Characterization of patients with atrial fibrillation not treated with oral anticoagulants

Abstract

Objective. An underuse of oral anticoagulants (OAC) in patients with atrial fibrillation (AF) has been suggested, as only 50% of all patients with AF receive OAC treatment. Whether this is due to contraindications, lack of an indication to treat, or an expression of underuse is sparsely investigated. This study therefore aimed to characterize individuals without OAC treatment in a real-life population of patients with AF. Design. Retrospective cross-sectional study. The medical records were scrutinized in order to identify the type of AF, risk factors for embolism and bleeding, and other factors of importance for OAC treatment. Setting. The municipalities of Skellefteå and Norsjö, northern Sweden. Subjects. A total of 2274 living residents with at least one verified episode of AF on or before December 31, 2010. Main outcome measures. Prevalence of treatment with OAC and documented reasons to withhold OAC treatment. Results. Among all 2274 patients with AF, 1187 (52%) were not treated with OAC. Of the untreated patients, 19% had no indication or had declined or had experienced adverse effects other than bleeding on warfarin treatment. The most common reason to withhold OAC was presence of risk factors for bleeding, found in 38% of all untreated patients. Furthermore, a documented reason could be identified to withhold OAC in 75%. Conclusions. Among patients with AF without OAC treatment a reason could be identified to withhold OAC in 75%. The underuse of OAC is estimated to be 25%.

Key Words::

• Atrial fibrillation
• anticoagulation
• epidemiology
• general practice
• risk factors
• thromboembolic risk
• thromboembolism
• Sweden

Acknowledgments

This study was supported by generous grants from the County Council of Västerbotten, the Joint Committee of Northern Sweden Health Care Region and the Foundation for Medical Research in Skellefteå. The authors would like to thank Thomas Suh, Skellefteå, for invaluable English language assistance.

Ethics, funding, and declaration of conflicting interests

The study was approved by the Regional Ethics Review Board of Umeå University. This study was supported by generous grants from the County Council of Västerbotten, the Joint Committee of Northern Sweden Health Care Region and the Foundation for Medical Research in Skellefteå. The authors declare that there is no conflict of interest.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the contents and writing of the paper.