Cargando…

Patterns of Warfarin Use in Subgroups of Patients with Atrial Fibrillation: A Cross-Sectional Analysis of 430 General Practices in the United Kingdom

BACKGROUND: Despite the proven efficacy of warfarin, its use in patients with Atrial Fibrillation (AF) is reportedly low. We investigated the underuse and overuse of warfarin in the management of AF in general practices in the United Kingdom (UK) against the National Institute of Clinical Excellence...

Descripción completa

Detalles Bibliográficos
Autores principales: Mohammed, Mohammed A., Marshall, Tom, Nirantharakumar, Krishnarajah, Stevens, Andrew, Fitzmaurice, David
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3642100/
https://www.ncbi.nlm.nih.gov/pubmed/23658703
http://dx.doi.org/10.1371/journal.pone.0061979
_version_ 1782268100038623232
author Mohammed, Mohammed A.
Marshall, Tom
Nirantharakumar, Krishnarajah
Stevens, Andrew
Fitzmaurice, David
author_facet Mohammed, Mohammed A.
Marshall, Tom
Nirantharakumar, Krishnarajah
Stevens, Andrew
Fitzmaurice, David
author_sort Mohammed, Mohammed A.
collection PubMed
description BACKGROUND: Despite the proven efficacy of warfarin, its use in patients with Atrial Fibrillation (AF) is reportedly low. We investigated the underuse and overuse of warfarin in the management of AF in general practices in the United Kingdom (UK) against the National Institute of Clinical Excellence (NICE, UK) guidelines whilst seeking to identify subgroups of AF patients to inform efforts to optimise warfarin use. METHODOLOGY: A retrospective database analysis to determine warfarin prescribing using tree models based on 50361 patients with AF (classified as low, moderate and high risk of stroke using CHADS2) from 430 general practices in the UK. RESULTS: Over one-third (37.0%, 4573/12351) of low risk AF patients were on warfarin, compared with 47.1% (8349/17709) moderate risk AF patients and 54.9% (11142/20301) high risk AF patients. Clinical subgroups (n = 15 low risk subgroups, n = 15 medium risk subgroups, n = 22 high risk subgroups) were identified. Several factors not supported by current guidelines (age, BMI, dementia, gender) were associated with the use of warfarin. Gender and BMI were associated with warfarin use in low and medium risk AF patients but not in high risk AF patients. CONCLUSION: Whilst NICE guidelines suggest that all high risk AF patients should be on warfarin, half of those at moderate risk should be on warfarin and none of those at low risk should be on warfarin, we found evidence of over and under use of warfarin. Interventions to optimise warfarin therapy tailored to and targeting specific subgroups of AF patients identified by the tree models are required.
format Online
Article
Text
id pubmed-3642100
institution National Center for Biotechnology Information
language English
publishDate 2013
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-36421002013-05-08 Patterns of Warfarin Use in Subgroups of Patients with Atrial Fibrillation: A Cross-Sectional Analysis of 430 General Practices in the United Kingdom Mohammed, Mohammed A. Marshall, Tom Nirantharakumar, Krishnarajah Stevens, Andrew Fitzmaurice, David PLoS One Research Article BACKGROUND: Despite the proven efficacy of warfarin, its use in patients with Atrial Fibrillation (AF) is reportedly low. We investigated the underuse and overuse of warfarin in the management of AF in general practices in the United Kingdom (UK) against the National Institute of Clinical Excellence (NICE, UK) guidelines whilst seeking to identify subgroups of AF patients to inform efforts to optimise warfarin use. METHODOLOGY: A retrospective database analysis to determine warfarin prescribing using tree models based on 50361 patients with AF (classified as low, moderate and high risk of stroke using CHADS2) from 430 general practices in the UK. RESULTS: Over one-third (37.0%, 4573/12351) of low risk AF patients were on warfarin, compared with 47.1% (8349/17709) moderate risk AF patients and 54.9% (11142/20301) high risk AF patients. Clinical subgroups (n = 15 low risk subgroups, n = 15 medium risk subgroups, n = 22 high risk subgroups) were identified. Several factors not supported by current guidelines (age, BMI, dementia, gender) were associated with the use of warfarin. Gender and BMI were associated with warfarin use in low and medium risk AF patients but not in high risk AF patients. CONCLUSION: Whilst NICE guidelines suggest that all high risk AF patients should be on warfarin, half of those at moderate risk should be on warfarin and none of those at low risk should be on warfarin, we found evidence of over and under use of warfarin. Interventions to optimise warfarin therapy tailored to and targeting specific subgroups of AF patients identified by the tree models are required. Public Library of Science 2013-05-02 /pmc/articles/PMC3642100/ /pubmed/23658703 http://dx.doi.org/10.1371/journal.pone.0061979 Text en © 2013 Mohammed et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Mohammed, Mohammed A.
Marshall, Tom
Nirantharakumar, Krishnarajah
Stevens, Andrew
Fitzmaurice, David
Patterns of Warfarin Use in Subgroups of Patients with Atrial Fibrillation: A Cross-Sectional Analysis of 430 General Practices in the United Kingdom
title Patterns of Warfarin Use in Subgroups of Patients with Atrial Fibrillation: A Cross-Sectional Analysis of 430 General Practices in the United Kingdom
title_full Patterns of Warfarin Use in Subgroups of Patients with Atrial Fibrillation: A Cross-Sectional Analysis of 430 General Practices in the United Kingdom
title_fullStr Patterns of Warfarin Use in Subgroups of Patients with Atrial Fibrillation: A Cross-Sectional Analysis of 430 General Practices in the United Kingdom
title_full_unstemmed Patterns of Warfarin Use in Subgroups of Patients with Atrial Fibrillation: A Cross-Sectional Analysis of 430 General Practices in the United Kingdom
title_short Patterns of Warfarin Use in Subgroups of Patients with Atrial Fibrillation: A Cross-Sectional Analysis of 430 General Practices in the United Kingdom
title_sort patterns of warfarin use in subgroups of patients with atrial fibrillation: a cross-sectional analysis of 430 general practices in the united kingdom
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3642100/
https://www.ncbi.nlm.nih.gov/pubmed/23658703
http://dx.doi.org/10.1371/journal.pone.0061979
work_keys_str_mv AT mohammedmohammeda patternsofwarfarinuseinsubgroupsofpatientswithatrialfibrillationacrosssectionalanalysisof430generalpracticesintheunitedkingdom
AT marshalltom patternsofwarfarinuseinsubgroupsofpatientswithatrialfibrillationacrosssectionalanalysisof430generalpracticesintheunitedkingdom
AT nirantharakumarkrishnarajah patternsofwarfarinuseinsubgroupsofpatientswithatrialfibrillationacrosssectionalanalysisof430generalpracticesintheunitedkingdom
AT stevensandrew patternsofwarfarinuseinsubgroupsofpatientswithatrialfibrillationacrosssectionalanalysisof430generalpracticesintheunitedkingdom
AT fitzmauricedavid patternsofwarfarinuseinsubgroupsofpatientswithatrialfibrillationacrosssectionalanalysisof430generalpracticesintheunitedkingdom