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Demand for warfarin anticoagulation monitoring in Tayside, Scotland
J M Evans1, L E Henderson, B Goudie
1Department of Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee.
Insights
Many atrial fibrillation patients at high risk for thromboembolic events were not prescribed warfarin. This indicates a growing demand for warfarin therapy and anticoagulant monitoring, especially in elderly populations.
Area of Science:
- Pharmacology
- Cardiology
- Public Health
Background:
- Warfarin is a crucial anticoagulant for preventing thromboembolic events in patients with atrial fibrillation.
- Assessing warfarin prescribing patterns and identifying unmet needs is essential for optimizing patient care.
- The study focuses on the Tayside region of Scotland, providing localized insights into anticoagulant use.
Purpose of the Study:
- To evaluate the demand for warfarin prescribing and monitoring in Tayside, Scotland.
- To identify patients with atrial fibrillation who could benefit from warfarin therapy.
- To analyze prescribing trends between 1989 and 1993.
Main Methods:
- Calculated incidence and prevalence of digoxin and warfarin prescribing from 1989-1993.
- Identified patients dispensed digoxin in 1993 as a proxy for atrial fibrillation.
- Stratified patients based on thromboembolic risk and assessed warfarin candidacy.
Main Results:
- Warfarin prescribing is increasing, particularly among elderly patients.
- A significant number of high-risk atrial fibrillation patients were not prescribed warfarin (only 35% received it).
- Other indications for warfarin are also rising, suggesting broader use.
Conclusions:
- Increasing demand for warfarin therapy and anticoagulant monitoring is anticipated.
- Healthcare systems must adapt by expanding existing clinic capacity or integrating primary care.
- There's a clear need to address the gap in warfarin prescribing for high-risk atrial fibrillation patients.
Aim:
The aim of this study was to assess the demand for warfarin prescribing and monitoring, and to identify patients with atrial fibrillation who might benefit from warfarin therapy. The study was carried out in the population of Tayside, Scotland (400,000 people) using patient-specific dispensed prescribing and hospitalisation data from the Medicines Monitoring Unit at the University of Dundee.
Methods:
The incidence and prevalence of digoxin and warfarin prescribing were calculated between 1989 and 1993. Patients dispensed digoxin in 1993 were assumed to have atrial fibrillation and they were stratified into high risk groups for an adverse thromboembolic event based on past medical history. The numbers of patients at high risk who were judged to be possible candidates for warfarin were calculated.
Results:
The prevalence of warfarin prescribing is increasing in Tayside and is mainly for elderly patients. There were also many patients assumed to have atrial fibrillation who were at particularly high risk for an adverse thromboembolic event, who had no record of warfarin prescribing. Only 35% received warfarin. Even given the methodological limitations of this study, and the use of aspirin as an alternative prophylactic agent, it is likely that these patients have been a source of increased prevalence of warfarin prescribing since 1993 and will be in the future. Other indications for warfarin prescribing are also increasing.
Conclusion:
It is anticipated that there will be increasing demands for anticoagulant monitoring, which will need to be met either by increasing the capacity of existing clinics, or by increasing the role of primary care.