Arrhythmias and conduction disturbanceDifferential Use of Warfarin for Secondary Stroke Prevention in Patients With Various Types of Atrial Fibrillation
Section snippets
Methods
The GWTG-S database was queried for demographic, clinical, and treatment data for consecutive patients presenting with ischemic stroke or TIA (International Classification of Diseases, Ninth Revision codes 433 to 436) and AF. Hospitals were recruited to participate during the course of the study. Mean follow-up in participating hospitals was 5.72 quarters. There were 562 participating hospitals from October 1, 2001, to when the data were analyzed as of December 31, 2005. GWTG-S uses preprinted
Results
A total of 147,128 patients with stroke were entered into the GWTG-S database from October 1, 2001, to December 31, 2005, at 562 hospitals with an average of 355 beds/institution. Characteristics of these hospitals are listed in Table 1. A total of 1,970 patients had documented contraindications to anticoagulation therapy in the database and were excluded. Contraindications were more frequently documented in group 1 compared with group 2 (1,940 of 9,575 vs 100 of 7,926 patients; p <0.0001).
Discussion
This was the first study to show that a comprehensive quality improvement program such as GWTG-S was associated with significantly improved adherence to anticoagulation guidelines in patients with stroke and electrocardiographic and telemetry evidence of AF. The observed success of this program may be caused by its comprehensive nature using an Internet-based concurrent Patient Management Tool, preprinted orders, educational conferences, and quality improvement review processes. This study also
Acknowledgment
The contents of this report are solely the responsibility of the authors and do not necessarily represent the official view of the National Center for Research Resources or National Institutes of Health. Dr. Lewis had full access to all data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis.
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Cited by (36)
Anticoagulation Drug Trials for Stroke Prevention in Atrial Fibrillation
2018, Stroke Prevention in Atrial FibrillationAvailability of patient decision aids for stroke prevention in atrial fibrillation: A systematic review
2017, American Heart JournalGuideline-adherent therapy for stroke prevention in atrial fibrillation in different health care settings: Results from RAMSES study
2017, European Journal of Internal MedicineCitation Excerpt :This may be due to the higher number of procedures such as cardioversion and catheter ablation of AF performed in THs. Despite clear guidelines on anticoagulation, real-world analyses showed that most of the patients with NVAF were either inadequately treated with antiplatelets or did not receive any treatment at all [13,14]. Furthermore, some of the low-risk patients were overtreated with warfarin or NOACs.
Registries in Atrial Fibrillation: From Trials to Real-Life Clinical Practice
2017, American Journal of Medicine2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A report of the American college of Cardiology/American heart association task force on practice guidelines and the heart rhythm society
2014, Journal of the American College of CardiologyCitation Excerpt :Even in well-conducted clinical trials, the time in therapeutic range (TTR) of those taking warfarin was reported as 55% to 66% (177–179), whereas in some community settings, TTR has been reported as approximately 50% (222,223). Despite underutilization of warfarin among eligible patients due to a variety of factors (217–221), a meta-analysis of contemporary studies found risk of stroke or systemic embolism estimated to be at 1.66% per year for warfarin in patients with AF (224) (Figure 5). See Online Data Supplements 4 and 5 for additional data on warfarin and antiplatelet therapy.
The data analysis of this study was performed by the Duke Clinical Research Institute, Durham, North Carolina, and funded by the American Heart Association, Dallas Texas. Dr. Super was supported by Grant No. M01 RR000080 from the National Center for Research Resources, National Institutes of Health, Bethesda, Maryland. Dr. Lewis has received speaker honoraria from Reliant Pharmaceuticals. Dr. Fonarow has received research grants from GlaxoSmithKline and honoraria from GlaxoSmithKline, Merck, Schering-Plough, and Bristol Myers Squibb and is or has been a consultant for Glaxo-Smith-Kline, Schering-Plough, Merck, and Bristol Myers Squibb. Dr. Cannon has received research grants from Accumetrics, AstraZeneca, Bristol-Myers Squibb, Glaxo Smith Kline, Merck, Sanofi-Aventis, and Schering Plough.