Prevalence of atrial fibrillation and warfarin use in older patients receiving hemodialysis
Journal of Nephrology, 05/16/2012
Winkelmayer WC et al. – While the prevalence of atrial fibrillation has been increasing among older hemodialysis patients, warfarin use was low and unchanged over time, perhaps reflecting the lack of evidence supporting its use.Methods
- The authors linked US Medicare and prescription claims from older patients undergoing HD in 2 Eastern US states.
- They established annual cohorts of prevalent HD patients; AF was ascertained from >2 claims (>7 days apart) in the same year, with a diagnosis code indicating AF.
- Among those with AF, the authors defined current and past warfarin use.
- Demographic and clinical characteristics were also ascertained for each cohort.
- The authors used repeated-measures logistic regression to define the odds of AF and of current or past versus absence of warfarin use.
- Of 6,563 unique patients, 2,185 were determined to have AF.
- The prevalence of AF increased from 26% in 1998 to 32% in 2005.
- In 2005, current warfarin use was present in 24% of AF patients and past use in 25%; 51% had no evidence of any warfarin use.
- No significant trends in utilization were observed from 1998 through 2005.
- Patients aged =85 years and nonwhites were less likely to have received warfarin; most comorbidities were not associated with warfarin use except for patients with past pulmonary embolism or deep venous thrombosis who were more likely than those without such history.