Treatment of atrial fibrillation with warfarin among older adults with end stage renal disease

Research output: Contribution to journalArticle

Abstract

Background: There is increasing evidence questioning the use of warfarin for atrial fibrillation (AF) among older adults with end stage renal disease (ESRD). We assessed the patterns and determinants of warfarin utilization among these patients in the US. Methods: We assembled a cohort of older adults (age ≥65) undergoing dialysis with incident AF from July 2007 to November 2011 from the US Renal Data System (USRDS). We used descriptive statistics to characterize warfarin utilization within 30 days of AF discharge, and logistic regression to quantify patient characteristics associated with warfarin initiation. Results: Among 5730 older adults undergoing dialysis with incident AF, 15.5% initiated warfarin. Among 2906 patients with high risk of bleeding, 12.7% initiated warfarin; whereas 14.9% initiated warfarin among 4824 patients with high risk of stroke. After adjustment for patient characteristics, warfarin initiation was lower among patients who were older [odds ratio (OR) = 0.74 per 10-year increase, 95% confidence interval (CI) 0.66–0.83] and those with a history of diabetes (OR = 0.75, 95% CI 0.63–0.90), myocardial infarction (OR = 0.64, 95% CI 0.50–0.80), or bleeding (OR = 0.63, 95% CI 0.50–0.80). There was no association between sex, race, or dialysis modality and warfarin initiation. Among patients who initiated warfarin, 46.8% discontinued warfarin use after a median treatment length of 8.6 months. Conclusion: Despite the unclear benefit and increased bleeding risk of warfarin treatment in patients with ESRD, 1 in 8 older adults undergoing dialysis with incident AF in the US who had high risk of bleeding used warfarin. Changes to warfarin therapy due to discontinuation were common after initiation.

Original languageEnglish (US)
Pages (from-to)831-839
Number of pages9
JournalJournal of Nephrology
Volume30
Issue number6
DOIs
StatePublished - Dec 1 2017

Fingerprint

Warfarin
Atrial Fibrillation
Chronic Kidney Failure
Therapeutics
Dialysis
Odds Ratio
Confidence Intervals
Hemorrhage
Information Systems
Logistic Models
Stroke
Myocardial Infarction

Keywords

  • Anticoagulants
  • Atrial fibrillation
  • Drug utilization
  • End stage renal disease
  • Warfarin

ASJC Scopus subject areas

  • Nephrology

Cite this

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title = "Treatment of atrial fibrillation with warfarin among older adults with end stage renal disease",
abstract = "Background: There is increasing evidence questioning the use of warfarin for atrial fibrillation (AF) among older adults with end stage renal disease (ESRD). We assessed the patterns and determinants of warfarin utilization among these patients in the US. Methods: We assembled a cohort of older adults (age ≥65) undergoing dialysis with incident AF from July 2007 to November 2011 from the US Renal Data System (USRDS). We used descriptive statistics to characterize warfarin utilization within 30 days of AF discharge, and logistic regression to quantify patient characteristics associated with warfarin initiation. Results: Among 5730 older adults undergoing dialysis with incident AF, 15.5{\%} initiated warfarin. Among 2906 patients with high risk of bleeding, 12.7{\%} initiated warfarin; whereas 14.9{\%} initiated warfarin among 4824 patients with high risk of stroke. After adjustment for patient characteristics, warfarin initiation was lower among patients who were older [odds ratio (OR) = 0.74 per 10-year increase, 95{\%} confidence interval (CI) 0.66–0.83] and those with a history of diabetes (OR = 0.75, 95{\%} CI 0.63–0.90), myocardial infarction (OR = 0.64, 95{\%} CI 0.50–0.80), or bleeding (OR = 0.63, 95{\%} CI 0.50–0.80). There was no association between sex, race, or dialysis modality and warfarin initiation. Among patients who initiated warfarin, 46.8{\%} discontinued warfarin use after a median treatment length of 8.6 months. Conclusion: Despite the unclear benefit and increased bleeding risk of warfarin treatment in patients with ESRD, 1 in 8 older adults undergoing dialysis with incident AF in the US who had high risk of bleeding used warfarin. Changes to warfarin therapy due to discontinuation were common after initiation.",
keywords = "Anticoagulants, Atrial fibrillation, Drug utilization, End stage renal disease, Warfarin",
author = "Jingwen Tan and Sunjae Bae and Jodi Segal and Junya Zhu and Dorry Segev and Alexander, {George Caleb} and {McAdams Demarco}, {Mara Ann}",
year = "2017",
month = "12",
day = "1",
doi = "10.1007/s40620-016-0374-6",
language = "English (US)",
volume = "30",
pages = "831--839",
journal = "Journal of Nephrology",
issn = "1121-8428",
publisher = "Wichtig Publishing",
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TY - JOUR

