Many patients with history of atrial fibrillation (AF) are not appropriately treated, according to results of a retrospective cross-sectional analysis reported in the November issue of Stroke. Many were not receiving warfarin when they should have been; many were receiving warfarin when they should not have been; and more than half who were eligible and being treated with warfarin were not in therapeutic range.
“The data clearly [show] that we’re not doing a good job of using warfarin to prevent stroke in people who have AF,” lead author Phillip Scott, MD, from the University of Michigan in Ann Arbor, says in a news release.
“Identifying, then encouraging people to begin treatment is part of the problem. In this respect, emergency departments occupy a unique position to identify AF patients at risk of stroke and to increase treatment.”
This review of 78,787 patient visits at three emergency departments of teaching hospitals in Cincinnati and Ann Arbor during a six-month period identified 866 records of patients with ECG-proven AF. Of 556 patients who had a prior history of AF, 40% were receiving warfarin alone, 5% warfarin plus aspirin, 28% aspirin alone, and 27% were not on any antithrombotic therapy. Patients who were eligible for warfarin but not receiving it included 68 patients (12%) who were receiving no antithrombotic therapy and 64 (12%) receiving antiplatelet therapy alone
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