title: Stroke prevention in atrial fibrillation: are we following the guidelines?
abstract: BACKGROUND
  Warfarin therapy substantially reduces stroke in atrial fibrillation (AF), yet medical literature reports it is only prescribed in 15-60% of eligible patients. No current national benchmarks for warfarin use in AF patients exist, and it is unclear whether the reported poor compliance represents current rates within primary care practices. The primary study objective was to measure the rate of warfarin use in eligible, high-risk AF patients in a large southeastern group family practice. Secondary objectives were to report the demographics, stroke-risk profiles, contraindications, and reasons for discontinuation of warfarin therapy
  
  
  METHODS
  A retrospective chart review was performed on all active patients with documented AF in a large southeastern group family practice/residency between July 1, 2000 and June 30, 2002. Data was abstracted on warfarin use, contraindications, stroke risk, and reasons for discontinuation.
  
  
  RESULTS
  Four hundred ninety-one (491) patients were identified from the electronic billing system as potential study subjects. Two hundred eighty-three (283) patients met study criteria, with 210 patients considered to be at high-risk of stroke without contraindications to warfarin therapy. Ninety-four percent (198/210) of these patients were prescribed warfarin during the study period, and 87% (172/198) continued warfarin throughout the study period.
  
  
  CONCLUSIONS
  Family physicians in this practice prescribe warfarin in AF more frequently than published rates demonstrating that high rates of physician adherence to standards are achievable in primary care. Most patients in this setting were considered high-risk for stroke.
authors.affiliation: Cabarrus Family Medicine Residency Program at NorthEast Medical Center, Concord, NC 28025, USA.
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Pusser
authors.forename: Sandy L
authors.initials: SL
authors.lastname: Robertson
authors.forename: Mark D
authors.initials: MD
authors.lastname: Robinson
authors.forename: Cole
authors.initials: C
authors.lastname: Barton
authors.forename: L Allen
authors.initials: LA
authors.lastname: Dobson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D000075202:Contraindications; D005194:Family Practice / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D020521:Stroke / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin