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Quality of care for atrial fibrillation among patients hospitalized for heart failure.
J Am Coll Cardiol. 2009 Sep 29; 54(14):1280-9.JACC

Abstract

OBJECTIVES

This study sought to examine quality of care and warfarin use at discharge in patients with atrial fibrillation (AF) and heart failure (HF).

BACKGROUND

Atrial fibrillation is common in HF, and national guidelines recommend discharge on warfarin for stroke prophylaxis. However, the frequency and factors associated with the guideline adherence are poorly described.

METHODS

We analyzed 72,534 HF admissions from January 2005 through March 2008 at 255 hospitals participating in the American Heart Association's Get With The Guidelines HF program. Multivariable logistic regression was used to identify independent factors associated with warfarin use at discharge.

RESULTS

In this HF population, 20.5% (n=14,901) had AF on admission, whereas another 13.7% (n=9,918) had a prior history of AF but were in a regular rhythm at admission. Contraindications to warfarin therapy were documented in 9.2%. Among eligible HF patients without contraindications, the median prevalence of warfarin therapy at discharge was 64.9% (interquartile range 55.5 to 73.4) and did not improve during the 3.5 years of study. After adjustment, major factors associated with no warfarin use at discharge included increasing age, nonwhite race, anemia, and treatment in the south. Warfarin use also varied inversely with CHADS2 (congestive heart failure, hypertension, age>75, diabetes, and prior stroke or transient ischemic attack) risk (70.9% to 59.5% for CHADS2 score 1 to 6, p<0.0001).

CONCLUSIONS

Guideline-recommended warfarin use in patients with AF and HF is less than optimal, has not improved over time, and varies significantly according to age, race, risk profile, region, and hospital site.

Authors+Show Affiliations

Duke Clinical Research Institute, Durham, North Carolina 27715, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

19778670

Citation

Piccini, Jonathan P., et al. "Quality of Care for Atrial Fibrillation Among Patients Hospitalized for Heart Failure." Journal of the American College of Cardiology, vol. 54, no. 14, 2009, pp. 1280-9.
Piccini JP, Hernandez AF, Zhao X, et al. Quality of care for atrial fibrillation among patients hospitalized for heart failure. J Am Coll Cardiol. 2009;54(14):1280-9.
Piccini, J. P., Hernandez, A. F., Zhao, X., Patel, M. R., Lewis, W. R., Peterson, E. D., & Fonarow, G. C. (2009). Quality of care for atrial fibrillation among patients hospitalized for heart failure. Journal of the American College of Cardiology, 54(14), 1280-9. https://doi.org/10.1016/j.jacc.2009.04.091
Piccini JP, et al. Quality of Care for Atrial Fibrillation Among Patients Hospitalized for Heart Failure. J Am Coll Cardiol. 2009 Sep 29;54(14):1280-9. PubMed PMID: 19778670.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Quality of care for atrial fibrillation among patients hospitalized for heart failure. AU - Piccini,Jonathan P, AU - Hernandez,Adrian F, AU - Zhao,Xin, AU - Patel,Manesh R, AU - Lewis,William R, AU - Peterson,Eric D, AU - Fonarow,Gregg C, AU - ,, PY - 2009/01/19/received PY - 2009/03/24/revised PY - 2009/04/03/accepted PY - 2009/9/26/entrez PY - 2009/9/26/pubmed PY - 2009/11/11/medline SP - 1280 EP - 9 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 54 IS - 14 N2 - OBJECTIVES: This study sought to examine quality of care and warfarin use at discharge in patients with atrial fibrillation (AF) and heart failure (HF). BACKGROUND: Atrial fibrillation is common in HF, and national guidelines recommend discharge on warfarin for stroke prophylaxis. However, the frequency and factors associated with the guideline adherence are poorly described. METHODS: We analyzed 72,534 HF admissions from January 2005 through March 2008 at 255 hospitals participating in the American Heart Association's Get With The Guidelines HF program. Multivariable logistic regression was used to identify independent factors associated with warfarin use at discharge. RESULTS: In this HF population, 20.5% (n=14,901) had AF on admission, whereas another 13.7% (n=9,918) had a prior history of AF but were in a regular rhythm at admission. Contraindications to warfarin therapy were documented in 9.2%. Among eligible HF patients without contraindications, the median prevalence of warfarin therapy at discharge was 64.9% (interquartile range 55.5 to 73.4) and did not improve during the 3.5 years of study. After adjustment, major factors associated with no warfarin use at discharge included increasing age, nonwhite race, anemia, and treatment in the south. Warfarin use also varied inversely with CHADS2 (congestive heart failure, hypertension, age>75, diabetes, and prior stroke or transient ischemic attack) risk (70.9% to 59.5% for CHADS2 score 1 to 6, p<0.0001). CONCLUSIONS: Guideline-recommended warfarin use in patients with AF and HF is less than optimal, has not improved over time, and varies significantly according to age, race, risk profile, region, and hospital site. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/19778670/Quality_of_care_for_atrial_fibrillation_among_patients_hospitalized_for_heart_failure_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)02253-0 DB - PRIME DP - Unbound Medicine ER -