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Patients with atrial fibrillation undertreated for stroke risk

A new study suggests new guidelines for determining a patient’s risk of having a stroke or dying after being newly diagnosed with atrial fibrillation, a common heart rhythm problem affecting more than two million Americans. And according to University Hospitals of Cleveland’s Albert L. Waldo, MD, the new scoring system should help doctors identify patients who are currently not being treated with medication and, therefore, at high risk of stroke and death.

From University Hospitals of Cleveland :

Patients with atrial fibrillation undertreated for stroke risk

(CLEVELAND): A study published in this week’s Journal of the American Medical Association (JAMA) suggests new guidelines for determining a patient’s risk of having a stroke or dying after being newly diagnosed with atrial fibrillation, a common heart rhythm problem affecting more than two million Americans. And according to University Hospitals of Cleveland’s Albert L. Waldo, MD, the new scoring system should help doctors identify patients who are currently not being treated with medication and, therefore, at high risk of stroke and death.

Dr. Waldo, writing in an editorial in the August 27th issue of JAMA, comments that less than half of patients who would be good candidates for treatment with blood thinners to reduce their risk of stroke are actually receiving the drugs. Elderly patients are least likely to be treated, says Waldo, who is also a professor of medicine at Case Western Reserve University School of Medicine.

“In short, not enough patients with atrial fibrillation at recognized risk for ischemic stroke receive warfarin (Coumadin) therapy, and patients with the greatest risk of ischemic stroke in the face of atrial fibrillation are the ones who receive it least.” The JAMA article suggesting a new way to “score” a patient’s risk was written by Thomas J. Wang, MD, and colleagues of the Framingham Heart Study in Framingham, Mass. They developed a scoring system involving the following risk predictors: advancing age, female, increasing systolic blood pressure, prior stroke or transient ischemic attack, and diabetes. The scores can be used to “easily stratify patients at particularly high or low risk,” for stroke or death, according to Dr. Wang. Once risk is properly assessed, patients can be provided appropriate counseling and/or treatment.

Patients who have been diagnosed with atrial fibrillation have a four-fold to five-fold increase in their risk of ischemic stroke (interruption of blood flow to the brain due to a clot). Warfarin or Coumadin therapy can reduce that risk by approximately 70 to 80 percent. Studies indicate that warfarin or Coumadin is much more effective than aspirin in preventing ischemic stroke.

Dr. Waldo notes that many physicians are wary of using warfarin, especially among elderly patients, because of the risk of bleeding due to falls or frailty. However, “the risk of stroke in the absence of warfarin therapy is greater than the risk of intracranial bleeding while receiving warfarin,” says Waldo. Careful attention to monitoring and maintaining appropriate blood clotting factors maximizes the benefit and minimizes the risk.

University Hospitals of Cleveland and University Hospitals Health System offers a Coumadin Clinic to more than 700 patients who are regularly monitored for treatment of various disorders, including atrial fibrillation. Roche Diagnostics recently recognized the UHC Coumadin Clinic for excellence in establishing a systematic and effective approach toward managing anti-coagulation therapy.




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