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National underuse of anti‐thrombotic therapy in chronic atrial fibrillation identified from digoxin prescribing
Author(s) -
Mahmud Azra,
Bennett Kathleen,
Okechukwu Ifeanyi,
Feely John
Publication year - 2007
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/j.1365-2125.2007.02954.x
Subject(s) - digoxin , atrial fibrillation , medicine , cardiology , heart failure
What is already known about this subject • Underuse of antithrombotic therapy in atrial fibrillation has been identified in hospital base and community surveys. • Whether this applies nationally and whether underuse is age or gender related is not established. What this study adds • Using a pharmacoepidemiological database with digoxin as a surrogate for atrial fibrillation, its prevalence and the concomitant use of antithrombotic therapy nationally mirrors that seen in smaller studies. • In addition, both prescribers' views and practice show that, based on age, those at highest risk and women are least likely to receive warfarin, which is predominantly used in the low‐risk population. • Such databases may be used nationally to examine adherence to guidelines. Aims To examine if appropriate antithrombotic therapy in atrial fibrillation is implemented nationally. Methods Using prescriptions for digoxin as a surrogate for atrial fibrillation, we identified its coprescription with antithrombotic therapy, aspirin or warfarin in a national prescribing database in 27 571 patients over 45 years old. Results Proportionately significantly more men were on warfarin, and use in those >75 years old was three times less than in those <65 years. Reluctance to use antithrombotics was confirmed in a postal survey. Conclusion Data suggest a missed opportunity to prevent stroke with women and those >75 years old least likely to receive warfarin.