Quality of Care for Atrial Fibrillation Among Patients Hospitalized for Heart Failure

Duke Clinical Research Institute, Durham, North Carolina 27715, USA.
Journal of the American College of Cardiology (Impact Factor: 16.5). 09/2009; 54(14):1280-9. DOI: 10.1016/j.jacc.2009.04.091
Source: PubMed


This study sought to examine quality of care and warfarin use at discharge in patients with atrial fibrillation (AF) and heart failure (HF).
Atrial fibrillation is common in HF, and national guidelines recommend discharge on warfarin for stroke prophylaxis. However, the frequency and factors associated with the guideline adherence are poorly described.
We analyzed 72,534 HF admissions from January 2005 through March 2008 at 255 hospitals participating in the American Heart Association's Get With The Guidelines HF program. Multivariable logistic regression was used to identify independent factors associated with warfarin use at discharge.
In this HF population, 20.5% (n=14,901) had AF on admission, whereas another 13.7% (n=9,918) had a prior history of AF but were in a regular rhythm at admission. Contraindications to warfarin therapy were documented in 9.2%. Among eligible HF patients without contraindications, the median prevalence of warfarin therapy at discharge was 64.9% (interquartile range 55.5 to 73.4) and did not improve during the 3.5 years of study. After adjustment, major factors associated with no warfarin use at discharge included increasing age, nonwhite race, anemia, and treatment in the south. Warfarin use also varied inversely with CHADS2 (congestive heart failure, hypertension, age>75, diabetes, and prior stroke or transient ischemic attack) risk (70.9% to 59.5% for CHADS2 score 1 to 6, p<0.0001).
Guideline-recommended warfarin use in patients with AF and HF is less than optimal, has not improved over time, and varies significantly according to age, race, risk profile, region, and hospital site.

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Available from: Manesh R Patel, Dec 16, 2013
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    • "Once the need for oral anticoagulation is identified, several additional factors must be considered. Despite the evidence demonstrating the benefits of anticoagulation therapy in AF and HF, adherence to these recommendations is far from optimal.10,29,30 The hesitation to anticoagulate patients is often based upon fear of adverse effects and poor adherence with monitoring, and this is most pronounced in the elderly.12 "
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    • "Malignant or benign brain neoplasms, bleeding disorders, alcoholism, Alzheimers and other dementias, seizure disorders, chronic renal disease, cerebal hemorrhage, liver disease, peptic ulcer disease, gastritis, or duodenitis Prescription or continuation of warfarin during office visit (52.2%) 2001- 2006 Piccini, 2009 15,748 R, O (nested in the prospective GWTG database) "
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    Preview · Article · Sep 2009 · Journal of the American College of Cardiology
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