Josephine M. Yim, PharmD; Kathyrn M. Belew, RN, MSN; Neville Bittar, MD; Charles R. Hattemer, MD; Bradley G. Phillips, PharmD; Stephanie Kemp; Ellen A. Hall, RN; David J. Morton; Peter H. Vlasses, PharmD

Arch Intern Med. 1996;156(20):2311-2316.

Abstract
Background
The risk of stroke in patients with atrial fibrillation can be significantly reduced with antithrombotic therapy. Despite this, many physicians remain hesitant to prescribe warfarin sodium or aspirin therapy for patients with atrial fibrillation.

Objective
To assess the use of antithrombotic therapy in patients with atrial fibrillation at 6 academic hospitals in the United States.

Methods
Records were reviewed from consecutive hospital admissions of 309 patients with atrial fibrillation at 6 members of the University HealthSystem Consortium, Oak Brook, Ill, which is a member-driven alliance of 70 academic health centers in the United States. Risk factors for stroke, contraindications to anticoagulant therapy, and use of antithrombotic therapy at admission and discharge were recorded.

Results
The mean age of patients was 71.6 years; 54% had chronic, 22% paroxysmal, and 24% new-onset atrial fibrillation. Eighty-two percent of the patients had cardiovascular risk factors that have been associated with increased risk of stroke. At least 1 relative contraindication to anticoagulant therapy was present in 44%. At the time of admission, 32% of the patients with previously diagnosed atrial fibrillation (n=235) were receiving warfarin (or warfarin plus aspirin), 31% were receiving aspirin alone, and 36% were receiving no antithrombotic therapy. At discharge (n=230), 41% of these patients were taking warfarin (or warfarin plus aspirin) and 36% were taking aspirin. Forty-four percent of the patients with risk factors for stroke and no contraindications to anticoagulation (n=134) were discharged on a regimen of warfarin (or warfarin plus aspirin), 34% were discharged on a regimen of aspirin, and 22% received no antithrombotic therapy.

Conclusions
About half of the patients with atrial fibrillation admitted to these academic hospitals had clinical risk factors that are associated with increased risk of stroke and no contraindications to anticoagulation. Antithrombotic therapy was underused in these patients.

Arch Intern Med. 1996;156:2311-2316

Author Affiliations
From the Stanford University Medical Center, Palo Alto, Calif (Dr Albers and Ms Kemp); University HealthSystem Consortium, Oak Brook, Ill (Drs Yim and Vlasses, Ms Hall, and Mr Morton); University of Missouri Medical Center, Columbia (Ms Belew); University of Wisconsin Medical Center, Madison (Dr Bittar); University of Cincinnati Medical Center, Cincinnati, Ohio (Dr Hattemer); and University of Illinois Medical Center, Chicago (Dr Phillips).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Quality of care for atrial fibrillation among patients hospitalized for heart failure.
Piccini et al.
J Am Coll Cardiol 2009;54:1280-1289.
ABSTRACT | FULL TEXT  

Potentially Preventable Strokes in High-Risk Patients With Atrial Fibrillation Who Are Not Adequately Anticoagulated
Gladstone et al.
Stroke 2009;40:235-240.
ABSTRACT | FULL TEXT  

Atrial fibrillation management by practice cardiologists: a prospective survey on the adherence to guidelines in the real world
Meiltz et al.
Europace 2008;10:674-680.
ABSTRACT | FULL TEXT  

'Rules of thumb' or reflective practice? Understanding senior physicians' decision-making about anti-thrombotic usage in atrial fibrillation
Anderson et al.
QJM 2007;100:263-269.
ABSTRACT | FULL TEXT  

Antithrombotic treatment in real-life atrial fibrillation patients: a report from the Euro Heart Survey on Atrial Fibrillation
Nieuwlaat et al.
Eur Heart J 2006;27:3018-3026.
ABSTRACT | FULL TEXT  

Translating the Results of Randomized Trials into Clinical Practice: The Challenge of Warfarin Candidacy Among Hospitalized Elderly Patients With Atrial Fibrillation
Hylek et al.
Stroke 2006;37:1075-1080.
ABSTRACT | FULL TEXT  

