title: Inappropriate use of oral anticoagulants for patients with atrial fibrillation.
abstract: BACKGROUND
  Atrial fibrillation (AF) is a common arrhythmic disorder among the elderly, and increases the risk of stroke. Oral anticoagulants (OAC) are highly effective in preventing stroke, and there are evidence-based guidelines for the optimal use of OAC in patients with AF. METHODS AND RESULTS: The Fushimi AF Registry is a community-based prospective survey of the AF patients in Fushimi-ku, Kyoto, a typical urban community in Japan with a total population of 283,000. Of the 3,282 patients enrolled by October 2012, 1-year follow-up was completed for 2,914 patients. OAC, mainly warfarin, were given to 1,546 patients (53.1%); overused for low-risk patients, and underused for patients at risk, based on the guidelines. Moreover, warfarin was sometimes given at a sub-therapeutic dose; only 54.4% of patients were within the optimal therapeutic range. The 1-year outcomes revealed that the incidences of both stroke and major bleeding were equivalent between patients taking OAC and those without; major clinical events were as follows: (OAC vs. non-OAC) stroke 2.7% vs. 2.8%, ischemic stroke 2.1% vs. 2.0% and major bleeding 1.4% vs. 1.5% (NS for all).
  
  
  CONCLUSIONS
  The Fushimi AF Registry provides a unique snapshot of current AF management in an urban community in Japan. The present study reveals inappropriate use of OAC for patients with AF, indicating discordance between guideline recommendations and real-world clinical practice.
authors: Department of Cardiology, National Hospital Organization Kyoto Medical Center.
authors: Masaharu
authors: M
authors: Akao
authors: Yeong-Hwa
authors: YH
authors: Chun
authors: Masahiro
authors: M
authors: Esato
authors: Mitsuru
authors: M
authors: Abe
authors: Hikari
authors: H
authors: Tsuji
authors: Hiromichi
authors: H
authors: Wada
authors: Koji
authors: K
authors: Hasegawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000453:epidemiology; D002545:Brain Ischemia / Q000139:chemically induced / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D057970:Inappropriate Prescribing; D007564:Japan / Q000453:epidemiology; D008297:Male; D012042:Registries; D020521:Stroke / Q000139:chemically induced / Q000453:epidemiology
chemical_list: D000925:Anticoagulants