American Journal of Cardiology
Volume 105, Issue 8 , Pages 1130-1134, 15 April 2010

Warfarin and Aspirin Use in Atrial Fibrillation Among Practicing Cardiologist (from the AFFECTS Registry)

  • Peter R. Kowey, MD

      Affiliations

    • Jefferson Medical College, Philadelphia, Pennsylvania
    • Corresponding Author InformationCorresponding author: Tel: (610) 645-2684; fax: (610) 896-0643
    • ,
  • James A. Reiffel, MD

      Affiliations

    • Columbia University, New York, New York
    • ,
  • Robert Myerburg, MD

      Affiliations

    • University of Miami, Miami, Florida
    • ,
  • Gerald V. Naccarelli, MD

      Affiliations

    • Penn State College of Medicine, Hershey, Pennsylvania
    • ,
  • Douglas L. Packer, MD

      Affiliations

    • Mayo Clinic, Rochester, Minnesota
    • ,
  • Craig M. Pratt, MD

      Affiliations

    • Baylor College of Medicine, Houston, Texas
    • ,
  • Michael J. Reiter, MD, PhD

      Affiliations

    • University of Colorado, Denver, Colorado
    • ,
  • Albert L. Waldo, MD

      Affiliations

    • University Hospitals Case Medical Center, Cleveland, Ohio
    • ,
  • AFFECTS Scientific Advisory Committee and Investigators

published online 22 February 2010.

Among patients with atrial fibrillation (AF), the risk of thromboembolism is a significant concern. However, the reported use of warfarin among patients with AF at elevated risk of stroke remains low. In the present study, we have provided information on anticoagulation use reported during the recent Atrial Fibrillation: Focus on Effective Clinical Treatment Strategies (AFFECTS) Registry. Among patients identified by their physician at baseline to be at an increased risk of stroke, as determined from an assessment of the medical history, 74% received warfarin and 29% received aspirin. Post hoc analysis of warfarin use stratified by Congestive heart failure, Hypertension, Age, Diabetes, Stroke, (CHADS2) doubled score revealed that at the end of the study, warfarin use was 73% (155 of 213) and 66% (185 of 280) in the rate- and rhythm-control patients with a score of ≥2, respectively, compared to 60% (183 of 306) and 49% (322 of 662) in the rate- and rhythm-control patients with a score of <2, respectively. The practicing cardiologists who participated in this registry initiated anticoagulation therapy in most of their patients with AF. However, warfarin use is not yet in line with the guidelines and evidence-based recommendations. Patients considered at no risk of stroke appear to have been overprescribed anticoagulant agents, and a considerable portion of high-risk patients did not receive warfarin. In conclusion, these results suggest that continued physician education of appropriate anticoagulation use in patients with AF is needed.

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 This study was supported by Reliant Pharmaceuticals, acquired by GlaxoSmithKline, Research Triangle Park, North Carolina, and was sponsored by Columbia University, New York, New York.

 All listed authors met the criteria for authorship set forth by the International Committee for Medical Journal Editors.

 The AFFECTS Registry was overseen by a Scientific Advisory Committee comprised of Peter R. Kowey, MD, Robert J. Myerburg, MD, Gerald V. Naccarelli, MD, Douglas Packer, MD, Craig M. Pratt, MD, Eric N. Prystowsky, MD, James A. Reiffel, MD, Michael Reiter, MD, PhD, and Albert L. Waldo, MD.

 The full list of investigators appears in the Appendix to the online version of this report.

PII: S0002-9149(09)02844-6

doi:10.1016/j.amjcard.2009.11.047

American Journal of Cardiology
Volume 105, Issue 8 , Pages 1130-1134, 15 April 2010

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