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Patients with atrial fibrillation undertreated for stroke risk

(CLEVELAND): A study published in this week's Journal of the American Medical Association (JAMA) suggests new guidelines for determining a patient's risk of having a stroke or dying after being newly diagnosed with atrial fibrillation, a common heart rhythm problem affecting more than two million Americans. And according to University Hospitals of Cleveland's Albert L. Waldo, MD, the new scoring system should help doctors identify patients who are currently not being treated with medication and, therefore, at high risk of stroke and death.

Dr. Waldo, writing in an editorial in the August 27th issue of JAMA, comments that less than half of patients who would be good candidates for treatment with blood thinners to reduce their risk of stroke are actually receiving the drugs. Elderly patients are least likely to be treated, says Waldo, who is also a professor of medicine at Case Western Reserve University School of Medicine.

"In short, not enough patients with atrial fibrillation at recognized risk for ischemic stroke receive warfarin (Coumadin) therapy, and patients with the greatest risk of ischemic stroke in the face of atrial fibrillation are the ones who receive it least." The JAMA article suggesting a new way to "score" a patient's risk was written by Thomas J. Wang, MD, and colleagues of the Framingham Heart Study in Framingham, Mass. They developed a scoring system involving the following risk predictors: advancing age, female, increasing systolic blood pressure, prior stroke or transient ischemic attack, and diabetes. The scores can be used to "easily stratify patients at particularly high or low risk," for stroke or death, according to Dr. Wang. Once risk is properly assessed, patients can be provided appropriate counseling and/or treatment.

Patients who have been diagnosed with atrial fibrillation have a four-fold to five-fold increase in their risk of ischemic stroke (interruption of blood flow to the brain due to a clot). Warfarin
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Contact: Eileen Korey
eileen.korey@uhhs.com
216-844-3825
University Hospitals of Cleveland
26-Aug-2003


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