Back to Journals » Vascular Health and Risk Management » Volume 8

Patterns of warfarin use and subsequent outcomes in atrial fibrillation in primary care practices

Authors Ewen E, Zhang Z, Simon TA, Kolm P, Liu X, Weintraub WS

Received 26 May 2012

Accepted for publication 15 June 2012

Published 19 October 2012 Volume 2012:8 Pages 587—598

DOI https://doi.org/10.2147/VHRM.S34280

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Edward Ewen,1 Zugui Zhang,1 Teresa A Simon,2 Paul Kolm,1 Xianchen Liu,3,4 William S Weintraub1

1Christiana Care Health System, Newark, DE, USA; 2Bristol-Myers Squibb, Princeton, NJ, USA; 3Indiana University School of Medicine, Indianapolis, IN, USA; 4Pfizer, Groton, CT, USA

Background: Warfarin is recommended for stroke prevention in high-risk patients with atrial fibrillation. However, it is often underutilized and inadequately managed in actual clinical practice.
Objectives: To examine the patterns of warfarin use and their relationship with stroke and bleeding in atrial fibrillation patients in community-based primary care practices.
Design: Retrospective longitudinal cohort study.
Participants: A total of 1141 atrial fibrillation patients were selected from 17 primary care practices with a shared electronic medical record and characterized by stroke risk, potential barriers to anticoagulation, and comorbid conditions.
Main measures: Duration and number of warfarin exposures, interruptions in warfarin exposure > 45 days, stroke, and bleeding events.
Results: Among 1141 patients with a mean age of 70 years (standard deviation 13.3) and mean follow-up of 3.4 years (standard deviation 3.0), 764 (67%) were treated with warfarin. Warfarin was discontinued within 1 year in 194 (25.4%), and 349 (45.7%) remained on warfarin at the end of follow-up. Interruptions in warfarin use were common, occurring in 32.6% (249 of 764) of patients. Those with two or more interruptions were younger and at lower baseline stroke risk when compared to those with no interruptions. There were 76 first strokes and 73 first-bleeding events in the follow-up period. When adjusted for baseline stroke risk, time to warfarin start, and total exposure time, two or more interruptions in warfarin use was associated with an increased risk of stroke (relative risk, 2.29; 95% confidence interval: 1.29–4.07). There was no significant association between warfarin interruptions and bleeding events.
Conclusion: Warfarin was underutilized in a substantial portion of eligible atrial fibrillation patients in these community-based practices. In addition, prolonged interruptions in anticoagulation were common in this population, and multiple interruptions were associated with over twice the risk of stroke when compared to those treated continuously.

Keywords: cardiovascular disease, primary care, quality assessment, outcomes

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]

 

Readers of this article also read:

Blood pressure control to prevent decline in cognition after stroke

Ihle-Hansen H, Thommessen B, Fagerland MW, Øksengård AR, Wyller TB, Engedal K, Fure B

Vascular Health and Risk Management 2015, 11:311-316

Published Date: 9 June 2015

Experimental study of sutureless vascular anastomosis with use of glued prosthesis in rabbits

Vokrri L, Qavdarbasha A, Rudari H, Ahmetaj H, Manxhuka-Kërliu S, Hyseni N, Porcu P, Cinquin P, Sessa C

Vascular Health and Risk Management 2015, 11:211-217

Published Date: 27 March 2015

Influence of serological factors and BMI on the blood pressure/hematocrit association in healthy young men and women

Salazar Vázquez BY, Salazar Vázquez MA, Chávez-Negrete A, Escobedo G, Cabrales P, Subramaniam S, Intaglietta M, Pérez-Tamayo R

Vascular Health and Risk Management 2014, 10:271-277

Published Date: 6 May 2014

The "Pulse Time Index of Norm" highly correlates with the left ventricular mass index in patients with arterial hypertension

Posokhov IN, Kulikova NN, Starchenkova IV, Grigoricheva EA, Evdokimov VV, Orlov AV, Rogoza AN

Vascular Health and Risk Management 2014, 10:139-144

Published Date: 19 March 2014

Postmarketing safety experience with edoxaban in Japan for thromboprophylaxis following major orthopedic surgery

Kuroda Y, Hirayama C, Hotoda H, Nishikawa Y, Nishiwaki A

Vascular Health and Risk Management 2013, 9:593-598

Published Date: 7 October 2013

Serum calcium levels are not associated with coronary heart disease

Jin Y, He L, Wang Q, Chen Y, Ren X, Tang H, Song X, Ding L, Qi Q, Huang Z, Yu J, Yao Y

Vascular Health and Risk Management 2013, 9:517-520

Published Date: 3 September 2013

The ClaudicatioNet concept: design of a national integrated care network providing active and healthy aging for patients with intermittent claudication

Lauret GJ, Gijsbers HJ, Hendriks EJ, Bartelink ML, de Bie RA, Teijink JA

Vascular Health and Risk Management 2012, 8:495-503

Published Date: 24 August 2012

The diagnostic value of endothelial function as a potential sensor of fatigue in health

Yoshiko Ohno, Teruto Hashiguchi, Ryuichi Maenosono, et al

Vascular Health and Risk Management 2010, 6:135-144

Published Date: 9 March 2010