Overuse of Anticoagulation in Treatment of Atrial Fibrillation Patients in University Hospitals of Tehran

Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice. Patients with AF have increased rates of mortality and are strongly at greater risk of stroke (1). Despite strong recommendation of anticoagulant therapies in AF patients, real world data demonstrates low adherence of physicians to prescribe anticoagulant medications for AF patients (2, 3). A study was designed to compare the practice of anticoagulant therapies in AF patients in two major university hospitals affiliated with Tehran University of Medical Sciences (TUMS) in Tehran with available guidelines. Emergency department visits in two affiliated hospitals of TUMS were screened for patients with AF arrhythmia on ECG studies. Patients were informed about the study and signed an informed consent. The patient selection was based on a non-random case finding from September 2012 to September 2013. The risk assessment was done according to Congestive heart failure, Hy-pertension, Age≥75 years, Diabetes, prior Stroke (CHADS 2) score system (4). The patients were allocated to low risk (CHADS 2 = 0), intermediate risk (CHADS 2 = 1 or 2) or high risk (CHADS 2 >2) groups. The guideline treatment was defined as no anticoagulants or antiplatelet therapy (CHADS 2 = 0), receiving low dose aspirin or anticoagulation (CHADS 2 = 1 or 2) and anticoagulation therapy with a vitamin K antagonist (warfarin) or an-tiplatelet therapy with low dose (80mg) aspirin in case of warfarin contraindication (CHADS 2 >2). Medication of patients was recorded off the medical documents and discharge notes and was further confirmed with the patients after discharge via telephone follow-ups. The treatment of patients was then compared with the available guidelines (2011). Overall, 123 patients were included to the analyses of the study. The mean age of patients was 70.4±13.3 years. Males were slightly more prevalent than females, 71 males (57.7%) versus 52 females (42.3%). Details of observed treatment pattern in each group of patients are shown in Table 1. The guideline adherence of treatment in low risk patients was 75%, which is comparable with reports of 60% (2) and 76.8% (3) in similar studies. However, 25% of low risk patients received anti-coagulation therapies, which is an overtreatment (Fig. 1). In intermediate risk patients, 64.3% received guideline adherent therapies, which is similar to reports of 64.8% (5) and 54.2% (6) in litera