About a quarter of all atrial fibrillation (AF) patients at the lowest risk for stroke receive unnecessary blood thinners from cardiology specialists, according to UCSF researchers, and these providers must be made aware of the resulting potential health risks.
Their research letter appears online and will be in the June 1 issue of JAMA Internal Medicine.
"The irony is that there is a general push to get providers to prescribe these drugs, and they are also generally under-prescribed among many AF patients who actually need them," said senior author Gregory Marcus, MD, MAS, director of clinical research in the UCSF Division of Cardiology. "Our study suggests people are trying to do the right thing but, due to a lack of understanding of some of the critical nuances, go too far in that direction in low-risk patients."
In AF, electrical impulses are triggered from many areas in and around the upper chambers (atria) of the heart instead of just one area. This activity is chaotic, and the atrial walls quiver rather than contract normally in moving blood to the lower chambers (ventricles).
For atrial fibrillation patients at risk for thromboembolism, anticoagulation therapies with warfarin or other drugs reduce morbidity and mortality. But because their use carries a bleeding risk, they are not recommended for AF patients at a particularly low risk for stroke.
In fact, current guidelines do not recommend oral anticoagulation in patients under age 60 without heart disease or other known risk factors for thromboembolism or in AF patients without any established risk factor for stroke. The previous guidelines, which were in place at the time the data for this study were collected, had, in fact, a very strong recommendation specifically to avoid anticoagulants in that population.
Marcus and his colleagues examined the prevalence of non-guideline adhering oral anticoagulant prescription in young and healthy patients at the lowest risk for thromboembolism by reviewing nearly 11,000 patients nationwide age 60 and under from the overall Practice Innovation and Clinical Excellence (PINNACLE) Registry of the National Cardiovascular Data Registry between 2008-2012. The PINNACLE Registry was created in 2008 by the American College of Cardiology as the first national, prospective, office-based cardiac quality improvement registry in the United States and enrolled more than 1.7 million patients.
Surprisingly, about 25 percent of patients (2,561) were prescribed oral anticoagulant therapy contrary to contemporary guideline recommendations. Further, the researchers found males with AF at the lowest risk of stroke were more likely to be prescribed oral anticoagulation than females, as were older patients and overweight patients without stroke risk factors.
As a result, providers may not be fully aware of the potential risks of these drugs or the particularly low risk of stroke in certain populations.
"Practitioners who prescribe blood thinners need to be diligent about weighing the risks and benefits of these medications," said lead author Jonathan C. Hsu, MD, MAS, of the UC San Diego Division of Cardiology and recent UCSF cardiology and electrophysiology graduate. "In those patients with no risk factors for stroke, the risk of bleeding likely outweighs the benefit of stroke reduction. The fact that blood thinners were prescribed to so many patients with no risk factors for stroke is a wake up call that we need to do better for our patients."
