Associations with anticoagulation: a cross-sectional registry-based analysis of stroke survivors with atrial fibrillation

Abdul-Rahim, A. H. , Wong, J., McAlpine, C., Young, C. and Quinn, T. J. (2014) Associations with anticoagulation: a cross-sectional registry-based analysis of stroke survivors with atrial fibrillation. Heart, 100(7), pp. 557-562. (doi: 10.1136/heartjnl-2013-305267)

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Publisher's URL: http://dx.doi.org/10.1136/heartjnl-2013-305267

Abstract

<b>Objective: </b>To describe vitamin K antagonist (VKA) anticoagulation prescribing patterns in stroke survivors with atrial fibrillation (AF), with particular emphasis on sociodemographic associations with VKA prescription.<p></p> <b>Methods:</b> We conducted a cross-sectional analysis of city-wide Glasgow primary care data held as part of the Local Enhanced Services (LES) for the year 2010. We collated clinical and sociodemographic data of community-dwelling ischaemic stroke survivors with AF, including risk factors; comorbidity; socioeconomic status and prescribing. We described stroke risk and bleeding risk using recommended stratification tools (CHA<sub>2</sub>DS<sub>2</sub>-VAS<sub>C</sub> and HAS-BLED). Univariate and multivariate associations with anticoagulant prescription were described by ORs and corresponding 95% CI.<p></p> <b>Results:</b> We identified 3429 community-dwelling, ischaemic stroke survivors with AF; median age 78 (IQR 72–84); 1699 (49%) male. Median CHA<sub>2</sub>DS<sub>2</sub>-VAS<sub>C</sub> score was 5 (IQR 4–6). VKA was prescribed in 1165 (34%). On univariate analysis, higher CHA<sub>2</sub>DS<sub>2</sub>-VAS<sub>C</sub> was associated with fewer VKA prescriptions (OR 0.90, 95% CI 0.45 to 0.95). On multivariate analysis, older age (OR 0.97, 95% CI 0.96 to 0.98) and higher deprivation scores (OR 0.59, 95% CI 0.57 to 0.76) were independently associated with non-prescription of VKA.<p></p> <b>Conclusions:</b> Anticoagulation was underused in this high-risk population, and those at highest risk were less likely to be treated. Strategies need to be developed to improve prescription of anticoagulation treatment.<p></p>

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McAlpine, Dr Christine and Abdul-Rahim, Dr Azmil and Quinn, Dr Terry and Young, Mrs Camilla
Authors: Abdul-Rahim, A. H., Wong, J., McAlpine, C., Young, C., and Quinn, T. J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Heart
Publisher:BMJ Publishing Group
ISSN:1355-6037
ISSN (Online):1468-201X

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