National underuse of anti-thrombotic therapy in chronic atrial fibrillation identified from digoxin prescribing

Area of Science:

• Cardiology
• Public Health
• Pharmacology

Background:

• Atrial fibrillation (AF) is a common arrhythmia associated with a high risk of stroke.
• Antithrombotic therapy (aspirin or warfarin) is crucial for stroke prevention in AF patients.
• National implementation of appropriate antithrombotic therapy in AF requires examination.

Purpose of the Study:

• To assess the national implementation of appropriate antithrombotic therapy in patients with atrial fibrillation.
• To identify demographic and prescribing patterns associated with antithrombotic use in AF.

Main Methods:

• Utilized a national prescribing database, identifying 27,571 patients over 45 years old prescribed digoxin as a surrogate for AF.
• Examined the coprescription rates of aspirin or warfarin with digoxin.
• Conducted a postal survey to investigate reasons for reluctance in prescribing antithrombotics.

Main Results:

• Warfarin use was disproportionately higher in men compared to women.
• Antithrombotic therapy use was significantly lower in patients over 75 years old compared to those under 65.
• A postal survey confirmed a reluctance among prescribers to use antithrombotic agents.

Conclusions:

• Significant disparities exist in the national prescription of antithrombotic therapy for atrial fibrillation.
• Women and elderly patients (over 75 years) are least likely to receive warfarin, representing a missed opportunity for stroke prevention.
• Findings underscore the need for improved strategies to ensure guideline-adherent antithrombotic prescribing in AF.