Go here to see the original:
Some atrial fibrillation patients receive unnecessary blood thinners
- US Interventional Cardiology Market to Decline by $500 Million Through 2017 [Last Updated On: January 8th, 2013] [Originally Added On: January 8th, 2013]
- Pediatric Cardiology by Shutikarn Wanichpoonphol, MD, Child Health Center at BHP - Video [Last Updated On: February 5th, 2013] [Originally Added On: February 5th, 2013]
- Listen to Fetal Heart Sounds- Cardiology - Video [Last Updated On: February 22nd, 2013] [Originally Added On: February 22nd, 2013]
- New physicians' office building opens next to Hoke hospital [Last Updated On: January 3rd, 2014] [Originally Added On: January 3rd, 2014]
- International Academy of Cardiology: Arthur L. Klatsky, M.D.: THE HIGH CORONARY DISEASE RISK OF - Video [Last Updated On: January 4th, 2014] [Originally Added On: January 4th, 2014]
- International Academy of Cardiology: Joel A. Garcia, M.D.: OPTICAL COHERENCE TOMOGRAPHY (OCT): WHAT - Video [Last Updated On: January 5th, 2014] [Originally Added On: January 5th, 2014]
- EMS 241- Paramedic Cardiology AP - Video [Last Updated On: January 14th, 2014] [Originally Added On: January 14th, 2014]
- Evidence rapidly building on utility of ultrasound in areas other than cardiology [Last Updated On: January 24th, 2014] [Originally Added On: January 24th, 2014]
- QScience's Cardiology Journal Indexed in PubMed Central Database [Last Updated On: April 10th, 2014] [Originally Added On: April 10th, 2014]
- QScience's Cardiology Journal Indexed in PubMed Central Database / 1 [Last Updated On: April 10th, 2014] [Originally Added On: April 10th, 2014]
- $18M from Medicare: local cardiologist makes list [Last Updated On: April 10th, 2014] [Originally Added On: April 10th, 2014]
- New Cardiology Clinic Set to Open [Last Updated On: April 10th, 2014] [Originally Added On: April 10th, 2014]
- American College of Cardiology [Last Updated On: April 10th, 2014] [Originally Added On: April 10th, 2014]
- Cardiology Articles (Diagnosis, Treatment, Prognosis ... [Last Updated On: April 10th, 2014] [Originally Added On: April 10th, 2014]
- Cardiology - Wikipedia, the free encyclopedia [Last Updated On: April 10th, 2014] [Originally Added On: April 10th, 2014]
- Port - Pre-operative Evaluation: When to Order a Stress Test and When to Consult Cardiology - Video [Last Updated On: April 10th, 2014] [Originally Added On: April 10th, 2014]
- Cardiology Medical Animation Deployment of Mitra - Video [Last Updated On: April 10th, 2014] [Originally Added On: April 10th, 2014]
- Daniele Gottardo Cardiology cover by nugie - Video [Last Updated On: April 10th, 2014] [Originally Added On: April 10th, 2014]
- PrognoCIS EMR - Cardiology - Video [Last Updated On: April 10th, 2014] [Originally Added On: April 10th, 2014]
- Cardiology Testimonial-Joy 2 Min-3.mpeg - Video [Last Updated On: April 10th, 2014] [Originally Added On: April 10th, 2014]
- Cardiology Part 1 - Video [Last Updated On: April 15th, 2014] [Originally Added On: April 15th, 2014]
- Cardiology 2014 Opening Ceremony - Video [Last Updated On: April 15th, 2014] [Originally Added On: April 15th, 2014]
- Cardiology 2014 Relavent conference - Video [Last Updated On: April 15th, 2014] [Originally Added On: April 15th, 2014]
- Pediatric Interventional Cardiology Market (by Congenital Heart Defect Closure Device, Procedures) worth $1,379.1 ... [Last Updated On: April 15th, 2014] [Originally Added On: April 15th, 2014]
- A global view on the prevention of cardiovascular disease [Last Updated On: April 15th, 2014] [Originally Added On: April 15th, 2014]
- Stenberg College Cardio Tech Grad Interview - Video [Last Updated On: April 15th, 2014] [Originally Added On: April 15th, 2014]
- Montefiore Selected for American College of Cardiology Patient Navigator Program [Last Updated On: April 16th, 2014] [Originally Added On: April 16th, 2014]
