TY - JOUR
T1 - Patterns and predictors of Warfarin use in patients with new-onset atrial fibrillation from the FRACTAL registry
AU - Reynolds, Matthew R.
AU - Shah, Jignesh
AU - Essebag, Vidal
AU - Olshansky, Brian
AU - Friedman, Paul A.
AU - Hadjis, Tomy
AU - Lemery, Robert
AU - Bahnson, Tristram D.
AU - Cannom, David S.
AU - Josephson, Mark E.
AU - Zimetbaum, Peter
N1 - Funding Information:
This study was supported by Medtronic, Inc., Minneapolis, Minnesota, and AstraZeneca, Inc., Wilmington, Delaware. Dr. Essebag is the recipient of a Clinician Scientist Award from the Canadian Institutes of Health Research, Ottawa, Ontario, Canada.
Funding Information:
We wish to thank Medtronic, Inc., and AstraZeneca, Inc., for financial support of the FRACTAL registry. FRACTAL registry participating centers (and local investigators) include the following: Beth Israel Deaconess Medical Center, Boston, Massachusetts (P. Zimetbaum, M.E. Josephson); Rhode Island Hospital, Providence, Rhode Island (R. Lemery, A.E. Buxton); Mayo Clinic, Rochester, Minnesota (P. Friedman, M.S. Stanton); Montreal General Hospital, Montreal, Quebec, Canada (T. Hadjis); Sentara Virginia Beach General Hospital, Virginia Beach, Virginia (J.J. Griffin); Victoria Heart Institute, Victoria, British Columbia, Canada (R.A. Leather); University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (D. Schwartzmann); Good Samaritan Hospital, Los Angeles, California (D. Cannom); Loyola University Medical Center, Chicago, Illinois (B. Olshansky); Kaiser Permanente Medical Center, Los Angeles, California (A. Kotlewski); Duke University Medical Center, Durham, North Caroline (T.D. Bahnson); Framingham/MetroWest Medical Center, Framingham, Massachusetts (D. Love); St. Paul Heart Clinic, St. Paul, Minnesota (D.N. Dunbar); University of Maryland Medical Center, Baltimore, Maryland (M.R. Gold); Mount Auburn Hospital, Cambridge, Massachusetts (P. Voukydis); University of Rochester Medical Center, Rochester, New York (D. Huang); and the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania (D. Callans).
PY - 2006/2/15
Y1 - 2006/2/15
N2 - Warfarin is underused for stroke prevention in atrial fibrillation (AF). Previous studies addressing this have lacked longitudinal assessment. This study sought to characterize contemporary warfarin use in new-onset AF and evaluate its change over time. It was hypothesized that AF recurrence has an important influence on warfarin use patterns. One thousand five adults from 17 centers in the United States and Canada were enrolled into a prospective observational registry after their first documented episodes of AF. Detailed demographic, clinical history, and management data were collected on all subjects at enrollment, including medication use. Patients were followed at regular intervals for interim events and changes in AF management. Warfarin use at baseline and last follow-up (mean 25 ± 8 months) after enrollment was modeled using multivariate analysis. Initially, 65% of subjects were prescribed warfarin, but only 44% were taking it at 30 months. Even in "ideal" candidates for warfarin, the rate of warfarin prescription decreased from 70% at baseline to 50% at 30 months. Stroke risk factors, including hypertension, congestive heart failure, valvular heart disease, and previous stroke or transient ischemic attack were significant predictors of warfarin prescription at baseline. At last follow-up, the relation between AF recurrence and warfarin use (odds ratio 2.3, 95% confidence interval 1.6 to 3.1) was stronger than that for any individual stroke risk factor. In conclusion, predictors of warfarin use in patients with AF include AF recurrence and selected stroke risk factors. The discontinuation of warfarin in a large number of patients with AF over time is a cause for concern in light of data from recent clinical trials.
AB - Warfarin is underused for stroke prevention in atrial fibrillation (AF). Previous studies addressing this have lacked longitudinal assessment. This study sought to characterize contemporary warfarin use in new-onset AF and evaluate its change over time. It was hypothesized that AF recurrence has an important influence on warfarin use patterns. One thousand five adults from 17 centers in the United States and Canada were enrolled into a prospective observational registry after their first documented episodes of AF. Detailed demographic, clinical history, and management data were collected on all subjects at enrollment, including medication use. Patients were followed at regular intervals for interim events and changes in AF management. Warfarin use at baseline and last follow-up (mean 25 ± 8 months) after enrollment was modeled using multivariate analysis. Initially, 65% of subjects were prescribed warfarin, but only 44% were taking it at 30 months. Even in "ideal" candidates for warfarin, the rate of warfarin prescription decreased from 70% at baseline to 50% at 30 months. Stroke risk factors, including hypertension, congestive heart failure, valvular heart disease, and previous stroke or transient ischemic attack were significant predictors of warfarin prescription at baseline. At last follow-up, the relation between AF recurrence and warfarin use (odds ratio 2.3, 95% confidence interval 1.6 to 3.1) was stronger than that for any individual stroke risk factor. In conclusion, predictors of warfarin use in patients with AF include AF recurrence and selected stroke risk factors. The discontinuation of warfarin in a large number of patients with AF over time is a cause for concern in light of data from recent clinical trials.
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U2 - 10.1016/j.amjcard.2005.09.086
DO - 10.1016/j.amjcard.2005.09.086
M3 - Article
C2 - 16461052
AN - SCOPUS:31944446445
SN - 0002-9149
VL - 97
SP - 538
EP - 543
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 4
ER -