Current treatment of atrial fibrillation in the United States and the potential for reduction in stroke

The Stroke Prevention PORT is 1 of several PORTs funded by the AHCPR to study practices and outcomes in specific medical conditions, and suggest ways to improve our treatment of these conditions. Key personnel of the Stroke Prevention PORT whose base is at Duke University, Center for Health Policy Research and Education, include Jack Whisnant, MD, Gordon DeFriese, PhD, Greg Samsa, PhD, Marak Ancukewicz, PhD, David Ballard, MD, PhD, Art Bonito, PhD, Joe Lipscomb, PhD, Janet Mitchell, PhD, and David Witter, MA. This paper describes the impact of stroke on the country and on individuals, and details responses from a large survey of those at risk for stroke showing how much patients fear stroke. AF is a very important risk factor for stroke, with about 1 in 5 strokes or 80,000 strokes per year in the U.S. attributable to AE. The impact of warfarin on stroke in AF is summarized. Chart review in 1,000+ outpatients found lack of warfarin treatment similar to rates in other inpatient surveys; overall about half of patients with AF were anticoagulated, with higher rates of anticoagulation in areas with access to coordinated ACS. In addition, only one-third to one-half of patients had INR within the recommended range. The U.S. Physician Survey for Stroke Prevention suggests that the problem is not lack of knowledge about warfarin, or unavailability of prothrombin testing, but is rather a system problem. The Stroke Prevention PORT MAST Study is described, a study randomizing clusters of outpatient practices so that some are provided access to a coordinated ACS. Rough calculations of the potential benefits and risks of ACS are given; it is estimated that 40,000 strokes could be prevented and half a billion dollars saved annually in the U.S. if optimal therapy were given for AF.

Duke Scholars

Author David Bruce Matchar Medicine, General Internal Medicine