Underutilization of antithrombotic therapy in elderly rural patients with atrial fibrillation

Underutilization of antithrombotic therapy in elderly rural patients with atrial fibrillation

Background Antithrombotic agents are underutilized in elderly patients with atrial fibrillation. In a peer-review audit of antithrombotic use in Missouri, rural patients were given antithrombotic therapy less often than rural patients for unclear reasons. Methods and Results The charts of 597 hospit...

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Bibliographic Details
Published in:The American heart journal Vol. 137; no. 2; pp. 307 - 312
Main Authors: Flaker, Greg C., McGowan, Daniel Joseph, Boechler, Michael, Fortune, Gary, Gage, Brian
Format: Journal Article
Language:English
Published: New York, NY Elsevier Inc 01-02-1999
Elsevier
Subjects:
Aged
Aged, 80 and over
Aspirin - therapeutic use
Atrial Fibrillation - drug therapy
Biological and medical sciences
Blood. Blood coagulation. Reticuloendothelial system
Cerebrovascular Disorders - epidemiology
Contraindications
Drug Utilization - statistics & numerical data
Female
Fibrinolytic Agents - therapeutic use
Humans
Logistic Models
Male
Medical sciences
Medicare - statistics & numerical data
Missouri - epidemiology
Pharmacology. Drug treatments
Practice Patterns, Physicians' - statistics & numerical data
Risk Factors
Rural Population
Thrombolytic Therapy - utilization
United States
Warfarin - therapeutic use
Human
Nervous system diseases
Stroke
Warfarin
Arrhythmia
Coumarine derivatives
Atrial fibrillation
Cardiovascular disease
Anticoagulant
Excitability disorder
Cerebral disorder
Vascular disease
Chemotherapy
Treatment
Heart disease
Central nervous system disease
Rural area
Elderly
Cerebrovascular disease
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Summary:Background Antithrombotic agents are underutilized in elderly patients with atrial fibrillation. In a peer-review audit of antithrombotic use in Missouri, rural patients were given antithrombotic therapy less often than rural patients for unclear reasons. Methods and Results The charts of 597 hospitalized Medicare patients discharged between October 1, 1993, and December 31, 1994, from urban and rural hospitals in Missouri were reviewed. In addition to antithrombotic therapy prescribed at the time of discharge, patient and physician information, relative contraindications to antithrombotic therapy, and risk factors for stroke were identified. Rural and urban patients were similar in terms of age, sex, and risk factors for stroke. At least one stroke risk factor was noted in 87% of rural patients and in 84% of urban patients. Urban patients were more likely to have a relative contraindication to antithrombotic therapy compared with rural patients (66% vs 54%, P =.04) but received antithrombotic therapy more often (58% vs 47%, P =.02). Cardiologists prescribed antithrombotic therapy significantly more often than noncardiologists (69% vs 52%, P =.003). Conclusions Elderly rural patients with atrial fibrillation receive antithrombotic therapy less frequently than urban patients despite having a similar high-risk profile and fewer relative contraindications. Primary care physicians prescribe antithrombotic therapy less often than cardiologists, which is one of the reasons for this underutilization. (Am Heart J 1999;137:307-12.)
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ISSN:0002-8703
1097-6744
DOI:10.1053/hj.1999.v137.91403