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Antithrombotic prescribing in atrial fibrillation: application of a prescribing indicator and multidisciplinary

Rohan A Elliott1, Michael C Woodward, C Alice Oborne

  • 1Centre for Applied Gerontology, Bundoora Extended Care Centre, Bundoora VIC 3083, Australia. rohan.elliott@armc.org.au

Age and Ageing
|September 21, 2002
PubMed

Insights

Antithrombotic therapy for atrial fibrillation in older patients was under-prescribed. Audit and feedback improved prescribing, particularly aspirin, though warfarin remained under-used.

Area of Science:

  • Geriatric Medicine
  • Cardiology
  • Pharmacology

Background:

  • Atrial fibrillation is prevalent in elderly populations, increasing ischemic stroke risk.
  • Antithrombotic therapy is underutilized despite its proven efficacy in stroke prevention.

Purpose of the Study:

  • To audit antithrombotic prescribing in elderly inpatients with atrial fibrillation using an evidence-based indicator.
  • To evaluate the impact of multidisciplinary feedback on antithrombotic prescribing rates.

Main Methods:

  • Cross-sectional notes-based audits were conducted before and after feedback.
  • Data collected from 1416 inpatients aged 65+ across nine Australian hospitals.
  • Appropriateness defined as receiving warfarin/aspirin or having contraindications.

Main Results:

  • Appropriate antithrombotic prescribing increased significantly from 72% to 92% post-feedback (P<0.0001).
  • Aspirin prescribing saw the most substantial improvement; warfarin remained under-prescribed.
  • Prescribing appropriateness slightly decreased at 6 months but remained elevated.

Conclusions:

  • Older patients with atrial fibrillation are frequently under-prescribed antithrombotics.
  • Audit and multidisciplinary feedback effectively improved antithrombotic use.
  • The intervention demonstrated a greater impact on aspirin compared to warfarin prescribing.
Abstract

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