Characterization of patients with atrial fibrillation not treated with oral anticoagulants

Abstract Objective. An underuse of oral anticoagulants (OAC) in patients with atrial fibrillation (AF) has been suggested, as only 50% of all patients with AF receive OAC treatment. Whether this is due to contraindications, lack of an indication to treat, or an expression of underuse is sparsely inv...

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Bibliographic Details
Published in:Scandinavian journal of primary health care 2014-12, Vol.32 (4), p.226-231
Main Authors: Johansson, Cecilia, Hägg, Lovisa, Johansson, Lars, Jansson, Jan-Håkan
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Anticoagulants
Anticoagulants - administration & dosage
Anticoagulants - adverse effects
Anticoagulants - therapeutic use
anticoagulation
Atrial fibrillation
Atrial Fibrillation - drug therapy
Atrial Fibrillation - epidemiology
Bleeding
Cardiac arrhythmia
Cardiovascular Diseases - drug therapy
Child
Child, Preschool
Cross-Sectional Studies
Embolism
Epidemiology
Female
general practice
Guideline Adherence
Humans
Infant
Infant, Newborn
Male
Medical records
Middle Aged
Original
Retrospective Studies
Risk Factors
romboembolism
Side effects
Sweden
Sweden - epidemiology
thromboembolic risk
thromboembolism
Warfarin
Young Adult
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Summary:Abstract Objective. An underuse of oral anticoagulants (OAC) in patients with atrial fibrillation (AF) has been suggested, as only 50% of all patients with AF receive OAC treatment. Whether this is due to contraindications, lack of an indication to treat, or an expression of underuse is sparsely investigated. This study therefore aimed to characterize individuals without OAC treatment in a real-life population of patients with AF. Design. Retrospective cross-sectional study. The medical records were scrutinized in order to identify the type of AF, risk factors for embolism and bleeding, and other factors of importance for OAC treatment. Setting. The municipalities of Skellefteå and Norsjö, northern Sweden. Subjects. A total of 2274 living residents with at least one verified episode of AF on or before December 31, 2010. Main outcome measures. Prevalence of treatment with OAC and documented reasons to withhold OAC treatment. Results. Among all 2274 patients with AF, 1187 (52%) were not treated with OAC. Of the untreated patients, 19% had no indication or had declined or had experienced adverse effects other than bleeding on warfarin treatment. The most common reason to withhold OAC was presence of risk factors for bleeding, found in 38% of all untreated patients. Furthermore, a documented reason could be identified to withhold OAC in 75%. Conclusions. Among patients with AF without OAC treatment a reason could be identified to withhold OAC in 75%. The underuse of OAC is estimated to be 25%.
ISSN:0281-3432
1502-7724
1502-7724
DOI:10.3109/02813432.2014.984952