title: Characterization of patients with atrial fibrillation not treated with oral anticoagulants.
abstract: OBJECTIVE
  An underuse of oral anticoagulants (OAC) in patients with atrial fibrillation (AF) has been suggested, as only 50% of all patients with AF receive OAC treatment. Whether this is due to contraindications, lack of an indication to treat, or an expression of underuse is sparsely investigated. This study therefore aimed to characterize individuals without OAC treatment in a real-life population of patients with AF.
  
  
  METHODS
  Retrospective cross-sectional study. The medical records were scrutinized in order to identify the type of AF, risk factors for embolism and bleeding, and other factors of importance for OAC treatment.
  
  
  METHODS
  The municipalities of Skellefteå and Norsjö, northern Sweden.
  
  
  METHODS
  A total of 2274 living residents with at least one verified episode of AF on or before December 31, 2010.
  
  
  METHODS
  Prevalence of treatment with OAC and documented reasons to withhold OAC treatment.
  
  
  RESULTS
  Among all 2274 patients with AF, 1187 (52%) were not treated with OAC. Of the untreated patients, 19% had no indication or had declined or had experienced adverse effects other than bleeding on warfarin treatment. The most common reason to withhold OAC was presence of risk factors for bleeding, found in 38% of all untreated patients. Furthermore, a documented reason could be identified to withhold OAC in 75%.
  
  
  CONCLUSIONS
  Among patients with AF without OAC treatment a reason could be identified to withhold OAC in 75%. The underuse of OAC is estimated to be 25%.
authors.affiliation: Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University , Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Johansson
authors.forename: Lovisa
authors.initials: L
authors.lastname: Hägg
authors.forename: Lars
authors.initials: L
authors.lastname: Johansson
authors.forename: Jan-Håkan
authors.initials: JH
authors.lastname: Jansson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000925:Anticoagulants
keywords: Atrial fibrillation; Sweden; anticoagulation; epidemiology; general practice; risk factors; thromboembolic risk; thromboembolism