Quality of Warfarin Anticoagulation in Indigenous and Non-Indigenous Australians With Atrial Fibrillation

Mau T. Nguyen, Celine Gallagher, Bradley M. Pitman, Mehrdad Emami, Kadhim Kadhim, Jeroen M. Hendriks, Melissa E. Middeldorp, Kurt C. Roberts-Thomson, Rajiv Mahajan, Dennis H. Lau, Prashanthan Sanders, Christopher X. Wong

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Studies have shown that suboptimal anticoagulation quality, as measured by time in therapeutic range (TTR), affects a significant percentage of patients with atrial fibrillation (AF). However, TTR has not been previously characterised in Indigenous Australians who experience a greater burden of AF and stroke. Method: Indigenous and non-Indigenous Australians with AF on warfarin anticoagulation therapy were identified from a large tertiary referral centre between 1999 and 2012. Time in therapeutic range was calculated as a proportion of daily international normalised ratio (INR) values between 2 and 3 for non-valvular AF and 2.5 to 3.5 for valvular AF. INR values between tests were imputed using the Rosendaal technique. Linear regression models were employed to characterise predictors of TTR. Results: Five hundred and twelve (512) patients with AF on warfarin were included (88 Indigenous and 424 non-Indigenous). Despite younger age (51±13 vs 71±12 years, p<0.001), Indigenous Australians had greater valvular heart disease, diabetes, and alcohol excess compared to non-Indigenous Australians (p<0.05 for all). Time in therapeutic range was significantly lower in Indigenous compared to non-Indigenous Australians (40±29 vs 50±31%, p=0.006). Univariate predictors of poorer TTR included Indigenous ethnicity, younger age, diuretic use, and comorbidities, such as valvular heart disease, heart failure and chronic obstructive pulmonary disease (p<0.05 for all). Valvular heart disease remained a significant predictor of poorer TTR in multivariate analyses (p=0.004). Conclusion: Indigenous Australians experience particularly poor warfarin anticoagulation quality. Our data also suggest that many non-Indigenous Australians spend suboptimal time in therapeutic range. These findings reinforce the importance of monitoring warfarin anticoagulation quality to minimise stroke risk.

Original languageEnglish
Pages (from-to)1122-1128
Number of pages7
JournalHeart Lung and Circulation
Volume29
Issue number8
DOIs
Publication statusPublished - Aug 2020
Externally publishedYes

Keywords

  • Anticoagulation
  • Atrial fibrillation
  • Indigenous
  • Stroke
  • Warfarin

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