European Journal of Clinical Pharmacology

, Volume 69, Issue 2, pp 245–253 | Cite as

Differences and time trends in drug treatment of atrial fibrillation in men and women and doctors’ adherence to warfarin therapy recommendations

A Swedish study of prescribed drugs in primary care in 2002 and 2007
  • Axel C. CarlssonEmail author
  • Per Wändell
  • Kristina Sundquist
  • Sven-Erik Johansson
  • Jan Sundquist
Pharmacoepidemiology and Prescription



Little is known about prescription trends in atrial fibrillation (AF) in primary health care in Sweden.


The aim was to study time trends in pharmacotherapy, in men and women with AF. We also aimed at studying doctors’ adherence to CHADS2 for prescribing warfarin. CHADS2 assesses stroke risk by presence of known risk factors, i.e., congestive heart failure, hypertension, age >75 years, diabetes, previous stroke and transient ischemic attack.


Data were obtained from primary health care records that contained individual clinical data. In total, 371,036 patients were included in the sample from 2002, and 424,329 patients were included in the sample from 2007. The study population consisted of individuals aged 45+ years who were diagnosed with AF in 2002 (1,330 men and 1,096 women) and 2007 (2,748 men and 2,234 women). The pharmacotherapies prescribed in 2002 and 2007 were analyzed separately in men and women. Logistic regression was used to calculate the association between the CHADS2 score and prescribed warfarin treatment.


Selective beta-blockers, anti-coagulant therapy and lipid-lowering drugs were prescribed more frequently in 2007 than in 2002. In 2007, antithrombotic and RAS-blocking agents were prescribed more frequently to men, whereas beta-1 selective beta-blockers were prescribed more frequently to women. There was no consistent association between the CHADS2 score and prescribed warfarin treatment.


Pharmacotherapy of AF has improved over time, though CHADS2 guidelines need to be implemented systematically in primary health care in Sweden to decrease the risk of stroke and improve quality of life in patients with AF.


Atrial fibrillation Pharmacotherapy Gender Warfarin CHADS2 Sweden 



This work was supported by grants to Kristina Sundquist and Jan Sundquist from the Swedish Research Council (K2005-27X-15428-01A, 2008-3110 and 2008-2638), the Swedish Council for Working Life and Social Research (2006-0386, 2007-1754 and 2007-1962) and the Swedish Research Council Formas (2006-4255-6596-99 and 2007-1352).


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Axel C. Carlsson
    • 1
    • 2
    • 5
    Email author
  • Per Wändell
    • 1
  • Kristina Sundquist
    • 3
  • Sven-Erik Johansson
    • 3
  • Jan Sundquist
    • 3
    • 4
  1. 1.Center for Family and Community MedicineKarolinska InstitutetStockholmSweden
  2. 2.Department of Public Health and Caring Sciences/ Section of GeriatricsUppsala UniversityUppsalaSweden
  3. 3.Center for Primary Health Care ResearchLund UniversityMalmöSweden
  4. 4.Stanford Prevention Research CenterStanford University School of MedicinePalo AltoUSA
  5. 5.Center for Family and Community MedicineKarolinska InstitutetHuddingeSweden

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