Prescribing patterns for the use of antithrombotics in the management of atrial fibrillations in Zimbabwe

OBJECTIVES: To assess the prescribing patterns for the use of antithrombotics in the management of atrial fibrillation. DESIGN: A descriptive cross sectional study. SETTING: Parirenyatwa Hospital, Harare, Zimbabwe. SUBJECTS: The outpatient records of 200 outpatients attending the cardiac clinic (with a documented history of an irregular pulse) between January and August 1999 at Parirenyatwa Hospital, Harare, Zimbabwe were reviewed. MAIN OUTCOME MEASURES: In addition to antithrombotic therapy prescribed at the time of review, patient information (rural or urban), relative contra-indications to antithrombotic therapy, and risk factors for stroke were identified. RESULTS: Patients were similar in terms of age, sex, and risk factors for stroke. At least one stroke risk factor was noted in 79% of urban and 83% of rural patients. Two risk factors were noted in 26% of patients. It was noted that urban patients were more likely to have a relative contra-indication to antithrombotic therapy compared with rural patients (24% vs 10%, p = 0.028) but received antithrombotic therapy more often (38% vs 19%, p = 0.025). CONCLUSIONS: Patients with atrial fibrillation are being inappropriately managed in terms of their major prognostic risk factor. Rural patients with atrial fibrillation receive antithrombotic therapy less frequently than urban patients despite having a similar high risk profile and fewer relative contra-indications.