Oral anticoagulation in patients with atrial fibrillation: Adherence with guidelines in an elderly cohort

Richard H White, Mary Ann McBurnie, Teri Manolio, Curt D. Furberg, Julius M. Gardin, Steven J. Kittner, Edwin Bovill, Laurie Knepper

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Abstract

PURPOSE: To determine adherence with practice guidelines in a population-based cohort of elderly persons aged 70 years or older with atrial fibrillation. SUBJECTS AND METHODS: This was a cross-sectional analysis of a subgroup of participants in the Cardiovascular Health Study, a prospective observational study involving four communities in the United States. Subjects were participants with atrial fibrillation on electrocardiogram at one or more yearly examinations from 1993 to 1995. The outcome measure was self- reported use of warfarin in 1995. RESULTS: In 1995, 172 (4.1%) participants had atrial fibrillation together with information regarding warfarin use and no preexisting indication for its use. Warfarin was used by 63 (37%) of these participants. Of the 109 participants not reporting warfarin use, 92 (84%) had at least one of the clinical risk factors (aside from age) associated with stroke in patients with atrial fibrillation. Among participants not taking warfarin, 47% were taking aspirin. Several characteristics were independently associated with warfarin use, including age [odds ratio (OR) = 0.6 per 5-year increment, 95% CI 0.5-0.9], a modified mini-mental examination score <85 points [OR = 0.3, 95% confidence interval (CI) 0.1-0.9], and among patients without prior stroke, female sex (OR = 0.5, 95% CI 0.2-1.0). CONCLUSIONS: Despite widely publicized practice guidelines to treat patients who have atrial fibrillation with warfarin, most participants who had atrial fibrillation were at high risk for stroke but were not treated with warfarin. More studies are needed to determine why elderly patients with atrial fibrillation are not being treated with warfarin.

Original languageEnglish (US)
Pages (from-to)165-171
Number of pages7
JournalAmerican Journal of Medicine
Volume106
Issue number2
DOIs
StatePublished - Feb 1999

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Guideline Adherence
Warfarin
Atrial Fibrillation
Stroke
Odds Ratio
Confidence Intervals
Practice Guidelines
Sex Ratio
Aspirin
Observational Studies
Electrocardiography
Cross-Sectional Studies
Outcome Assessment (Health Care)
Prospective Studies

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Oral anticoagulation in patients with atrial fibrillation : Adherence with guidelines in an elderly cohort. / White, Richard H; McBurnie, Mary Ann; Manolio, Teri; Furberg, Curt D.; Gardin, Julius M.; Kittner, Steven J.; Bovill, Edwin; Knepper, Laurie.

In: American Journal of Medicine, Vol. 106, No. 2, 02.1999, p. 165-171.

