News | Antiplatelet and Anticoagulation Therapies | June 02, 2016

Female Heart Patients Less Likely to Get Blood Thinning Therapy

New decision support tool suggests optimal therapy for individual patients based on risk of atrial fibrillation-related stroke and major bleeding

female patients, atrial fibrillation, blood thinning therapy, AFDST, decision support tool, Cincinnati

June 2, 2016 — Female atrial fibrillation patients are less likely than their male counterparts to receive blood thinning therapies to prevent stroke, say University of Cincinnati College of Medicine researchers.

Researchers noted the sex differences as they reviewed medical therapies for 1,585 patients whose doctors were testing a computerized decision support tool that uses patient information and characteristics to aid physicians and patients with decisions about anticoagulant therapy to prevent stroke in atrial fibrillation patients, explains Mark Eckman, M.D., Posey Professor of Clinical Medicine and lead study investigator. Those enrolled in the trial were all patients in the UC Health primary care network.

The computerized model is known as the Atrial Fibrillation Decision Support Tool (AFDST) and is a decision analytic model integrated into UC Health’s electronic health record. It pulls information about patients with atrial fibrillation and is able to calculate for the individual patient his or her risk of AF-related stroke and major bleeding while taking blood thinning therapy, said Eckman, a UC Health physician. Based on this information, the AFDST makes suggestions for the best treatment to prevent AF-related stroke.

Under-treatment of patients with AF is a national problem and the AFDST is designed to get more Tristate AF patients using anticoagulants when appropriate, said Eckman, director of the Division of General Internal Medicine at UC. The AFDST supports clinician decision-making by suggesting when blood thinning therapy is warranted. About 45 percent of women AF patients (326/725) were receiving potentially non-optimal treatment to prevent AF-related stroke (i.e., treatment that was different than that suggested by the AFDST), while only 39 percent of men with AF (338/860) were receiving discordant therapy, said Eckman.

“The irony is that women have a higher risk of AF-related stroke, controlling for other risk factors such as hypertension, diabetes, congestive heart failure, yet women are being under-treated,” said Eckman.

“There are some take-home messages,” said Eckman. “Doctors need to realize we have mental biases that women are healthier and at lower risk of stroke. It’s the same story for coronary artery disease and risk of heart attacks. We think women are at lower risk and we ignore warning signs. Thus, when we are making decisions for blood thinning therapy for patients with atrial fibrillation, we need to remember that women are at higher risk and we need to make sure we treat them aggressively enough to prevent stroke.”

The findings were published online in May in the Journal of the American Geriatrics Society.

Other faculty and staff in the UC College of Medicine contributing to this research are: Alexandru Costea, M.D.; Jack Kues, Ph.D.; Matthew Flaherty, M.D.; Ruth Wise, MSN; Brett Kissela, M.D.; Dawn Kleindorfer, M.D.; Anthony Leonard, Ph.D.; Dylan Steen, M.D.; Peter Baker; Robert Ireton; Dave Hoskins; Brett Harnett; Carlos Aguilar, M.D.; and Nita Walker, M.D. Lora Arduser, Ph.D., McMicken College of Arts and Sciences, was also a contributor.

Gregory Y.H. Lip, M.D., University of Birmingham, Birmingham, England, contributed to this research. Lip has served as a consultant for Bayer, Astellas, Merck, Sanofi, BMS/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, Medtronic and Sanofi Aventis. Matthew Flaherty has served as a consultant for Boehringer Ingelheim and has served on an advisory board for, as a consultant to, and on a speaker’s program for CSL Behring.

The research was supported in part by grants from Bristol-Meyers Squibb/Pfizer Education Consortium, Pfizer Medical Education Group, Informed Medical Decisions Foundation and the National Institutes of Health/National Center for Advancing Translational Sciences.

For more information: www.onlinelibrary.wiley.com

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