title: The changing characteristics of atrial fibrillation patients treated with warfarin.
abstract: It has been suggested that direct oral anticoagulants are being preferentially used in low risk atrial fibrillation (AF) patients. Understanding the changing risk profile of new AF patients treated with warfarin is important for interpreting the quality of warfarin delivery through an anticoagulation clinic. Six anticoagulation clinics participating in the Michigan Anticoagulation Quality Improvement Initiative enrolled 1293 AF patients between 2010 and 2014 as an inception cohort. Abstracted data included demographics, comorbidities, medication use and all INR values. Risk scores including CHADS2, CHA2DS2-VASc, HAS-BLED, SAMe-TT2R2, and Charlson comorbidity index (CCI) were calculated for each patient at the time of warfarin initiation. The quality of anticoagulation was assessed using the Rosendaal time in the therapeutic range (TTR) during the first 6 months of treatment. Between 2010 and 2014, patients initiating warfarin therapy for AF had an increasing mean CHADS2 (2.0 ± 1.1 to 2.2 ± 1.4, p = 0.02) and CCI (4.7 ± 1.8 to 5.1 ± 2.0, p = 0.03), and a trend towards increasing mean CHA2DS2-VASc, HAS-BLED, and SAMe-TT2R2 scores. The actual TTR remained unchanged over the study period (62.6 ± 18.2 to 62.7 ± 17.0, p = 0.98), and the number of INR checks did not change (18.9 ± 5.2 to 18.5 ± 5.1, p = 0.06). Between 2010 and 2014, AF patients newly starting warfarin had mild increases in risk for stroke and death with sustained quality of warfarin therapy.
authors.affiliation: University of Michigan Cardiovascular Center, 24 Frank Lloyd Wright Dr., Lobby A Rm 3201, Ann Arbor, MI, 48106, USA. putnama@med.umich.edu.
authors.forename: Andrew
authors.initials: A
authors.lastname: Putnam
authors.affiliation: University of Michigan Cardiovascular Center, 24 Frank Lloyd Wright Dr., Lobby A Rm 3201, Ann Arbor, MI, 48106, USA.
authors.forename: Xiaokui
authors.initials: X
authors.lastname: Gu
authors.affiliation: University of Michigan Cardiovascular Center, 24 Frank Lloyd Wright Dr., Lobby A Rm 3201, Ann Arbor, MI, 48106, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Haymart
authors.affiliation: University of Michigan Cardiovascular Center, 24 Frank Lloyd Wright Dr., Lobby A Rm 3201, Ann Arbor, MI, 48106, USA.
authors.forename: Eva
authors.initials: E
authors.lastname: Kline-Rogers
authors.affiliation: William Beaumont Hospital, 4600 Investment Dr., Suite 200, Troy, MI, 48098, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Almany
authors.affiliation: Huron Valley Sinai Hospital, 1 William Carls Dr., Commerce, MI, 48382, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Kozlowski
authors.affiliation: Henry Ford Health System, 2799 W. Grand Blvd., Detroit, MI, 48202, USA.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Krol
authors.affiliation: Hurley Medical Center, 1 Hurley Plaza, Flint, MI, 48503, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Kaatz
authors.affiliation: University of Michigan Cardiovascular Center, 24 Frank Lloyd Wright Dr., Lobby A Rm 3201, Ann Arbor, MI, 48106, USA.
authors.forename: James B
authors.initials: JB
authors.lastname: Froehlich
authors.affiliation: University of Michigan Cardiovascular Center, 24 Frank Lloyd Wright Dr., Lobby A Rm 3201, Ann Arbor, MI, 48106, USA.
authors.forename: Geoffrey D
authors.initials: GD
authors.lastname: Barnes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000139:chemically induced / Q000453:epidemiology; D013997:Time Factors; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D014859:Warfarin
keywords: Anticoagulation; Atrial fibrillation; Warfarin