Administrative Memos

199909

FROM: Theodore O. Will, Chief Executive Officer
DATE: Jul 24, 1999
SUBJECT: Antithrombotic Therapy in Hospitalized New York State Medicare Patients with Atrial Fibrillation
IPRO CONTACTS:

Marguerite Shaffer, R.N., Director Downstate, Improvement Strategies QI - Ext. 356
Barbara Shields, R.N., C.P.H.Q., Upstate Director, Improvement Strategies/QI (1-800-233-0360)

Enclosed please find the report entitled "Antithrombotic Therapy in Hospitalized New York State Medicare Patients with Atrial Fibrillation: Point Prevalence Trends for 1993, 1996, 1998." This report shows improving trends in the use of drugs to prevent cardioembolic stroke.

The report demonstrates an increase in the use of antithrombotic agents since the IPRO effort started in 1994. Nevertheless, there still exist opportunities for improvement in the use of warfarin, particularly in the elderly. Of note, is the increasing use of both aspirin and warfarin in patients with atrial fibrillation and concomitant coronary artery disease. IPRO will continue its effort to improve New York State antithrombotic practices as part of a three-year HCQIP national project on stroke prevention (1999-2001).

Should you have any questions about this project or report, please feel free to call one of the above-mentioned contacts.

EXECUTIVE SUMMARY

Atrial fibrillation (AF) is among the most common forms of cardiac arrhythmia in the elderly. Individuals with atrial fibrillation are at a much higher risk of having strokes and the risk of stroke in AF patients also increases with increasing age. Multiple clinical trials have shown that the use of anticoagulants such as warfarin or, to much lesser degree, the antiplatelet agent aspirin, significantly reduces the likelihood of embolic stroke. This report is a description of trends based upon a three analyses of warfarin and aspirin use in hospitalized Medicare patients discharged in 1993, 1996 and 1998 with either a primary or secondary diagnosis of atrial fibrillation.

All data were collected by retrospective chart review. Reviewers utilized a standardized data abstraction instrument and passed both gold standard and inter-rater reliability assessments prior to general data collection. Patients were considered eligible for antithrombotic therapy if they did not have any of 16 exclusions such as a blood dyscrasia or history of a hemorrhagic stroke.

The proportion of patients on warfarin (either with or without aspirin) increased from 49% in 1993 to 68% in 1998. A proportionately greater increase occurred in patients who were greater than or equal to 75 years of age (43% in 1993 to 64% in 1998).

The IPRO HCQIP project on antithrombotic therapy for atrial fibrillation has been associated with a significant increase in warfarin and aspirin use. Despite improvements, there are still patients receiving suboptimal therapy. IPRO will continue its effort to improve antithrombotic practices as part of a three year HCQIP national project on stroke prevention (1999-2001).