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Stroke prophylaxis in institutionalized elderly patients with atrial fibrillation.

Abstract：

OBJECTIVES:To identify patterns and predictors of antithrombotic use and to evaluate the appropriateness of antithrombotic therapy for stroke prophylaxis in institutionalized elderly patients with atrial fibrillation. DESIGN:Retrospective study. SETTING:Seventeen long-term care institutions in Edmonton, Alberta. SUBJECTS:Two hundred sixty-five long-term care residents, aged 65 and older, with atrial fibrillation. MEASUREMENTS:The proportion of patients who were prescribed warfarin, acetylsalicylic acid (ASA), both, or neither was determined. Odds ratios were calculated to identify risk factors for stroke and bleeding that are predictive of the receipt of anticoagulant therapy. Appropriateness of therapy was evaluated based on whether patients were prescribed antithrombotic therapy in accordance with their risk factors for stroke and bleeding. RESULTS:Warfarin was prescribed for 49% of patients, ASA for 22%, both for 8%, and neither for 20%. Nearly all patients (97%) were considered to be at high risk for stroke, with age being the predominant risk factor (88%>75), whereas about half were considered to be at low risk for bleeding. Multivariate analyses did not find any associations between individual risk factors for bleeding and anticoagulant treatment, with the exception of recent surgery (odds ratio=0.59, 95% confidence interval=0.37-0.94). Overall, 54.8% of patients received appropriate antithrombotic therapy. Of patients who were optimal candidates for anticoagulation, 60% received appropriate therapy (warfarin with or without ASA). CONCLUSION:Although warfarin was the most appropriate treatment in nearly all of this population at high risk for stroke, it was prescribed in fewer than two-thirds of patients. Antithrombotic therapy was not always prescribed in accordance with patients' risk factors for stroke and bleeding. There is a need for systematic identification of appropriate candidates for anticoagulation in the long-term care setting.

journal_name

J Am Geriatr Soc

journal_title

Journal of the American Geriatrics Society

authors

Lau E,Bungard TJ,Tsuyuki RT

doi

10.1111/j.1532-5415.2004.52117.x

subject

Has Abstract

pub_date

2004-03-01 00:00:00

pages

428-33

issue

eissn

0002-8614

issn

1532-5415

pii

52117

journal_volume

pub_type

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Stroke prophylaxis in institutionalized elderly patients with atrial fibrillation.