Underutilization of antithrombotic therapy in elderly rural patients with atrial fibrillation

• 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
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1053/hj.1999.v137.91403

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.)