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Physicians generally followed drug treatment guidelines for atrial fibrillation, but only one-third used warfarin

Atrial fibrillation (AF) is a common type of irregular heart rhythm that can cause stroke and other problems. Treatment includes the use of cardiac rate-controlling drugs, such as beta-blockers, antiarrhythmic drugs, and anticoagulants such as warfarin to reduce the risk of stroke. During the study period, trends in the use of digoxin, beta-blockers, and Class Ia antiarrhythmic drugs for patients with AF generally followed the evidence-based recommendations. However, only about one-third (37 percent) of patient visits for AF included use of warfarin, even among patients who were 60 years and older.

The low and unchanging use of warfarin during the 4-year study period may indicate a need for physician education and intervention to improve use of warfarin and reduce patient risk of stroke, note the researchers. They analyzed medications mentioned by U.S. office-based physicians during visits with AF patients between 1999 and 2003, using data from the IMS Health National Disease and Therapeutic Index™.

Digoxin, considered to be the least effective rate-controlling drug in most AF patients, was the most commonly mentioned rate-controlling drug in 23 percent of patient visits, followed by beta-blockers in 11 percent, and calcium-channel blockers in 8 percent. During the study period, mentions of digoxin significantly decreased, and mentions of beta-blockers significantly increased, a practice change more in line with clinical evidence. Mentions of antiarrythmic drugs, most commonly amiodarone, were reported in an average of 12 percent of patient visits throughout the study period.

The study was supported in part by the Agency for Healthcare Research and Quality (HS10548).

More details are in "Outpatient use of anticoagulants, rate-controlling drugs, and antiarrhythmic drugs for atrial fibrillation," by Nancy M. Allen LaPointe, Pharm.D., Laura Governale, Pharm.D., M.B.A., Jerry Watkins, M.S., and others, in the November 2007 American Heart Journal 154, pp. 893-898.

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