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Stroke prevention practices in patients with atrial fibrillation and pacemaker therapy: evidence for under-use of
J Carlsson1, S Miketic, G Dees
1Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany.
Insights
Many pacemaker patients with atrial fibrillation are not receiving indicated anticoagulation therapy. This study highlights a critical gap in care, urging wider use of anticoagulation for eligible patients.
Area of Science:
- Cardiology
- Geriatrics
- Clinical Medicine
Background:
- Atrial fibrillation is common in pacemaker patients.
- Older adults and those with atrial fibrillation have increased risks for stroke.
- Anticoagulation is a key preventative therapy for stroke in atrial fibrillation.
Purpose of the Study:
- To assess the prevalence of atrial fibrillation in pacemaker patients.
- To evaluate the rate of anticoagulation therapy in pacemaker patients with atrial fibrillation.
- To identify barriers to anticoagulation in this population.
Main Methods:
- Retrospective analysis of 326 pacemaker patients.
- Patient data including age, sex, pacemaker type, and rhythm were collected.
- Medication records (anticoagulation, aspirin) were reviewed.
Main Results:
- 43% of patients had atrial fibrillation, and were significantly older than those in sinus rhythm.
- Only 28% of patients with atrial fibrillation were on anticoagulation.
- A significant proportion of patients with atrial fibrillation not on anticoagulation had no contraindications.
- Anticoagulation use decreased with age, despite increasing atrial fibrillation prevalence.
Conclusions:
- A majority of pacemaker patients with indicated anticoagulation for atrial fibrillation do not receive it.
- There is a significant underutilization of anticoagulation therapy in this patient group.
- Healthcare providers should prioritize and increase the use of anticoagulation in eligible pacemaker patients with atrial fibrillation.
Abstract:
This study presents a survey of pacemaker patients followed in a pacemaker clinic. Three hundred and twenty-six patients of mean age 77.7 +/- 9.6 years, 52% female, 75% VVI, 25% dual chamber were analysed. One hundred and forty (43%) were in atrial fibrillation and were older, 80.5 +/- 7.1 years, compared with 75.5 +/- 11.4 years (P = 0.014) for those in sinus rhythm. Temporary pacemaker reprogramming was necessary in 86% in order to determine the abnormal rhythm. Thirty-nine (28%) of those in atrial fibrillation were anticoagulated; 37% were on aspirin; only 10.8% of those in atrial fibrillation who were not anticoagulated had contraindications to this therapy. Prevalence of atrial fibrillation increased with age, whereas that of anticoagulation decreased with age. In conclusion, the majority of pacemaker patients with atrial fibrillation, for whom anticoagulation is indicated, fails to receive it: those caring for these patients are urged to ensure its much wider use.