Frequency and Risk Factors for Under- and Over-Treatment in Stroke Prevention for Patients with Non-Valvular Atrial Fibrillation in General Practice |
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Authors: | Derk L Arts Stefan Visscher Wim Opstelten Joke C Korevaar Ameen Abu-Hanna Henk C P M van Weert |
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Institution: | 1. Department of General Practice, Academic Medical Centre, Amsterdam, The Netherlands.; 2. Department of Medical Informatics, Academic Medical Centre, Amsterdam, The Netherlands.; 3. Netherlands Institute for Health Services Research, Utrecht, The Netherlands.; 4. Dutch College of General Practitioners, Utrecht, The Netherlands.; Maastricht University Medical Center, Netherlands, |
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Abstract: | ObjectiveTo determine adequacy of antithrombotic treatment in patients with non-valvular atrial fibrillation. To determine risk factors for under- and over-treatment.DesignRetrospective, cross-sectional study of electronic health records from 36 general practitioners in 2008.SettingGeneral practice in the Netherlands.SubjectsPrimary care physicians (n = 36) and patients (n = 981) aged 65 years and over.Main Outcome MeasuresRates of adequate, under and over-treatment, risk factors for under and over-treatment.ResultsOf the 981 included patients with a mean of age 78, 18% received no antithrombotic treatment (under-treatment), 13% received antiplatelet drugs and 69% received oral anticoagulation (OAC). Further, 43% of the included patients were treated adequately, 26% were under-treated, and 31% were over-treated. Patients with a previous ischaemic stroke were at high risk for under-treatment (OR 2.4, CI 1.6–3.5), whereas those with contraindications for OAC were at high risk for over-treatment (OR 37.0, CI 18.1–79.9). Age over 75 (OR 0.2, CI: 0.1–0.3]), diabetes (OR 0.1, CI: 0.1–0.3), heart failure (OR 0.2, CI: 0.1–0.3), hypertension (OR 0.1, CI: 0.1–0.2) and previous ischaemic stroke (OR 0.04, CI: 0.02–0.11) protected against over-treatment.ConclusionsIn general practice, CHADS2-criteria are being used, but the antithrombotic treatment of patients with atrial fibrillation frequently deviates from guidelines on this topic. Patients with previous stroke are at high risk of not being prescribed OAC. Contraindications for OAC, however, seem to be frequently overlooked. |
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