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Published on: February 28, 2012
Who gets stroke prevention? Stroke prevention in atrial fibrillation patients in the inpatient setting
Robyn Gallagher1, Kellie Roach2, Leonie Sadler3
1Sydney Nursing School, Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006.
Insights
Stroke prevention medication use in atrial fibrillation (AF) patients is suboptimal. High-risk patients were less likely to receive warfarin or novel oral anticoagulants (NOACs) if they had non-valvular AF and no procedure.
Area of Science:
- Cardiology
- Internal Medicine
- Pharmacology
Background:
- Guidelines recommend antithrombotic therapy for stroke prevention in atrial fibrillation (AF) patients.
- Warfarin and novel oral anticoagulants (NOACs) are key stroke prevention medications.
- Suboptimal medication use persists despite strong recommendations.
Purpose of the Study:
- To describe stroke prevention medication use in AF inpatients.
- To identify factors influencing prescription patterns in a Sydney health district.
Main Methods:
- Prospective audit of medical records for AF inpatients.
- Exclusion of cardiac surgery patients.
- Risk stratification for stroke and bleeding; logistic regression for predictor identification.
Main Results:
- 204 patients enrolled (mean age 75 years, 50% male).
- Warfarin/NOAC prescription was lower in non-valvular AF patients without procedures (p=.03).
- Aspirin prescription was lower in patients without AF procedures (p=.01).
- High stroke risk increased warfarin/NOAC odds (OR 3.1) in non-valvular, non-procedural AF patients.
Conclusions:
- Evidence-to-practice gaps in stroke prevention medication for AF patients.
- Prescription patterns are influenced by AF type and procedural status.
Background:
Current guidelines strongly recommend antithrombotic therapy, particularly warfarin, for stroke prevention in atrial fibrillation (AF) patients at high risk of stroke. Despite this, use of these medications is far from optimal. The aim of this study was to describe the use of stroke prevention medication in inpatients and identify factors associated with prescription in one local health district in Sydney, Australia.
Methods:
A prospective audit of medical records for patients admitted with an AF diagnosis to five hospitals in the health district and excluding cardiac surgery patients was undertaken. Patients were classified as high or low for stroke risk as well as for risk of bleeding and predictors were identified by logistic regression.
Results:
A total of 204 patients were enrolled from July 2012 to April 2013, with a mean age of 75 years (SD 13) and half (50%) were male. Valve disease was present in 17% and 15% received a procedure for their AF (cardioversion/ablation/pulmonary vein isolation). Patients were least likely to be prescribed warfarin/novel oral anticoagulant (NOAC) if they were non-valvular and did not undergo cardioversion/ablation (p=.03), and least likely to be prescribed aspirin if they had no AF procedure (p=.01). In non-valvular patients who did not have cardioversion/ablation the odds of being prescribed warfarin/NOAC were increased by being classified at high risk of stroke (OR 3.1, 95% CI 1.0 -9.5) and decreased if there was a prescription for aspirin (OR .3. 95% CI .1 -.6).
Conclusions:
Overall use of stroke prevention medication indicates that gaps remain in translation of evidence into clinical practice.
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