+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Patterns of warfarin use in subgroups of patients with atrial fibrillation: a cross-sectional analysis of 430 general practices in the United Kingdom

Patterns of warfarin use in subgroups of patients with atrial fibrillation: a cross-sectional analysis of 430 general practices in the United Kingdom

Plos one 8(5): E61979

Despite the proven efficacy of warfarin, its use in patients with Atrial Fibrillation (AF) is reportedly low. We investigated the underuse and overuse of warfarin in the management of AF in general practices in the United Kingdom (UK) against the National Institute of Clinical Excellence (NICE, UK) guidelines whilst seeking to identify subgroups of AF patients to inform efforts to optimise warfarin use. A retrospective database analysis to determine warfarin prescribing using tree models based on 50,361 patients with AF (classified as low, moderate and high risk of stroke using CHADS2) from 430 general practices in the UK. Over one-third (37.0%, 4573/12,351) of low risk AF patients were on warfarin, compared with 47.1% (8349/17,709) moderate risk AF patients and 54.9% (11,142/20,301) high risk AF patients. Clinical subgroups (n = 15 low risk subgroups, n = 15 medium risk subgroups, n = 22 high risk subgroups) were identified. Several factors not supported by current guidelines (age, BMI, dementia, gender) were associated with the use of warfarin. Gender and BMI were associated with warfarin use in low and medium risk AF patients but not in high risk AF patients. Whilst NICE guidelines suggest that all high risk AF patients should be on warfarin, half of those at moderate risk should be on warfarin and none of those at low risk should be on warfarin, we found evidence of over and under use of warfarin. Interventions to optimise warfarin therapy tailored to and targeting specific subgroups of AF patients identified by the tree models are required.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 054899443

Download citation: RISBibTeXText

PMID: 23658703

DOI: 10.1371/journal.pone.0061979

Related references

Representativeness of the dabigatran, apixaban and rivaroxaban clinical trial populations to real-world atrial fibrillation patients in the United Kingdom: a cross-sectional analysis using the General Practice Research Database. Bmj Open 2(6):, 2012

Dabigatran, Rivaroxaban, or Apixaban versus Warfarin in Patients with Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-Analysis of Subgroups. Thrombosis 2013: 640723, 2013

Cross sectional database analysis of antidepressant prescribing in general practice in the United Kingdom, 1993-5. Bmj 313(7061): 861-862, 1996

Evaluation of Time in Therapeutic Range (TTR) in Patients with Non-Valvular Atrial Fibrillation Receiving Treatment with Warfarin in Tehran, Iran: A Cross-Sectional Study. Journal of Clinical and Diagnostic Research 10(9): Fc04-Fc06, 2016

Saudi Atrial Fibrillation Survey: national, observational, cross-sectional survey evaluating atrial fibrillation management and the cardiovascular risk profile of patients with atrial fibrillation. Angiology 66(3): 244-248, 2015

A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia, New Zealand, and the United Kingdom. International Journal of Nursing Studies 49(6): 727-738, 2012

Patterns of anticoagulation in patients hospitalized with atrial fibrillation: warfarin is underused in paroxysmal atrial fibrillation. Connecticut Medicine 67(10): 595-598, 2003

Quality of oral anticoagulation in patients with atrial fibrillation: a cross-sectional study in general practice. European Journal of General Practice 12(4): 163-168, 2006

Meta-analysis to assess the quality of warfarin control in atrial fibrillation patients in the United States. Journal of Managed Care Pharmacy 15(3): 244-252, 2009

Utilization of antithrombotic therapy for stroke prevention in atrial fibrillation: a cross-sectional baseline analysis in general practice. Journal of Clinical Pharmacy and Therapeutics 41(4): 432-440, 2016

Patterns of warfarin use and subsequent outcomes in atrial fibrillation in primary care practices. Vascular Health and Risk Management 8: 587-598, 2012

Comparison of management patterns and clinical outcomes in patients with atrial fibrillation in Canada and the United States (from the analysis of the Atrial Fibrillation Follow-up Investigation of Rhythm Management [AFFIRM] database). American Journal of Cardiology 96(6): 815-821, 2005

Evaluation of atrial fibrillation management and cardiovascular risk profile in atrial fibrillation patients: A cross-sectional survey. Medicina 53(1): 19-25, 2017

The associations between atrial fibrillation and parameters of nutritional status assessment in the general hospital population - a cross-sectional analysis of medical documentation. Kardiologia Polska 75(3): 231-239, 2017

Warfarin usage among elderly atrial fibrillation patients with traumatic injury, an analysis of United States Medicare fee-for-service enrollees. Journal of Clinical Pharmacology 55(1): 25-32, 2015