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Open Access Research article

The use of warfarin in veterans with atrial fibrillation

Dawn M Bravata125*, Karen Rosenbeck3, Sue Kancir3 and Lawrence M Brass45

Author Affiliations

1 Clinical Epidemiology Research Center, VA Connecticut Healthcare System, 950 Campbell Avenue 11C-2, West Haven, CT 06516, USA

2 Department of Internal Medicine, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA

3 Department of Quality Management, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA

4 Department of Neurology, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA

5 Yale University School of Medicine, 333 Cedar Street, Room IE-61 SHM, New Haven, CT 06520-8088, USA

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BMC Cardiovascular Disorders 2004, 4:18  doi:10.1186/1471-2261-4-18

Published: 21 October 2004

Abstract

Background

Warfarin therapy is effective for the prevention of stroke in patients with atrial fibrillation. However, warfarin therapy is underutilized even among ideal anticoagulation candidates. The purpose of this study was to examine the use of warfarin in both inpatients and outpatients with atrial fibrillation within a Veterans Affairs (VA) hospital system.

Methods

This retrospective medical record review included outpatients and inpatients with atrial fibrillation. The outpatient cohort included all patients seen in the outpatient clinics of the VA Connecticut Healthcare System during June 2000 with a diagnosis of atrial fibrillation. The inpatient cohort included all patients discharged from the VA Connecticut Healthcare System West Haven Medical Center with a diagnosis of atrial fibrillation during October 1999 – March 2000. The outcome measure was the rate of warfarin prescription in patients with atrial fibrillation.

Results

A total of 538 outpatients had a diagnosis of atrial fibrillation and 73 of these had a documented contraindication to anticoagulation. Among the 465 eligible outpatients, 455 (98%) were prescribed warfarin. For the inpatients, a total of 212 individual patients were discharged with a diagnosis of atrial fibrillation and 97 were not eligible for warfarin therapy. Among the 115 eligible inpatients, 106 (92%) were discharged on warfarin.

Conclusions

Ideal anticoagulation candidates with atrial fibrillation are being prescribed warfarin at very high rates within one VA system, in both the inpatient and outpatient settings; we found warfarin use within our VA was much higher than that observed for Medicare beneficiaries in our state.

Keywords:
Atrial fibrillation; warfarin; anticoagulation; preventive medicine; guideline adherence