PURPOSE: To investigate the use of warfarin at hospital discharge in patients with atrial fibrillation (AF) with no contraindications to warfarin.
METHODS: We investigated in 557 consecutive patients, mean age 76 years, with nonvalvular AF the use of warfarin at hospital discharge.
RESULTS: Results: Of 557 patients with AF, 116 (21%) had contraindications to warfarin. In 441 patients eligible for warfarin, warfarin was used in 27 of 27 patients (100%) with CHADS2 scores of 4-6, in 72 of 77 patients ((94%) with a CHADS2 score of 3, in 121 of 175 patients (70%) with a CHADS2 score of 2, in 82 of 132 patients (62%) with a CHADS2 score of 1, and in 8 of 30 patients (27%) with a CHADS2 score of 0. In 279 patients with a CHADS2 score of 2 or higher, warfarin was used in 23 of 32 patients (72%) age < 65 years, in 74 of 79 patients (94%) age 65-75 years, and in 123 of 168 patients (73%) age >75 years (p< 0.001 comparing age >75 years with 65-75 years and < 0.005 comparing age < 65 years with 65-75 years). In patients with a CHADS2 score of 2 or higher, warfarin was used in 140 of 163 patients (86%) with a glomerular filtration rate (GFR) of 60 or higher ml/min/1.73 m2 and in 80 of 116 patients (69%) with a GFR < 60 ml/min/1.73 m2 (p< 0.001). There was no significant difference in warfarin use between men versus women and whites versus nonwhites.
CONCLUSION: Warfarin was underutilized in patients with AF and a CHADS2 score < 2, with decreased GFR, and in patients < 65 years and >75 years.
CLINICAL IMPLICATIONS: Physicians need to be taught to use warfarin in patients with AF at increased risk for thromboembolic events despite age and decreased GFR if they have no contraindications to use of warfarin.
DISCLOSURE: Hoang Lai, No Financial Disclosure Information; No Product/Research Disclosure Information