Use warfarin therapy more, urge researchers, PROs

Only 32% of eligible patients with atrial fibrillation were administered warfarin in 1992 and 1993, according to a recent study, which concludes that the drug, which alleviates blood clotting and reduces stroke risk in atrial fibrillation patients, was underused between 1989 and 1993. According to the study’s authors, the "substantial increase" in warfarin use from 7% in 1980 and 1981 to 32% in 1992 and 1993 still "falls short of expectations." Up to 70% of patients with atrial fibrillation should be anticoagulated, they say.

Because of the risk of complications, intense anticoagulant monitoring is required in patients treated with warfarin. Some hospitals have developed specialized anticoagulant centers to take some of the burden off the prescribing physician. An article in next month’s QI/TQM describes the development and activities of such a center.

In addition, 32 state quality improvement organizations (QIOs — formerly peer review organizations) have initiated more than 50 projects to increase awareness of warfarin therapy and educate providers, physicians, and beneficiaries. Among those projects:

• The Arkansas Foundation for Medical Care performed an improvement project in which educational feedback of data to local hospitals on the use of warfarin was followed by QIO analysis of patient medical records. Follow-up study showed marked improvement of warfarin use by hospitals, in many cases an improvement of 100%, while statewide average use increased from 24.2% to 40.2%.

• The Michigan Peer Review Organization’s Center for Clinical Evaluation and Outcomes found that only about 50% of eligible patients received warfarin. Working closely with hospital staffs, the Center’s efforts resulted in an increase in warfarin use from 10% to 80% in the 18 participating hospitals. "If the project were taken to the state level, Michigan would have averted 300 strokes a year, saving about $16 million," claims the Center’s director, Jane Deane Clark, PhD. Savings would total $6 million when discounting for the cost of the anticoagulation therapy.

• California Medical Review engaged in a study with 12 hospitals looking at stroke prevention, atrial fibrillation, and warfarin use. With an estimated 52,984 California Medicare beneficiaries with this complication, QIO leaders say the state could save as much as $60 million through encouraging the use of anticoagulants.

• In Pennsylvania, KePRO, found that of approximately 32,000 inpatients who are annually eligible for warfarin treatment, only about half receive it. [Arch Intern Med 1996; 156:2,537-2,541.]