0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.196.24.103. Please contact the publisher to request reinstatement.
ARTICLE |

Is Warfarin Underused in the Treatment of Elderly Persons With Atrial Fibrillation?

Jeff Whittle, MD, MPH; Leona Wickenheiser, RN; Laura N. Venditti
Arch Intern Med. 1997;157(4):441-445. doi:10.1001/archinte.1997.00440250097011.
Text Size: A A A
Published online

Background:  Several randomized clinical trials have shown that among patients with atrial fibrillation, warfarin sodium use protects against stroke. Recently, experts have voiced concern about possible underuse of warfarin by practicing physicians. Few studies, however, have quantitated the amount of warfarin underuse.

Methods:  We randomly sampled 65 Medicare beneficiaries discharged alive from each of 5 small Pennsylvania hospitals between July 1, 1993, and June 30, 1994, with a discharge diagnosis code for atrial fibrillation. Trained abstractors verified that atrial fibrillation was present at some time during the hospitalization, determined the presence of contraindications to anticoagulation, and identified warfarin or aspirin use at discharge for each patient. An internist used implicit criteria to identify the reason for warfarin nonuse in patients who had none of the explicit contraindications to warfarin and did not receive it.

Results:  Of 322 charts reviewed, 48 patients were not in atrial fibrillation during the hospitalization, 79 had contraindications to warfarin use, 21 either died or were transferred to another hospital, and 2 were admitted with a complication of warfarin. Of the 172 remaining patients, 76 (44%) underwent anticoagulation. On implicit review of the 96 patients who did not undergo anticoagulation, the internist judged that warfarin would not have been appropriate in 54. After excluding those patients, 76 (64%) of the remaining 118 patients underwent anticoagulation. Patients not receiving warfarin were slightly older (81.6 vs 78.3 years old), but this was not statistically significant after stratifying by hospital. Rates of warfarin use at the 5 hospitals varied widely (32%, 57%, 79%, 82%, 94%; P<.001, χ2 with 4 df). Patients with newly diagnosed atrial fibrillation were not more likely to undergo anticoagulation, nor were patients treated by internal medicine or cardiology specialists.

Conclusions:  There may be significant warfarin underuse in some hospitals. Overall, approximately one third of patients with atrial fibrillation for whom it appeared appropriate were not anticoagulated with warfarin. Although the fact that data were not available to or were missed by our review surely justifies some of the underuse, one should recall that even a small amount of underuse may affect a large number of people with this common condition.Arch Intern Med. 1997;157:441-445

Topics

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 85

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
brightcove.createExperiences();