 |
|
Temporal Trends in the Use of Anticoagulants Among Older Adults With Atrial Fibrillation
Nicholas L. Smith, PhD, MPH;
Bruce M. Psaty, MD, PhD;
Curt D. Furberg, MD, PhD;
Richard White, MD;
Joao A. C. Lima, MD;
Anne B. Newman, MD, MPH;
Teri A. Manolio, MD, MHS
Arch Intern Med. 1999;159:1574-1578.
Background Several recent randomized clinical trials have demonstrated that warfarin sodium treatment, and to a lesser extent aspirin, reduces risk of stroke and death compared with placebo in persons with atrial fibrillation. Insufficient documentation exists on the extent to which the use of these therapies following trial publications has continued to increase in the elderly with atrial fibrillation.
Methods We used data from the Cardiovascular Health Study, a study of 5888 community-dwelling adults aged 65 years or older, to determine the prevalence of warfarin and aspirin use in persons with electrocardiogram-identified atrial fibrillation. Electrocardiogram examinations were conducted at baseline from 1989 through 1990, and at 6 subsequent annual examinations through 1995-1996. Medication data were collected by inventory methods at each examination. Temporal change in use of anticoagulants was analyzed by comparing percentage use in 1990 to use in each year through 1996.
Results The use of warfarin increased 4-fold from 13% in 1990 to 50% in 1996 among participants with prevalent atrial fibrillation (P<.001). Daily use of aspirin did not increase over time. Participants younger than 80 years were 4 times more likely to use warfarin in 1996 (P<.001) than those 80 years and older. Use of aspirin did not vary significantly with age.
Conclusions Warfarin use in community-dwelling elderly persons with electrocardiogram-documented atrial fibrillation increased steadily following the first publication of its treatment benefit, reaching 50% by 1996. In contrast, use of aspirin was unchanged during this same period. Continued efforts to promote appropriate anticoagulation therapy to physicians and their patients may still be needed.
From the Departments of Medicine (Drs Smith and Psaty), Epidemiology (Dr Psaty), and Health Services (Dr Psaty), University of Washington, Seattle; Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (Dr Furberg); Division of General Medicine, University of California, Davis (Dr White); Division of Cardiology, Johns Hopkins University, Hagerstown, Md (Dr Lima); Department of Medicine, University of Pittsburgh, Pittsburgh, Pa (Dr Newman); and Division of Epidemiology and Clinical Application, National Heart, Lung, and Blood Institute, Bethesda, Md (Dr Manolio).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED ARTICLE
Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 1999;159(14):1630-1631.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Left Atrial Appendage Occlusion Does Not Eliminate the Need for Warfarin
Whitlock et al.
Circulation 2009;120:1927-1932.
FULL TEXT
Epidemiology of ischemic stroke from atrial fibrillation in Dijon, France, from 1985 to 2006
Bejot et al.
Neurology 2009;72:346-353.
ABSTRACT
| FULL TEXT
Newly Detected Atrial Fibrillation and Compliance With Antithrombotic Guidelines
Glazer et al.
Arch Intern Med 2007;167:246-252.
ABSTRACT
| FULL TEXT
The increasing incidence of anticoagulant-associated intracerebral hemorrhage
Flaherty et al.
Neurology 2007;68:116-121.
ABSTRACT
| FULL TEXT
Escalating polypharmacy
Gorard
QJM 2006;99:797-800.
ABSTRACT
| FULL TEXT
Atrial Fibrillation and Stroke in the General Medicare Population: A 10-Year Perspective (1992 to 2002)
Lakshminarayan et al.
Stroke 2006;37:1969-1974.
ABSTRACT
| FULL TEXT
The Relationship Between Stature and the Prevalence of Atrial Fibrillation in Patients With Left Ventricular Dysfunction
Hanna et al.
J Am Coll Cardiol 2006;47:1683-1688.
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
Time Trends of Ischemic Stroke Incidence and Mortality in Patients Diagnosed With First Atrial Fibrillation in 1980 to 2000: Report of a Community-Based Study
Miyasaka et al.
Stroke 2005;36:2362-2366.
ABSTRACT
| FULL TEXT
Warfarin Maintenance Dosing Patterns in Clinical Practice: Implications for Safer Anticoagulation in the Elderly Population
Garcia et al.
Chest 2005;127:2049-2056.
ABSTRACT
| FULL TEXT
Stroke in the Very Elderly * Response
Marti et al.
Stroke 2005;36:705-706.
FULL TEXT
National Trends in Antiarrhythmic and Antithrombotic Medication Use in Atrial Fibrillation
Fang et al.
Arch Intern Med 2004;164:55-60.
ABSTRACT
| FULL TEXT
Measuring quality of outpatient cardiovascular care
Koelling and Eagle
J Am Coll Cardiol 2003;41:69-72.
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
Review: warfarin prevents stroke in non-rheumatic atrial fibrillation but has a higher risk for haemorrhage than other agents
Douketis
Evid. Based Med. 2001;6:150-150.
FULL TEXT
Atrial Fibrillation and Stroke : Concepts and Controversies
Hart and Halperin
Stroke 2001;32:803-808.
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
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
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
|