T1 - Treatment of atrial fibrillation with warfarin among older adults with end stage renal disease

AU - Tan, Jingwen

AU - Bae, Sunjae

AU - Segal, Jodi

AU - Zhu, Junya

AU - Segev, Dorry

AU - Alexander, George Caleb

AU - McAdams Demarco, Mara Ann

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background: There is increasing evidence questioning the use of warfarin for atrial fibrillation (AF) among older adults with end stage renal disease (ESRD). We assessed the patterns and determinants of warfarin utilization among these patients in the US. Methods: We assembled a cohort of older adults (age ≥65) undergoing dialysis with incident AF from July 2007 to November 2011 from the US Renal Data System (USRDS). We used descriptive statistics to characterize warfarin utilization within 30 days of AF discharge, and logistic regression to quantify patient characteristics associated with warfarin initiation. Results: Among 5730 older adults undergoing dialysis with incident AF, 15.5% initiated warfarin. Among 2906 patients with high risk of bleeding, 12.7% initiated warfarin; whereas 14.9% initiated warfarin among 4824 patients with high risk of stroke. After adjustment for patient characteristics, warfarin initiation was lower among patients who were older [odds ratio (OR) = 0.74 per 10-year increase, 95% confidence interval (CI) 0.66–0.83] and those with a history of diabetes (OR = 0.75, 95% CI 0.63–0.90), myocardial infarction (OR = 0.64, 95% CI 0.50–0.80), or bleeding (OR = 0.63, 95% CI 0.50–0.80). There was no association between sex, race, or dialysis modality and warfarin initiation. Among patients who initiated warfarin, 46.8% discontinued warfarin use after a median treatment length of 8.6 months. Conclusion: Despite the unclear benefit and increased bleeding risk of warfarin treatment in patients with ESRD, 1 in 8 older adults undergoing dialysis with incident AF in the US who had high risk of bleeding used warfarin. Changes to warfarin therapy due to discontinuation were common after initiation.

AB - Background: There is increasing evidence questioning the use of warfarin for atrial fibrillation (AF) among older adults with end stage renal disease (ESRD). We assessed the patterns and determinants of warfarin utilization among these patients in the US. Methods: We assembled a cohort of older adults (age ≥65) undergoing dialysis with incident AF from July 2007 to November 2011 from the US Renal Data System (USRDS). We used descriptive statistics to characterize warfarin utilization within 30 days of AF discharge, and logistic regression to quantify patient characteristics associated with warfarin initiation. Results: Among 5730 older adults undergoing dialysis with incident AF, 15.5% initiated warfarin. Among 2906 patients with high risk of bleeding, 12.7% initiated warfarin; whereas 14.9% initiated warfarin among 4824 patients with high risk of stroke. After adjustment for patient characteristics, warfarin initiation was lower among patients who were older [odds ratio (OR) = 0.74 per 10-year increase, 95% confidence interval (CI) 0.66–0.83] and those with a history of diabetes (OR = 0.75, 95% CI 0.63–0.90), myocardial infarction (OR = 0.64, 95% CI 0.50–0.80), or bleeding (OR = 0.63, 95% CI 0.50–0.80). There was no association between sex, race, or dialysis modality and warfarin initiation. Among patients who initiated warfarin, 46.8% discontinued warfarin use after a median treatment length of 8.6 months. Conclusion: Despite the unclear benefit and increased bleeding risk of warfarin treatment in patients with ESRD, 1 in 8 older adults undergoing dialysis with incident AF in the US who had high risk of bleeding used warfarin. Changes to warfarin therapy due to discontinuation were common after initiation.

KW - Anticoagulants

KW - Atrial fibrillation

KW - Drug utilization

KW - End stage renal disease

KW - Warfarin

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