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Women with AF less likely to receive oral anticoagulant therapy than men
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A comparison of current treatment vs. recommended treatment for atrial fibrillation revealed that women were 1.8 times as likely to be undertreated with oral anticoagulant therapy for stroke prevention than men, according to a report in the Journal of the American Geriatrics Society.
“The irony is that women have a higher risk of AF-related stroke, controlling for other risk factors such as hypertension, diabetes [and] congestive [HF], yet women are being undertreated,” Mark Eckman, MD, MS, Posey Professor of Clinical Medicine and director of the division of general internal medicine at the University of Cincinnati, said in a press release.
Mark Eckman
Eckman and colleagues conducted a retrospective study of 1,585 adults (46% women) with nonvalvular AF or atrial flutter who were seen at ambulatory primary care practices in a Cincinnati-area academic health care system from March 2013 to February 2014. The mean CHA2DS2-VASc score was 3.7.
The researchers compared current antithrombotic therapy with recommended therapy based on the AF decision support tool, which calculated a patient’s risk for AF-related stroke and major bleeding if taking oral anticoagulant therapy.
According to the results, 50% of the patients were receiving some form of oral anticoagulant therapy, with warfarin the most common. The decision support tool recommended blood thinner therapy for 1,374 patients (87%), aspirin for 65 patients (4%) and no antithrombotic therapy for 146 patients (9%).
Discordance in treatment
Current treatment matched recommended treatment in 58% of the patients. Of the 42% in which there was a discordance, 37% were receiving no antithrombotic therapy or only aspirin when the decision support tool recommended oral anticoagulant therapy, 2% of the patients were not on any therapy when aspirin was recommended, and 3% were receiving aspirin or oral anticoagulant therapy when the tool advised against antithrombotic medications.
Data revealed a trend toward women having lower levels of oral anticoagulant therapy than men (48% vs. 52%; P = .06). In addition, there was more discordance between current and recommended treatment in women than in men (45% vs. 39%; P = .02), and 44% of women were undertreated compared with 31% of men (P < .001).
Guideline not followed
An analysis comparing current treatment to the most recent American Heart Association/American College of Cardiology/Heart Rhythm Society guideline-based therapy showed that 51% of women and 37% of men had treatment that did not match the guideline (P < .001).
“Doctors need to realize we have mental biases that women are healthier and at lower risk of stroke,” Eckman said in the release. “It’s the same story for [CAD] and risk of [MI]. We think women are at lower risk and we ignore warning signs. Thus, when we are making decisions for blood-thinning therapy for patients with [AF], we need to remember that women are at higher risk and we need to make sure we treat them aggressively enough to prevent stroke.” – by Tracey Romero
Disclosure: The study received funding from Bristol-Myers Squibb/Pfizer Education Consortium, Informed Medical Decisions Foundation and Pfizer Medical Education Group. Eckman reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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