Atrial fibrillation management: a prospective survey in ESC Member Countries: The Euro Heart Survey on Atrial Fibrillation
Nieuwlaat et al.
Eur Heart J 2005;26:2422-2434.
ABSTRACT | FULL TEXT  

Hospitalized Patients With Atrial Fibrillation and a High Risk of Stroke Are Not Being Provided With Adequate Anticoagulation
Waldo et al.
J Am Coll Cardiol 2005;46:1729-1736.
ABSTRACT | FULL TEXT  

Safety of Electroconvulsive Therapy in Patients Receiving Long-term Warfarin Therapy
Mehta et al.
Mayo Clin Proc. 2004;79:1396-1401.
ABSTRACT  

Safety of Anticoagulation Therapy in Well-informed Older Patients
Kagansky et al.
Arch Intern Med 2004;164:2044-2050.
ABSTRACT | FULL TEXT  

A Pharmacokinetic Study of the Combined Administration of Amiodarone and Ximelagatran, an Oral Direct Thrombin Inhibitor
Teng et al.
J Clin Pharmacol 2004;44:1063-1071.
ABSTRACT | FULL TEXT  

Atrial fibrillation: an emerging epidemic?
Steinberg
Heart 2004;90:239-240.
FULL TEXT  

Knowledge and management of transient ischemic attacks among US primary care physicians
Nguyen-Huynh et al.
Neurology 2003;61:1455-1456.
FULL TEXT  

Anticoagulant-Related Bleeding in Older Persons With Atrial Fibrillation: Physicians' Fears Often Unfounded
Man-Son-Hing and Laupacis
Arch Intern Med 2003;163:1580-1586.
ABSTRACT | FULL TEXT  

Measuring quality of outpatient cardiovascular care
Koelling and Eagle
J Am Coll Cardiol 2003;41:69-72.
FULL TEXT  

Prevalence of Atrial Fibrillation and Antithrombotic Prophylaxis in Emergency Department Patients
Scott et al.
Stroke 2002;33:2664-2669.
ABSTRACT | FULL TEXT  

Prevalence and Quality of Warfarin Use for Patients With Atrial Fibrillation in the Long-term Care Setting
McCormick et al.
Arch Intern Med 2001;161:2458-2463.
ABSTRACT | FULL TEXT  

Management of atrial fibrillation: discrepancy between guideline recommendations and actual practice exposes patients to risk for complications
Frykman et al.
Eur Heart J 2001;22:1954-1959.
ABSTRACT  

Evaluation of Risk Factors for Stroke/Embolism and of Complications Due to Anticoagulant Therapy in Atrial Fibrillation
Wehinger et al.
Stroke 2001;32:2246-2252.
ABSTRACT | FULL TEXT  

Improvement in antithrombotic management in atrial fibrillation also requires effective INR control
MURPHY and CASEY
Postgrad. Med. J. 2001;77:487a-488.
FULL TEXT  

Are the Results of Randomized Controlled Trials on Anticoagulation in Patients With Atrial Fibrillation Generalizable to Clinical Practice?
Evans and Kalra
Arch Intern Med 2001;161:1443-1447.
ABSTRACT | FULL TEXT  

New Transient Ischemic Attack and Stroke: Outpatient Management by Primary Care Physicians
Goldstein et al.
Arch Intern Med 2000;160:2941-2946.
ABSTRACT | FULL TEXT  

Warfarin for Stroke Prevention Still Underused in Atrial Fibrillation : Patterns of Omission
Cohen et al.
Stroke 2000;31:1217-1222.
ABSTRACT | FULL TEXT  

Prospective cohort study to determine if trial efficacy of anticoagulation for stroke prevention in atrial fibrillation translates into clinical effectiveness
Kalra et al.
BMJ 2000;320:1236-1239.
ABSTRACT | FULL TEXT  

The Quality of Anticoagulation Management
Ansell
Arch Intern Med 2000;160:895-896.
FULL TEXT  

Adverse Outcomes and Predictors of Underuse of Antithrombotic Therapy in Medicare Beneficiaries With Chronic Atrial Fibrillation
Gage et al.
Stroke 2000;31:822-827.
ABSTRACT | FULL TEXT  

