Underutilization of oral anticoagulant therapy for stroke prevention in elderly patients with heart failure

Background: Oral anticoagulant therapy is the most effective prophylaxis against stroke in atrial fibrillation. Relatively few studies have examined the use of oral anticoagulant therapy for stroke prevention in a large cohort of elderly patients with heart failure. To examine the use of stroke prevention therapy, we studied elderly patients with heart failure admitted to 30 hospitals in northeast Ohio between 1992 and 1994. Methods and Results: The sample consisted of 12,911 Medicare-insured patients ≥65 years of age who were consecutively admitted with a principal diagnosis of heart failure between 1992 and 1994. Baseline demographic and clinical characteristics for patients with the diagnosis of atrial fibrillation were calculated. Bivariate associations between receiving anticoagulant therapy and select demographic and clinical variables were calculated. In our cohort of patients with heart failure, 2093 had atrial fibrillation (16%). Only 414 (20%) of the patients with atrial fibrillation received oral anticoagulant therapy. Older age and history of gastrointestinal bleeding were significantly negatively associated with receiving oral anticoagulant therapy. History of stroke or transient ischemic attack was positively associated with receiving oral anticoagulant therapy. Conclusions: Atrial fibrillation is common in older patients with heart failure; oral anticoagulant therapy for stroke prevention, which has been shown to be effective, is underutilized in this patient population.