From the General Medicine Division, Massachusetts General Hospital,
Medical Services and Department of Medicine, Harvard Medical School (R.S.S.,
D.E.S.), and Department of Epidemiology, Harvard School of Public Health
(D.E.S.), Boston, Mass.
Correspondence to Randall S. Stafford, MD, PhD, 50 Staniford St, 9th Floor, Boston, MA 02114. E-mail stafford{at}sol.mgh.harvard.edu
Background—Studies of selected
populations suggest that anticoagulation in atrial fibrillation is
underused and that nonclinical factors influence the use of this
stroke-preventing therapy. We wished to examine recent national trends
and predictors of warfarin sodium use in atrial fibrillation.
Methods and Results—A nationally representative
sample of office visits from the 1989 to 1996 National Ambulatory
Medical Care Surveys was used. We selected 1125 visits by patients with
atrial fibrillation, including 877 visits to cardiologists and primary
care physicians in which apparent contraindications for anticoagulation
were absent. The principal outcome measure was the proportion of visits
with warfarin reported. We analyzed trends in warfarin use and
statistically evaluated the predictors of warfarin use. Warfarin use
increased from 13% of atrial fibrillation visits in 1989 to 40% in
1993 (P for trend <.001) in patients without
contraindications. Between 1993 and 1996, however, there was no change
in warfarin use. Independent of other factors, warfarin was
significantly more likely to be reported in patients with a history of
stroke and in patients residing outside of the South.
Conclusions—Warfarin use in atrial fibrillation has not increased
recently, indicating inadequate implementation of this highly effective
therapy. Barriers to anticoagulation in real-world clinical practice
need to be identified and addressed.
© 1998 American Heart Association, Inc.
Brief Rapid Communications
Recent National Patterns of Warfarin Use in Atrial Fibrillation
Key Words: atrial fibrillation • anticoagulants • physician practice patterns
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|
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|
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|
|
|
|
|
|
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|
|
|
|
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|
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|
|
|
|
|
|
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|
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|
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|
|
|
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|
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|
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|
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|
|
|
|
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|
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|
|
|
|
|
|
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|
|