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Newly Detected Atrial Fibrillation and Compliance With Antithrombotic Guidelines
Nicole L. Glazer, MPH;
Sascha Dublin, MD, PhD;
Nicholas L. Smith, PhD, MPH;
Benjamin French, MS;
Lisa A. Jackson, MD, MPH;
Jennifer B. Hrachovec, PharmD;
David S. Siscovick, MD, MPH;
Bruce M. Psaty, MD, PhD;
Susan R. Heckbert, MD, PhD
Arch Intern Med. 2007;167(3):246-252.
Background Guidelines recommend the use of antithrombotic therapy for stroke prevention in patients with atrial fibrillation (AF), but compliance with such guidelines has not been widely studied among patients with newly detected AF. Our objective was to assess compliance with antithrombotic guidelines and to identify patient characteristics associated with warfarin use.
Methods A population-based study of newly detected AF (patient age, 30-84 years) was conducted within a large health plan. Cardiovascular disease risk factors, comorbid conditions, medication use, and international normalized ratios were abstracted from the medical record. Patients were stratified by embolic risk according to American College of Chest Physicians (ACCP) criteria. We analyzed the proportion of patients with AF receiving warfarin or aspirin ( 325 mg/d) during the 6 months following AF. Relative risk regression estimated the association of risk factors and patient characteristics with warfarin use.
Results Overall, 73% of patients (418/572) with newly detected AF had evidence of antithrombotic use after AF onset. Among the 76% (437/572) of patients with AF at high risk for stroke, 59% (257/437) used warfarin, 28% (123/437) used aspirin, and 24% (104/437) used neither. The major predictor of warfarin use was AF classification; intermittent or sustained AF had relative risks for warfarin use of 2.8 (95% confidence interval, 2.2-3.6) and 2.9 (95% confidence interval, 2.2-3.7), respectively, compared with transitory AF.
Conclusions Three quarters of the patients with newly detected AF received antithrombotic therapy, yet many at high risk of stroke did not receive warfarin. Atrial fibrillation classification, rather than stroke risk factors, was strongly associated with warfarin use.
Author Affiliations: Cardiovascular Health Research Unit and Department of Epidemiology (Ms Glazer and Drs Smith, Siscovick, Psaty, and Heckbert), and Departments of Biostatistics (Mr French), Medicine (Drs Siscovick and Psaty), and Health Services (Dr Psaty), University of Washington, VA Puget Sound Health Care System (Dr Dublin), and Center for Health Studies, Group Health Cooperative (Drs Jackson, Hrachovec, and Heckbert), Seattle.
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