[Quality of anticoagulation management in ambulatory care of patients with atrial fibrillation].
Many patients with atrial fibrillation do not receive anticoagulation due to accepted contraindications but also due to considerable underuse. We screened 2215 consecutive patients when they entered the Medical Emergency Department for any acute condition. The decision on correct use or underuse of oral anticoagulation was made from the charts by consensus of two experienced physicians. The prevalence of atrial fibrillation was 3.7%. 43 of 83 patients with atrial fibrillation had oral anticoagulation (52%, mean age 76 years). 32 patients were treated with Aspirin only (38%, mean age 79 years). 29 patients (35%) did not receive anticoagulation because of accepted contraindications, i.e., dementia and risk for recurrent falls (n = 16), history of bleeding (n = 6), drug malcompliance due to forgetfulness (n = 4) and psychiatric disease (n = 1). Underuse of anticoagulation occurred only in three patients (4%, unclear reasons in two patients, patient's unwillingness in one patient).


CONCLUSIONS
We did not observe substantial underuse of anticoagulation in patients with atrial fibrillation.
Gubler
D
D
Medizinische Notfallstation und Medizinische Universitätspoliklinik, Departement Innere Medizin, Kantonsspital Basel.
Martina
B
B
Arpagaus
M
M
Dieterle
Th
T
D000368:Aged; D000553:Ambulatory Care; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D000075202:Contraindications; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology / Q000517:prevention & control; D008297:Male; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013557:Switzerland
D000925:Anticoagulants