Abstract
IntroductionAtrial fibrillation affects an estimated 2.5 million Americans and incurs an average annual stroke risk of 4.5% per year. Despite warfarin reducing stroke risk by approximately 66%, prior studies show warfarin usage rates to be about 50%. However, the methods that define warfarin as "inappropriate underutilization" might not be sensitive enough to pick up relative contraindications. We assessed the inappropriate underutilization of warfarin in atrial fibrillation patients at our hospital by abstracting individual patient charts.MethodsMedical records were reviewed to determine stroke risk factors, warfarin use, and documented contraindications to warfarin use in 364 consecutive patients with atrial fibrillation.ResultsAmongst 364 atrial fibrillation patients, 54.6% received warfarin anticoagulation. Overall, 29.5 % of patients had documented reasons for not prescribing warfarin. Primary reasons listed by treating physicians included: gastrointestinal bleed 10.7%, secondary/transient atrial fibrillation 8.2%, and fall risk 6.3%. Only 7.1% of the patients had no documented reasons for the lack of warfarin use.ConclusionConsistent with previous reports, 45.4% of patients in this atrial fibrillation cohort were not prescribed warfarin. However, after reviewing medical charts for documented reasons why warfarin was not used, the inappropriate underutilization rate was only 7.1%. These findings suggest that studies utilizing administrative database and ICD-9 CM coding might overestimate warfarin underutilization.
Highlights
Atrial fibrillation affects an estimated 2.5 million Americans and incurs an average annual stroke risk of 4.5% per year
Primary reasons listed by treating physicians included: gastrointestinal bleed 10.7%, secondary/transient atrial fibrillation 8.2%, and fall risk 6.3%
After reviewing medical charts for documented reasons why warfarin was not used, the inappropriate underutilization rate was only 7.1%. These findings suggest that studies utilizing administrative database and ICD-9 The International Classification of Diseases (CM) coding might overestimate warfarin underutilization
Summary
Atrial fibrillation affects an estimated 2.5 million Americans and incurs an average annual stroke risk of 4.5% per year. Atrial fibrillation (AF) currently affects an estimated 2.5 million patients in the United States and this number is expected to double within the 20 years. [712] Due to the inherent study design and methodology, warfarin underutilization rates can be overestimated in such studies by including patients with relative or perceived contraindications to anticoagulation. The objectives of this study were a) To determine the rate of warfarin underutilization in a cohort of AF patients by retrospectively reviewing medical charts including physician verification of electrocardiograms (EKG), b) To compare methodologies of prior studies investigating warfarin underutilization and the role of chart review in estimating warfarin underutilization in AF patients and c) Attempt to identify physician-professed reasoning for not initiating warfarin therapy and analyze the adequacy of these reasons/contraindications
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