Use of vitamin K antagonists for secondary stroke prevention depends on the treating healthcare provider in Germany - results from the German AFNET registry

Publikation: Beitrag in FachzeitschriftForschungsartikelBeigetragenBegutachtung

Beitragende

  • behalf of the AFNET registry investigators - , Charité – Universitätsmedizin Berlin (Autor:in)
  • Institut für Pharmakologie und Toxikologie
  • Ludwig-Maximilians-Universität München (LMU)
  • Institut für Herzinfarktforschung
  • Klinikum Lippe
  • Universitätsklinikum Brandenburg an der Havel
  • Universität Hamburg
  • Institut für Pharmakologie und Toxikologie
  • Westfälische Wilhelms-Universität Münster
  • University of Birmingham

Abstract

Background: Anticoagulation using vitamin K antagonists (VKAs) significantly reduces the risk of recurrent stroke in stroke patients with atrial fibrillation (AF) and is recommended by guidelines. Methods: The German Competence NETwork on Atrial Fibrillation established a nationwide prospective registry including 9,574 AF patients, providing the opportunity to analyse AF management according to German healthcare providers. Results: On enrolment, 896 (9.4%) patients reported a prior ischaemic stroke or transient ischaemic attack. Stroke patients were significantly older, more likely to be female, had a higher rate of cardiovascular risk factors, and more frequently received anticoagulation (almost exclusively VKA) than patients without prior stroke history. Following enrolment, 76.4% of all stroke patients without VKA contraindications received anticoagulation, which inversely associated with age (OR 0.95 per year; 95 % CI 0.92-0.97). General practitioners/internists (OR 0.40; 95 % CI 0.21-0.77) and physicians working in regional hospitals (OR 0.47; 95 % CI 0.29-0.77) prescribed anticoagulation for secondary stroke prevention less frequently than physicians working at university hospitals (reference) and office-based cardiologists (OR 1.40; 95 % CI 0.76-2.60). The impact of the treating healthcare provider was less evident in registry patients without prior stroke. Conclusions: In the AFNET registry, anticoagulation for secondary stroke prevention was prescribed in roughly three-quarters of AF patients, a significantly higher rate than in primary prevention. We identified two factors associated with withholding oral anticoagulation in stroke survivors, namely higher age and-most prominently-treatment by a general practitioner/internist or physicians working at regional hospitals.

Details

OriginalspracheEnglisch
Aufsatznummer129
FachzeitschriftBMC neurology
Jahrgang15
Ausgabenummer1
PublikationsstatusVeröffentlicht - 5 Aug. 2015
Peer-Review-StatusJa

Externe IDs

PubMed 26242880

Schlagworte

ASJC Scopus Sachgebiete

Schlagwörter

  • Anticoagulants, Atrial fibrillation, German AFNET registry, Ischaemic stroke, Secondary stroke prevention