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Eur Heart J. 2006 Aug;27(16):1954-64. Epub 2006 Jul 17.

Stroke prophylaxis in atrial fibrillation: who gets it and who does not? Report from the Stockholm Cohort-study on Atrial Fibrillation (SCAF-study).

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  • 1Karolinska Institute at South Hospital, Stockholm, Sweden. leif.friberg@stockholm.bonet.se

Abstract

AIMS:

Underuse of warfarin for stroke prophylaxis in atrial fibrillation (AF) is extensive and represents a major problem in clinical practice. To identify factors associated with warfarin treatment in eligible AF patients.

METHODS AND RESULTS:

The study population consisted of all Swedish resident AF patients at the Stockholm South General Hospital during 2002 (n=2796). Medical records were examined and complemented by data from the Swedish National Hospital Discharge Register. Sixty-eight percent of the patients (1898/2796) had indications, and no apparent contraindications for warfarin treatment. Of these 54% (1029/1898) got warfarin. Factors favouring warfarin treatment after adjustment for other factors were history of ischaemic stroke, an implanted pacemaker, treatment in a cardiology rather than internal medicine ward and valvular defect. Factors associated with a reduced likelihood of warfarin treatment were paroxysmal type of AF and age >80 years. Important risk factors for stroke in AF like heart failure, hypertension, and diabetes did not increase the chances of warfarin treatment.

CONCLUSION:

Risk stratification using known risk factors of stroke seems to affect warfarin treatment only to a minor degree in clinical practice. Undertreatment was particularly common in patients with paroxysmal AF and in patients aged >80 years and calls for improved clinical routines in accordance with international guidelines.

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PMID:
16847008
[PubMed - indexed for MEDLINE]
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