- Medicine Board Review: Cardiology 1 CARDIAC STRESS TESTING - Video [Last Updated On: April 16th, 2014] [Originally Added On: April 16th, 2014]
- Doctor Will Pay $1 Million for False Claims [Last Updated On: April 17th, 2014] [Originally Added On: April 17th, 2014]
- Sports and Exercise Cardiology: Boom Times for CV Specialists and Athletes - Video [Last Updated On: April 17th, 2014] [Originally Added On: April 17th, 2014]
- Board Review Cardiology-3 Pulmonary artery catheterization, Indications, Interpretation, Examples - Video [Last Updated On: April 17th, 2014] [Originally Added On: April 17th, 2014]
- Board Review Cardiology-2 CARDIAC CATHETERIZATION AND SCANS, Indications, Types - Video [Last Updated On: April 17th, 2014] [Originally Added On: April 17th, 2014]
- Doctor Will Pay $1M for False Claims [Last Updated On: April 18th, 2014] [Originally Added On: April 18th, 2014]
- Your Doctor apr 13 Part 1(Interventional Cardiology) - Video [Last Updated On: April 18th, 2014] [Originally Added On: April 18th, 2014]
- Board Review Cardiology-5 HEART MURMURS: Overview- Valsalva, Standing, HandGrip etc - Video [Last Updated On: April 19th, 2014] [Originally Added On: April 19th, 2014]
- Cardiology News & Opinion theheart.org and Medscape [Last Updated On: April 22nd, 2014] [Originally Added On: April 22nd, 2014]
- MTI MA Springfield Clinic Cardiology - Video [Last Updated On: April 22nd, 2014] [Originally Added On: April 22nd, 2014]
- 1st Annual International Conference : Cardiology & Cardiovascular Medicine Research 2013 - Video [Last Updated On: April 22nd, 2014] [Originally Added On: April 22nd, 2014]
- How to tell if the palpitations you are getting are serious or not - Video [Last Updated On: April 22nd, 2014] [Originally Added On: April 22nd, 2014]
- Polycom video conferencing enables improved cardiology care at Evelina Childrens Hospital [Last Updated On: April 25th, 2014] [Originally Added On: April 25th, 2014]
- Centegra - Cardiology - Video [Last Updated On: April 25th, 2014] [Originally Added On: April 25th, 2014]
- John Muir hospital opens new nuclear medicine and non-invasive-cardiology department [Last Updated On: April 25th, 2014] [Originally Added On: April 25th, 2014]
- Preventive Cardiology Hangout - Apr 25, 8AM PST - Video [Last Updated On: April 25th, 2014] [Originally Added On: April 25th, 2014]
- Cardiology Review 4.23.14 - Video [Last Updated On: April 27th, 2014] [Originally Added On: April 27th, 2014]
- Medicine Board Review Cardiology 5 2 MITRAL STENOSIS Location, Sound, Physiology - Video [Last Updated On: April 27th, 2014] [Originally Added On: April 27th, 2014]
- World Congress of Cardiology 2014 to put spotlight on salt and heart disease deaths [Last Updated On: April 28th, 2014] [Originally Added On: April 28th, 2014]
- PREVENTIVE CARDIOLOGY HANGOUT SERIES - Video [Last Updated On: April 28th, 2014] [Originally Added On: April 28th, 2014]
- Medicine Board Review Cardiology 5 1 AORTIC STENOSIS Location, Sound, Physiology - Video [Last Updated On: April 28th, 2014] [Originally Added On: April 28th, 2014]
- Boston Medical Center cardiologist Gary Balady, M.D., receives AHA's Paul Dudley White Award [Last Updated On: April 29th, 2014] [Originally Added On: April 29th, 2014]
- Medicine Board Review Cardiology 7 Chronic Stable Angina Evaluation and Treatment - Video [Last Updated On: April 29th, 2014] [Originally Added On: April 29th, 2014]
- Mednick Associates Announces New Medical Experts in OBGYN and Cardiology [Last Updated On: April 30th, 2014] [Originally Added On: April 30th, 2014]
- Cardiology discussion - Video [Last Updated On: May 2nd, 2014] [Originally Added On: May 2nd, 2014]
- Mount Sinai launches Sports Cardiology Program [Last Updated On: May 3rd, 2014] [Originally Added On: May 3rd, 2014]
