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Status of antithrombotic therapy for patients with atrial fibrillation in university hospitals
G W Albers1, J M Yim, K M Belew
1Stanford University Medical Center, Palo Alto, CA, USA.
Insights
Antithrombotic therapy, crucial for preventing stroke in atrial fibrillation patients, was underused in academic hospitals. Many at-risk patients with no contraindications did not receive appropriate anticoagulation or aspirin treatment.
Area of Science:
- Cardiology
- Internal Medicine
- Pharmacology
Background:
- Atrial fibrillation (AF) poses a significant stroke risk.
- Antithrombotic therapy is proven to reduce this risk.
- Physician hesitancy in prescribing warfarin or aspirin for AF patients persists.
Purpose of the Study:
- To evaluate antithrombotic therapy use in atrial fibrillation patients.
- Study conducted across 6 academic hospitals in the United States.
- Assessed therapy at admission and discharge.
Main Methods:
- Reviewed records of 309 consecutive atrial fibrillation admissions.
- Data collected from University Health System Consortium hospitals.
- Recorded stroke risk factors, contraindications, and antithrombotic use.
Main Results:
- 82% of patients had stroke risk factors; 44% had contraindications.
- At admission, 36% received no antithrombotic therapy.
- At discharge, 22% of eligible patients received no antithrombotic therapy.
Conclusions:
- Many atrial fibrillation patients in academic hospitals have stroke risk factors.
- Antithrombotic therapy is underutilized in this patient population.
- Opportunities exist to improve stroke prevention strategies in AF.
Background:
The risk of stroke in patients with atrial fibrillation can be significantly reduced with antithrombotic therapy. Despite this, many physicians remain hesitant to prescribe warfarin sodium or aspirin therapy for patients with atrial fibrillation.
Objective:
To assess the use of antithrombotic therapy in patients with atrial fibrillation at 6 academic hospitals in the United States.
Methods:
Records were reviewed from consecutive hospital admissions of 309 patients with atrial fibrillation at 6 members of the University Health System Consortium, Oak Brook, III, which is a member driven alliance of 70 academic health centers in the United States. Risk factors for stroke, contraindications to anticoagulant therapy, and use of antithrombotic therapy at admission and discharge were recorded.
Results:
The mean age of patients was 71.6 years, 54% had chronic, 22% paroxysmal, and 24% new-onset atrial fibrillation. Eighty-two percent of the patients had cardiovascular risk factors that have been associated with increased risk of stroke. At least 1 relative contraindication to anticoagulant therapy was present in 44%. At the time of admission. 32% of the patients with previously diagnosed atrial fibrillation (n = 235) were receiving warfarin (or warfarin plus aspirin), 31% were receiving aspirin alone, and 36% were receiving no antithrombotic therapy. At discharge (n = 230), 41% of these patients were taking warfarin (or warfarin plus aspirin) and 36% were taking aspirin. Forty-four percent of the patients with risk factors for stroke and no contraindications to anticoagulation (n = 134) were discharged on a regimen of warfarin (or warfarin plus aspirin), 34% were discharged on a regimen of aspirin, and 22% received no antithrombotic therapy.
Conclusions:
About half of the patients with atrial fibrillation admitted to these academic hospitals had clinical risk factors that are associated with increased risk of stroke and no contraindications to anticoagulation. Antithrombotic therapy was underused in these patients.