oa Examining secular trends in the utilization of warfarin among Middle Eastern Arab and South Asian patients hospitalized with atrial fibrillation: 20-year experience from Qatar (1991-2010)

Objectives: There is paucity of data relevant to anticoagulation rates and trends of treatment in patients with atrial fibrillation (AF) in developing countries and whether there are ethnic differences in the utilization of warfarin as some reports have suggested. The aim of this study is to evaluate trends of utilization of warfarin in Arab and South Asian patients hospitalized with AF in a real-world population in a Middle Eastern country. Methods: Retrospective analysis of prospective registry of all patients hospitalized with AF in Qatar from 1991 through 2010 was made. Rate and trends of warfarin use was examined in relation to ethnicity over the years of the study. Results: During the 20 year period; 2857 Arabs and 548 Asians were hospitalized for AF. The mean age of Arabs was 58 years and of Asians 49 years. Overall, 31.8% of Arabs and 39.4% of Asians received warfarin at hospital discharge (p= 0.001). The overall use of warfarin was significantly trending higher from 17 % in the earlier years of the study to 44.1% in the latter years but no differences were found between Arabs and Asians throughout the study period except at the latter years of the study when it was significantly higher in Asians (53% Asians vs. 41.7% Arabs; p= 0.009). Conclusions: Although the trend is significantly increasing over time, warfarin remains underutilized in patients hospitalized with AF irrespective of ethnicity. There is an urgent need for prospective studies to investigate warfarin contraindications, relative warfarin efficacy and bleeding risks in our region to help guide healthcare providers prescribing warfarin and consequently reduce the risk of AF-related disabling strokes.