- ASNC2014 "19th Annual Scientific Session" to be Held in Boston [Last Updated On: May 3rd, 2014] [Originally Added On: May 3rd, 2014]
- The Arizona Health Connection Live: Dr. Daniel Einhorn From East Valley Cardiology - Video [Last Updated On: May 3rd, 2014] [Originally Added On: May 3rd, 2014]
- Interventional Cardiology & Social Media: Twitter Best Practices - Video [Last Updated On: May 3rd, 2014] [Originally Added On: May 3rd, 2014]
- The Arizona Health Connection Live: Dr. James Ganem from East Valley Cardiology - Video [Last Updated On: May 4th, 2014] [Originally Added On: May 4th, 2014]
- 'Lifestyle change increases cardiology cases Expert'- Dr Yusuf kumble - Video [Last Updated On: May 4th, 2014] [Originally Added On: May 4th, 2014]
- Minister to address international cardiology conference [Last Updated On: May 5th, 2014] [Originally Added On: May 5th, 2014]
- Recognizing Cardiology-Specific Challenges - Video [Last Updated On: May 6th, 2014] [Originally Added On: May 6th, 2014]
- Brian Bailey, MD - Cardiology - Video [Last Updated On: May 6th, 2014] [Originally Added On: May 6th, 2014]
- Interventional Cardiology & Social Media: How to Set Up a Twitter Account - Video [Last Updated On: May 6th, 2014] [Originally Added On: May 6th, 2014]
- New tools to help prevent the burden of rheumatic heart disease amongst children [Last Updated On: May 8th, 2014] [Originally Added On: May 8th, 2014]
- Interventional Cardiology Devices Market by Product (Catheters, PTCA Guidewires, Stents, Balloon Inflation Devices ... [Last Updated On: May 8th, 2014] [Originally Added On: May 8th, 2014]
- Deaths follow transfer delays [Last Updated On: May 8th, 2014] [Originally Added On: May 8th, 2014]
- Mount Sinai Beth Israel Appoints New Heart Leadership Team for Cardiology and Cardiothoracic Surgery [Last Updated On: May 9th, 2014] [Originally Added On: May 9th, 2014]
- Session 2: Hearty performance in cardiology unit - CMES 2014 - Video [Last Updated On: May 9th, 2014] [Originally Added On: May 9th, 2014]
- Amy Booth, Nurse Practitioner, Cardiology - Video [Last Updated On: May 9th, 2014] [Originally Added On: May 9th, 2014]
- Paris Cardiology Outreach Clinic - Video [Last Updated On: May 9th, 2014] [Originally Added On: May 9th, 2014]
- Interventional Cardiology & Social Media: Why Social Media? - Video [Last Updated On: May 9th, 2014] [Originally Added On: May 9th, 2014]
- Interventional Cardiology & Social Media: Why Tweet? - Video [Last Updated On: May 10th, 2014] [Originally Added On: May 10th, 2014]
- day1 ksnmmi 2013 - 02 PET MR in cardiology - Video [Last Updated On: May 10th, 2014] [Originally Added On: May 10th, 2014]
- Interventional Cardiology & Social Media: How to Develop a Following on Twitter - Video [Last Updated On: May 11th, 2014] [Originally Added On: May 11th, 2014]
- Ramesh Gudapati Head Cardiology Department Star Hospitals - Video [Last Updated On: May 12th, 2014] [Originally Added On: May 12th, 2014]
- Humboldt Medical Specialists to expand cardiology services [Last Updated On: May 14th, 2014] [Originally Added On: May 14th, 2014]
- Acute cardiology referral practice. - Video [Last Updated On: May 14th, 2014] [Originally Added On: May 14th, 2014]
- New Diagnostic Modalities in Cardiology - Video [Last Updated On: May 14th, 2014] [Originally Added On: May 14th, 2014]
- Research Shows Hope for Normal Heart Function in Children with Fatal Heart Disease [Last Updated On: May 14th, 2014] [Originally Added On: May 14th, 2014]
- Societies publish recommendations to guide minimally invasive valve therapy programs for patients [Last Updated On: May 14th, 2014] [Originally Added On: May 14th, 2014]
- CARDIOLOGY MASTER CLASS x264 - Video [Last Updated On: May 16th, 2014] [Originally Added On: May 16th, 2014]