Chronic Disease

Doctors underprescribe warfarin to prevent strokes in patients with atrial fibrillation and heart failure

As many as 7,000 preventable strokes occur each year among patients treated for heart failure (HF) and atrial fibrillation (AF). One problem is inadequate prescribing of the blood thinner warfarin to prevent strokes among patients discharged from the hospital after treatment for HF with AF, according to a new study. Patients hospitalized for HF alone have a 1-year mortality exceeding 30 percent and readmission rates exceeding 50 percent; these percentages are even worse for patients with both HF and AF.

The researchers found that among the patients hospitalized for HF, 20.5 percent had AF upon admission and another 13.7 percent had a prior history of AF. Overall, 64.9 percent of the HF patients studied who did not have problems that prevented the use of warfarin were discharged on warfarin therapy, and this proportion did not increase over the 3.5 years of the study. The percentage of eligible patients receiving warfarin treatment at discharge varied widely among the hospitals, from 0 percent to 96 percent. Furthermore, patients in the South and West regions of the United States were more than 30 percent less likely to be placed on warfarin than patients in the Northeast.

The study analyzed data collected through the American Heart Association's Get With the Guidelines (GWTG) Program on patients hospitalized for HF from January 1, 2005, through March 25, 2008. In total, the researchers analyzed treatment data on 75,534 patients with HF admitted to 255 hospitals participating in the GWTG-HF registry. The study was funded in part by the Agency for Healthcare Research and Quality (HS16964).

More details are in "Quality of care for atrial fibrillation among patients hospitalized for heart failure," by Jonathan P. Piccini, M.D., Adrian F. Hernandez, M.D., M.H.S., Xin Zhao, Ph.D., and others in the Journal of the American College of Cardiology 54(14), pp. 1280-1289, 2009.

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