Warfarin in atrial fibrillation: LIMITATIONS AND FUTURE CONSIDERATIONS(2)

LIMITATIONS AND FUTURE CONSIDERATIONS(2)

Further studies should try to address risk/ benefit factors by stratifymg patients based on age and underlymg factors that are commonly associated with atrial fibrillation, such as heart disease and hypertension. The presence of two or more factors increases the risk of developmg stroke up to 17.6% per yea. Further studtes also need to assess how long war farin therapy should be con tin ued, especially with older patients who are more likely to have bleeding complications over time. ventolin inhaler

This analysis is based on modelling, condensing care into a ‘best estimate’. It could be described as predictive rather than prospect ive or retrospective. As such, it relies heavily upon clinical judgement and published results, both of which have limitations. It would be beneficial to employ these other models to ver ify our predictions.

The quality of life issue was not addressed in this analysis, although it is an important aspect of any intervention. The inconvenience of regular blood sampling and increased rate of bleeding have been viewed by some as detriments to quality of life. However, in a study of patients who participated in the Boston Area Anticoagulation Trial for Atrial Fibrillation, no statistical difference in health perception was found between the warfarin and placebo group. Clearly, quality of life issues need to be studied further.

Perhaps the most meaningful information will come from analyses that incorporate cost-effectiveness information, quality of life issues and alternative interventions over a time horizon of several years. That approach would help the decisionmaker not only to provide the most appropriate care for the patient, but also to do so in a cost-effective manner without compromising patient quality of life and care.

CONCLUSION

This report shows that warfarin intervention, versus no antithrombotic therapy, is a cost-effective strategy from an economic standpoint. However, more important, this and other studies also show warfarin reduces the number of strokes and increases the patient’s survival chances from an embolic event. The dollar savings and increased survival probabilities are benefits that may be realized by society, if warfarin therapy is used routinely by prudent physicians for those patients who qualify.

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