Research output: Contribution to journalArticle

White, RH, McBurnie, MA, Manolio, T, Furberg, CD, Gardin, JM, Kittner, SJ, Bovill, E & Knepper, L 1999, 'Oral anticoagulation in patients with atrial fibrillation: Adherence with guidelines in an elderly cohort', American Journal of Medicine, vol. 106, no. 2, pp. 165-171. https://doi.org/10.1016/S0002-9343(98)00389-1
White, Richard H ; McBurnie, Mary Ann ; Manolio, Teri ; Furberg, Curt D. ; Gardin, Julius M. ; Kittner, Steven J. ; Bovill, Edwin ; Knepper, Laurie. / Oral anticoagulation in patients with atrial fibrillation : Adherence with guidelines in an elderly cohort. In: American Journal of Medicine. 1999 ; Vol. 106, No. 2. pp. 165-171.
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abstract = "PURPOSE: To determine adherence with practice guidelines in a population-based cohort of elderly persons aged 70 years or older with atrial fibrillation. SUBJECTS AND METHODS: This was a cross-sectional analysis of a subgroup of participants in the Cardiovascular Health Study, a prospective observational study involving four communities in the United States. Subjects were participants with atrial fibrillation on electrocardiogram at one or more yearly examinations from 1993 to 1995. The outcome measure was self- reported use of warfarin in 1995. RESULTS: In 1995, 172 (4.1{\%}) participants had atrial fibrillation together with information regarding warfarin use and no preexisting indication for its use. Warfarin was used by 63 (37{\%}) of these participants. Of the 109 participants not reporting warfarin use, 92 (84{\%}) had at least one of the clinical risk factors (aside from age) associated with stroke in patients with atrial fibrillation. Among participants not taking warfarin, 47{\%} were taking aspirin. Several characteristics were independently associated with warfarin use, including age [odds ratio (OR) = 0.6 per 5-year increment, 95{\%} CI 0.5-0.9], a modified mini-mental examination score <85 points [OR = 0.3, 95{\%} confidence interval (CI) 0.1-0.9], and among patients without prior stroke, female sex (OR = 0.5, 95{\%} CI 0.2-1.0). CONCLUSIONS: Despite widely publicized practice guidelines to treat patients who have atrial fibrillation with warfarin, most participants who had atrial fibrillation were at high risk for stroke but were not treated with warfarin. More studies are needed to determine why elderly patients with atrial fibrillation are not being treated with warfarin.",
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N2 - PURPOSE: To determine adherence with practice guidelines in a population-based cohort of elderly persons aged 70 years or older with atrial fibrillation. SUBJECTS AND METHODS: This was a cross-sectional analysis of a subgroup of participants in the Cardiovascular Health Study, a prospective observational study involving four communities in the United States. Subjects were participants with atrial fibrillation on electrocardiogram at one or more yearly examinations from 1993 to 1995. The outcome measure was self- reported use of warfarin in 1995. RESULTS: In 1995, 172 (4.1%) participants had atrial fibrillation together with information regarding warfarin use and no preexisting indication for its use. Warfarin was used by 63 (37%) of these participants. Of the 109 participants not reporting warfarin use, 92 (84%) had at least one of the clinical risk factors (aside from age) associated with stroke in patients with atrial fibrillation. Among participants not taking warfarin, 47% were taking aspirin. Several characteristics were independently associated with warfarin use, including age [odds ratio (OR) = 0.6 per 5-year increment, 95% CI 0.5-0.9], a modified mini-mental examination score <85 points [OR = 0.3, 95% confidence interval (CI) 0.1-0.9], and among patients without prior stroke, female sex (OR = 0.5, 95% CI 0.2-1.0). CONCLUSIONS: Despite widely publicized practice guidelines to treat patients who have atrial fibrillation with warfarin, most participants who had atrial fibrillation were at high risk for stroke but were not treated with warfarin. More studies are needed to determine why elderly patients with atrial fibrillation are not being treated with warfarin.

AB - PURPOSE: To determine adherence with practice guidelines in a population-based cohort of elderly persons aged 70 years or older with atrial fibrillation. SUBJECTS AND METHODS: This was a cross-sectional analysis of a subgroup of participants in the Cardiovascular Health Study, a prospective observational study involving four communities in the United States. Subjects were participants with atrial fibrillation on electrocardiogram at one or more yearly examinations from 1993 to 1995. The outcome measure was self- reported use of warfarin in 1995. RESULTS: In 1995, 172 (4.1%) participants had atrial fibrillation together with information regarding warfarin use and no preexisting indication for its use. Warfarin was used by 63 (37%) of these participants. Of the 109 participants not reporting warfarin use, 92 (84%) had at least one of the clinical risk factors (aside from age) associated with stroke in patients with atrial fibrillation. Among participants not taking warfarin, 47% were taking aspirin. Several characteristics were independently associated with warfarin use, including age [odds ratio (OR) = 0.6 per 5-year increment, 95% CI 0.5-0.9], a modified mini-mental examination score <85 points [OR = 0.3, 95% confidence interval (CI) 0.1-0.9], and among patients without prior stroke, female sex (OR = 0.5, 95% CI 0.2-1.0). CONCLUSIONS: Despite widely publicized practice guidelines to treat patients who have atrial fibrillation with warfarin, most participants who had atrial fibrillation were at high risk for stroke but were not treated with warfarin. More studies are needed to determine why elderly patients with atrial fibrillation are not being treated with warfarin.

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