Underutilization of Warfarin in Older Persons with Chronic Nonvalvular Atrial Fibrillation at High Risk for Developing Stroke

Q: What does this research mean for the field?

Warfarin is significantly underutilized, with only 49% of eligible high-risk older patients with chronic nonvalvular atrial fibrillation receiving appropriate anticoagulation therapy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Gad Mendelson; Wilbert S. Aronow

doi:10.1111/j.1532-5415.1998.tb06011.x

November 1, 1998Journal of the American Geriatrics SocietyOpen Access

Underutilization of Warfarin in Older Persons with Chronic Nonvalvular Atrial Fibrillation at High Risk for Developing Stroke

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Key Points

To evaluate the prevalence of therapeutic warfarin use (target INR 2.0 to 3.0) in high-risk older patients with chronic nonvalvular atrial fibrillation who lack contraindications.
Retrospective chart review of all older patients (N=1563; 380 men, 1183 women; mean age 80±8 years, range 59–103) evaluated during 1997 at an academic hospital-based geriatrics practice.
Identified patients with chronic nonvalvular atrial fibrillation and stratified them by stroke risk criteria (prior thromboembolism, congestive heart failure, abnormal left ventricular systolic function, systolic BP >160 mm Hg, or women >75 years) and warfarin contraindications.
Chronic nonvalvular atrial fibrillation was identified in 141 of 1563 patients (9%), with 127 of 141 (90%) classified as high risk for thromboembolic stroke.
Among 124 high-risk patients without contraindications to anticoagulation (3 excluded due to contraindications), only 61 (49%) received warfarin to maintain an INR of 2.0–3.0, while 45 (36%) received 325 mg aspirin daily.
Among 14 low-risk atrial fibrillation patients, 1 (7%) received warfarin with target INR 2.0–3.0 and 6 (43%) received 325 mg aspirin daily.

Structured PICO

P

Population

1,563 older persons (380 men, 1183 women, mean age 80+/-8 years) seen during 1997 at an academic hospital-based geriatrics practice, including 141 with chronic nonvalvular atrial fibrillation (AF).

I

Intervention

Warfarin to maintain an international normalized ratio (INR) between 2.0 and 3.0

O

Outcome

Prevalence of warfarin use

Warfarin is significantly underutilized for stroke prevention in older patients with chronic nonvalvular atrial fibrillation who are at high risk for thromboembolic events.

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Implication

Warfarin underuse in high-risk older AF patients warrants attention; leaves open barriers and strategies to improve uptake.

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Cite This Study

Mendelson et al. (1998) studied this question.

synapsesocial.com/papers/6a1c1bcc666b677c61a92b69 https://doi.org/10.1111/j.1532-5415.1998.tb06011.x

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Underutilization of Warfarin in Older Persons with Chronic Nonvalvular Atrial Fibrillation at High Risk for Developing Stroke

Key Points

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Underutilization of Warfarin in Older Persons with Chronic Nonvalvular Atrial Fibrillation at High Risk for Developing Stroke

Key Points

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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