Stroke prevention practices in patients with atrial fibrillation and pacemaker therapy. Evidence for under-use of anticoagulation

Abstract

This study presents a survey of pacemaker patients followed in a pacemaker clinic. Three hundred and twenty-six patients of mean age 77.7 +/- 9.6 years, 52% female, 75% VVI, 25% dual chamber were analysed. One hundred and forty (43%) were in atrial fibrillation and were older, 80.5 +/- 7.1 years, compared with 75.5 +/- 11.4 years (P = 0.014) for those in sinus rhythm. Temporary pacemaker reprogramming was necessary in 86% in order to determine the abnormal rhythm. Thirty-nine (28%) of those in atrial fibrillation were anticoagulated; 37% were on aspirin; only 10.8% of those in atrial fibrillation who were not anticoagulated had contraindications to this therapy. Prevalence of atrial fibrillation increased with age, whereas that of anticoagulation decreased with age. In conclusion, the majority of pacemaker patients with atrial fibrillation, for whom anticoagulation is indicated, fails to receive it: those caring for these patients are urged to ensure its much wider use.

Neurologische Ereignisse bei Patienten mit Vorhofflimmern: Outcome und Präventionspraxis

“…Trotz erwiesener Effizienz (21) wird die Antikoagulation in der täglichen Praxis unzureichend durchgeführt. Zur Primärprophylaxe insgesamt liegen eine Vielzahl von Untersuchungen in diversen klinischen "settings" vor, die Antikoagulationsraten bei Patienten mit Vorhofflimmern zwischen 20-40% fanden (1,7,13,14,24,25,27,28). In den USA stieg die Rate antikoagulierter Patienten mit VHF und fehlenden Kontraindikationen gegen Antikoagulation von 13% in 1989 auf 40% in 1993 (27).…”

“…Verbindende Feststellung in allen Untersuchungen zur Praxis der Primärprophylaxe ist die mit höherem Lebensalter trotz erhöhten Schlaganfallrisikos sinkende Rate an antikoagulierten Patienten und eine insgesamt niedrige Prävalenz von Kontraindikationen gegen diese Therapie (7,25,28).…”

Anticoagulation treatment for the reduction of stroke in atrial fibrillation: a cohort study to examine the gap between guidelines and routine medical practice

“…Much of the literature from studies outside Germany points to under-utilisation of this therapy [11][12][13][14][15][16][17]. Although good current data on the care of stroke is available, there is a dearth of information on the current practice patterns in the treatment of AF in Germany regarding anticoagulation.…”

Anticoagulants for atrial fibrillation: Why is the treatment rate so low?

“…The use of anticoagulants in patients with AF and pacemakers was investigated by Carlsson et al, 22 who found that only 28% of eligible patients at risk were on anticoagulants and 37% were treated with aspirin. In this particular group, however, the diagnosis of AF was not always clear on the electrocardiogram because of the presence of the pacemaker.…”