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Stroke prophylaxis in institutionalized elderly patients with atrial fibrillation
Elaine Lau1, Tammy J Bungard, Ross T Tsuyuki
1Epidemiology Coordinating and Research Centre, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.
Journal of the American Geriatrics Society
|February 14, 2004
Summary
In long-term care, many elderly atrial fibrillation patients at high stroke risk did not receive appropriate anticoagulation. Warfarin, the most suitable treatment, was underprescribed, highlighting a need for better candidate identification.
Area of Science:
- Geriatric Medicine
- Cardiology
- Pharmacology
Background:
- Atrial fibrillation (AF) significantly increases stroke risk in elderly individuals.
- Antithrombotic therapy is crucial for stroke prevention in AF patients.
- Institutionalized elderly populations present unique challenges in managing AF and antithrombotic therapy.
Purpose of the Study:
- To determine patterns of antithrombotic medication use (warfarin, aspirin) in institutionalized elderly patients with AF.
- To identify predictors of antithrombotic therapy prescription.
- To assess the appropriateness of prescribed antithrombotic therapy based on stroke and bleeding risk factors.
Main Methods:
- Retrospective study design.
- Inclusion of 265 residents aged 65+ with AF from 17 long-term care facilities.
- Analysis of prescription patterns and evaluation of therapy appropriateness against established risk factors.
Main Results:
- Warfarin was prescribed to 49%, aspirin (ASA) to 22%, both to 8%, and neither to 20% of patients.
- Nearly all patients (97%) had high stroke risk, while about half had low bleeding risk.
- Only 54.8% of patients received appropriate antithrombotic therapy; 60% of optimal candidates received appropriate treatment.
Conclusions:
- Warfarin, the most appropriate treatment for most high-stroke-risk AF patients, was underutilized.
- Antithrombotic therapy prescription did not consistently align with individual patient stroke and bleeding risk profiles.
- Systematic identification of appropriate anticoagulation candidates is needed in long-term care settings.