Abstract
Introduction: Therapy with warfarin has been shown to decrease the risk of stroke associated with atrial fibrillation and flutter. Current guidelines recommend warfarin therapy for patients with atrial fibrillation who are at intermediate to high risk of thromboembolism. Multiple studies have shown that increasing age and female gender have been associated with underutilization of warfarin. We evaluated women in the Kentucky Women's Health Registry (KWHR) with self-reported atrial fibrillation to determine the rates of warfarin utilization in this population. Methods: Between November 2009 and June 2010, we administered electronic or mailed surveys to KWHR participants who reported an arrhythmia on the Registry questionnaire. Survey questions targeted arrhythmia identification and treatment, medical and social history, pregnancy history and demographics. Herein we analyze the data to determine baseline characteristics of the atrial fibrillation (and flutter) group, including CHADS 2 score and use of anticoagulation. Results: Of the 572 women initially surveyed, 365 responded to the questionnaire, yielding 107 cases of atrial fibrillation and flutter. Baseline characteristics of this group were notable for high education levels and greater than average annual income (see table). Of this population, 36 of 106, (34%) had a CHADS 2 score of >1. Of the women with CHADS 2 scores of >1 who reported their warfarin use, only 10 of 33 [30% (95% confidence intervals, 17-47%)] were receiving warfarin. As expected, the warfarin treated group tended to be older with mean age 73.4 years vs 61.8 years (p<0.001) with a higher CHADS 2 score (p<0.003). Conclusion: Warfarin anticoagulation is underutilized in this group of Kentucky women. This is not attributable to disparities in socioeconomic status given the relatively affluent, highly educated status of the survey respondents. Baseline Characterisitics of Paticipants with Atrial Fibrillation and Flutter Variable Proportion of responders n 95% Confidence Intervals Age (mean years) 63.2 102 61.1-65.3 Hypertension 65% (68) 104 0.56 -0.74 Diabetes 13% (13) 102 0.08-0.21 Congestive heart failure 11% (11) 104 0.06-0 .18 Stroke/TIA 8% (8) 102 0.04-0.15 BMI in kg/m 2 (mean) 28.8 104 27.5-30.1 Aspirin use 49% (51) 104 0.40-0.59 Clopidogrel use 5 % (5) 104 0.02 -0.11 Warfarin use 15% (16) 104 0.10-0.24 CHADS 2 score >1 34% (36) 106 0.25-0 .43 White Race 93% (98) 105 0.87-0 .97 Level of education: Some college or higher 85% (89) 105 0.77-0.90 Median annual household income (Dollars) 60-79,999 101 Inter-quartile range: 40-89,999 (Kentucky median 41,489)
Published Version
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