Secular trends in the management of hypertension and atrial fibrillation in patients presenting with stroke
Smithard et al.
QJM 2000;93:41-44.
ABSTRACT | FULL TEXT  

Stroke prevention practices in patients with atrial fibrillation and pacemaker therapy: Evidence for under-use of anticoagulation
Carlsson et al.
Europace 2000;2:115-118.
ABSTRACT  

North Carolina Stroke Prevention and Treatment Facilities Survey : Statewide Availability of Programs and Services
Goldstein et al.
Stroke 2000;31:66-70.
ABSTRACT | FULL TEXT  

Warfarin Use among Ambulatory Patients with Nonvalvular Atrial Fibrillation: The AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study
Go et al.
ANN INTERN MED 1999;131:927-934.
ABSTRACT | FULL TEXT  

Use of antithrombotic measures for stroke prevention in atrial fibrillation
Perez et al.
Heart 1999;82:570-574.
ABSTRACT | FULL TEXT  

Supplement to the Guidelines for the Management of Transient Ischemic Attacks : A Statement From the Ad Hoc Committee on Guidelines for the Management of Transient Ischemic Attacks, Stroke Council, American Heart Association
Albers et al.
Stroke 1999;30:2502-2511.
FULL TEXT  

Anticoagulant prophylaxis against stroke in atrial fibrillation: effectiveness in actual practice
Caro et al.
CMAJ 1999;161:493-497.
ABSTRACT | FULL TEXT  

Preventing stroke in atrial fibrillation: Why are so many eligible patients not receiving anticoagulant therapy?
Connolly
CMAJ 1999;161:533-534.
FULL TEXT  

A Patient Decision Aid Regarding Antithrombotic Therapy for Stroke Prevention in Atrial Fibrillation: A Randomized Controlled Trial
Man-Son-Hing et al.
JAMA 1999;282:737-743.
ABSTRACT | FULL TEXT  

Risk Assessment and Anticoagulation for Primary Stroke Prevention in Atrial Fibrillation
Kalra et al.
Stroke 1999;30:1218-1222.
ABSTRACT | FULL TEXT  

Choosing Antithrombotic Therapy for Elderly Patients With Atrial Fibrillation Who Are at Risk for Falls
Man-Son-Hing et al.
Arch Intern Med 1999;159:677-685.
ABSTRACT | FULL TEXT  

Identification and treatment of patients with atrial fibrillation in primary care
HOBBS
Heart 1999;81:333-334.
FULL TEXT  

Warfarin Use Following Ischemic Stroke Among Medicare Patients With Atrial Fibrillation
Brass et al.
Arch Intern Med 1998;158:2093-2100.
ABSTRACT | FULL TEXT  

Choice of Antithrombotic Therapy for Stroke Prevention in Atrial Fibrillation: Warfarin, Aspirin, or Both?
Albers
Arch Intern Med 1998;158:1487-1491.
FULL TEXT  

Cost-Effectiveness of Preference-Based Antithrombotic Therapy for Patients With Nonvalvular Atrial Fibrillation
Gage et al.
Stroke 1998;29:1083-1091.
ABSTRACT | FULL TEXT  

Recent National Patterns of Warfarin Use in Atrial Fibrillation
Stafford and Singer
Circulation 1998;97:1231-1233.
ABSTRACT | FULL TEXT  

Stroke Risk Management : Changes in Mainstream Practice
Kalra et al.
Stroke 1998;29:53-57.
ABSTRACT | FULL TEXT  

Warfarin Use Among Patients With Atrial Fibrillation
Brass et al.
Stroke 1997;28:2382-2389.
ABSTRACT | FULL TEXT  

Underuse of Warfarin in Atrial Fibrillation
Cheng
Arch Intern Med 1997;157:1505-1505.
ABSTRACT  

Cardiovascular Disease
Gore and Dalen
JAMA 1997;277:1845-1846.
 

Anticoagulant Therapy in Patients Aged 80 Years or More With Atrial Fibrillation: More Caution Is Needed
Ackermann
Arch Fam Med 1997;6:105-110.
ABSTRACT  

ANTICOAGULANTS FOR PATIENTS WITH AF
JWatch General 1996;1996:4-4.
FULL TEXT