Journal ArticleDOI
Failure to prescribe warfarin to patients with nonrheumatic atrial fibrillation
Meghal R. Antani,Rebecca J. Beyth,Rebecca J. Beyth,Kenneth E. Covinsky,Kenneth E. Covinsky,Philip A. Anderson,Philip A. Anderson,David G. Miller,Randall D. Cebul,Linda M. Quinn,Linda M. Quinn,C. Seth Landefeld,C. Seth Landefeld +12 more
TLDR
Warfarin was prescribed infrequently to these patients with nonrheumatic atrial fibrillation, especially the older patients and even the patients for whom warfar in was judged appropriate, indicating a substantial opportunity to prevent stroke.Abstract:
OBJECTIVE: To determine how often warfarin was prescribed to patients with nonrheumatic atrial fibrillation in our community in 1992 when randomized trials had demonstrated that warfarin could prevent stroke with little increase in the rate of hemorrhage, and to determine whether warfarin was prescribed less frequently to older patients—the patients at highest risk of stroke but of most concern to physicians in terms of the safety of warfarin. DESIGN: Cross-sectional study. Appropriateness of warfarin was classified for each patient based on the independent judgments of three physicians applying relevant evidence and guidelines. SETTING: Two teaching hospitals and five community-based practices. PATIENTS: Consecutive patients with nonrheumatic atrial fibrillation (n=189). MEASUREMENTS AND MAIN RESULTS: Warfarin was prescribed to 44 (23%) of the 189 patients. Warfarin was judged appropriate in 98 patients (52%), of whom 36 (37%) were prescribed warfarin. Warfarin was prescribed to 11 (14%) of 76 patients aged 75 years or older with hypertension, diabetes mellitus, or past stroke, the group at highest risk of stroke. In a multivariable logistic regression model controlling for appropriateness of warfarin and other patient characteristics, patients aged 75 years or older were less likely than younger patients to be treated with warfarin (odds ratio 0.25; 95% confidence interval 0.10, 0.65). CONCLUSIONS: Warfarin was prescribed infrequently to these patients with nonrheumatic atrial fibrillation, especially the older patients and even the patients for whom warfarin was judged appropriate. These findings indicate a substantialopportunity to prevent stroke.read more
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External validity of randomised controlled trials: “To whom do the results of this trial apply?”
TL;DR: In this paper, the authors present a checklist for clinicians to consider external validity in the design and reporting of RCTs and make recommendations for greater consideration of external validity for clinical trials.
Journal ArticleDOI
Long-term follow-up of patients from a randomised trial of atrial versus ventricular pacing for sick-sinus syndrome
Henning Rud Andersen,Jens Cosedis Nielsen,P. E. B. Thomsen,Leif Thuesen,Peter Thomas Mortensen,Thomas Vesterlund,Anders Kirstein Pedersen +6 more
TL;DR: Patients with sick-sinus syndrome should be treated with an atrial rather than ventricular-pacing system because after long-term follow-up, atrial pacing is associated with a significantly higher survival, less atrial fibrillation, fewer thromboembolic complications, less heart failure, and a low-risk of atrioventricular block.
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Prospective evaluation of an index for predicting the risk of major bleeding in outpatients treated with warfarin
TL;DR: The Outpatient Bleeding Risk Index prospectively classified patients according to risk of major bleeding and performed better than physicians and may be preventable in many high-risk patients by avoidance of over-anticoagulation and nonsteroidal anti-inflammatory agents.
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Epidemiology and natural history of atrial fibrillation: clinical implications.
TL;DR: An understanding of the epidemiology and natural history of AF is crucial to the future allocation of resources and the utilization of an expanding range of therapies aimed at reducing the impact of this disease on a changing patient population.
Journal ArticleDOI
Warfarin Use among Ambulatory Patients with Nonvalvular Atrial Fibrillation: The AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study
Alan S. Go,Elaine M. Hylek,Leila H. Borowsky,Kathleen A. Phillips,Joe V. Selby,Daniel E. Singer +5 more
TL;DR: A large, contemporary sample of ambulatory patients with nonvalvular atrial fibrillation treated in a health maintenance organization was assembled and the prevalence and determinants of warfarin use for stroke prevention were assessed.
References
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Prevalence, Age Distribution, and Gender of Patients With Atrial Fibrillation
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Atrial Fibrillation: A Major Contributor to Stroke in the Elderly. The Framingham Study
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