Abstract
Background
Atrial fibrillation is associated with substantial mortality and morbidity from stroke
and thromboembolism. Despite an efficacious oral anticoagulation therapy (warfarin),
atrial fibrillation patients at high risk for stroke are often under-treated. This
systematic review compares current treatment practices for stroke prevention in atrial
fibrillation with published guidelines.
Methods
Literature searches (1997-2008) identified 98 studies concerning current treatment
practices for stroke prevention in atrial fibrillation. The percentage of patients
eligible for oral anticoagulation due to elevated stroke risk was compared with the
percentage treated. Under-treatment was defined as treatment of <70% of high-risk
patients.
Results
Of 54 studies that reported stroke risk levels and the percentage of patients treated,
most showed underuse of oral anticoagulants for high-risk patients. From 29 studies
of patients with prior stroke/transient ischemic attack who should all receive oral
anticoagulation according to published guidelines, 25 studies reported under-treatment,
with 21 of 29 studies reporting oral anticoagulation treatment levels below 60% (range
19%-81.3%). Subjects with a CHADS2 (congestive heart failure, hypertension, age >75 years, diabetes mellitus, and prior stroke or transient ischemic attack) score ≥2 also were suboptimally treated, with
7 of 9 studies reporting treatment levels below 70% (range 39%-92.3%). Studies (21
of 54) using other stroke risk stratification schemes differ in the criteria they
use to designate patients as “high risk,” such that direct comparison is not possible.
Conclusions
This systematic review demonstrates the underuse of oral anticoagulation therapy for
real-world atrial fibrillation patients with an elevated risk of stroke, highlighting
the need for improved therapies for stroke prevention in atrial fibrillation.
Keywords
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Article info
Footnotes
Funding: This study was funded by Bayer Healthcare, UK.
Conflict of Interest: Dr. Gregory Y.H. Lip has acted as a consultant for Bayer Healthcare, AstraZeneca, Astellas, and Boehringer; and Warren Cowell is employed by Bayer Healthcare, UK. The other authors have no conflict of interest.
Authorship: All authors had full access to data for this study and participated in writing and review of the manuscript.
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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- Anticoagulation for Atrial Fibrillation: Underuse?The American Journal of MedicineVol. 124Issue 7
