Prevalence of atrial fibrillation and warfarin use in older patients receiving hemodialysis

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.

Results

• 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.

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