Improving Thromboprophylaxis in Elderly Patients with Non-Valvular Atrial Fibrillation

Abstract

Background: Non-valvular atrial fibrillation (NVAF) is more common in elderly people, and is one of the most powerful independent risk factors predisposing to stroke. This risk increases with age. Despite evidence that full dose anticoagulation reduces this risk, and Scottish Intercollegiate Guidelines, warfarin is still being under prescribed, especially in elderly individuals. Objectives: To audit warfarin prescribing in elderly hospital patients with NVAF, and assess whether audit feedback and evidence based guidelines improved warfarin usage. Methods: Discharge summaries and medical notes were reviewed, and warfarin prescribing identified, for all patients with NVAF discharged from the Medicine for the Elderly Department between January 2001 and December 2002. This was done before (16 months) and after (7 months) audit results were presented at a departmental meeting, and evidence based guidelines were produced. Results: Warfarin prescribing significantly increased from 38/121 (31.4%) prior to audit feedback and the introduction of guidelines to 30/55 (54.5%), Chi²—test, p<0.01 Conclusions: Older patients with NVAF were under prescribed warfarin. Audit feedback and the introduction of evidence based guidelines significantly increased anticoagulation usage.