Date of Award

5-2009

Degree Type

Thesis

Degree Name

Departmental Honors

Department

Nutrition, Dietetics, and Food Sciences

First Advisor

Megan Bunch

Abstract

Background: Atrial fibrillation (AF) is the most common observed arrhythmia in clinical practice. Over the next decades, the number ofpeople affected by AF is estimated to be anywhere from 5.6 to over 12 million. In patients with AF, thromboembolism is a central concern, as it can lead to stroke with significant morbidity and mortality. Coumadin anticoagulation has been shown to significantly reduce stroke risk, particularly in patients with other risks, such as hypertension, diabetes, prior stroke, or heart failure. Although Coumadin is effective in reducing stroke, its chronic use requires frequent international normalized ratio (INR)/protime monitoring. This is necessary because nutritional status, compliance, and drug interactions can lead to under-or over-coagulation. There can be numerous interactions with food and medications in patients using Coumadin. In addition, Coumadin carries with it the major concern ofintracranial bleeding. Consequently, identifying knowledge deficits related to Coumadin use is critical to improving patient outcomes.

Methods: This study took place at Intermountain Medical Center, Murray, Utah, in collaboration with Utah State University, Logan, Utah. Patients with known AF, who were receiving treatment from the Utah Heart Clinic (n=75), were asked to complete a one-time questionnaire. The data thus obtained was analyzed to identify any knowledge deficits related to Coumadin use.

Results: It was found that 90.7 percent ofthe sample had at least one stroke risk factor. Descriptive data indicated 21.3 percent ofall participants reported consuming grapefruit and/or grapefruit juice and were unaware ofthe interaction with Coumadin.

Conclusions: This is ofgreat clinical significance as lack ofknowledge increased the risk for thromboembolism and intracranial bleeding. The results may be skewed due to the common knowledge ofgrapefruit-drug interactions. We conclude that better strategies need to be devised to effectively educate AF patients on Coumadin to improve treatment outcomes in the future.

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