Clinical InvestigationAcute Ischemic Heart DiseaseImprovement in use of anticoagulation therapy in patients with ischemic stroke: Results from Get With The Guidelines–Stroke
Section snippets
Methods
The methodology for the GWTG-Stroke quality improvement program has been described previously.8 Hospitals were recruited to participate over the course of the study. Patients were enrolled by querying the GWTG-Stroke database for demographic, clinical, and treatment data on consecutive patients presenting with ischemic stroke or TIA and AF. Between 2003 and 2007, patients were included if they had documented AF. In 2008, patients with atrial flutter were also included. Thus, patients with
Results
A total of 1,161,628 patients with stroke or TIA were entered into the GWTG-Stroke database between April 1, 2003, and April 1, 2010. Most (82.9%) were ischemic in nature. Of the patients with ischemic stroke or TIA (n = 962,940), AF was present in 197,778 (20.5%). There were 15,714 patients excluded because they were treated with comfort care measures only by the time of discharge. An additional 19,282 patients were excluded because they died, or were discharged to another acute care hospital
Discussion
In this cohort of patients with AF hospitalized with ischemic stroke or TIA from GWTG-Stroke, adherence to anticoagulation treatment guidelines increased over time, and the increase was achieved early and maintained over time. This study confirms previously published findings10 and extends the follow-up period to 6 years. Importantly, we show that the increase in anticoagulation treatment at discharge was not simply due to better documentation of contraindications but, rather, due to increasing
Conclusions
Data from the GWTG-Stroke quality improvement program demonstrate that improvement in anticoagulation initiation in patients with AF and ischemic stroke or TIA can be achieved early and maintained over time. This study demonstrates the highest rate of anticoagulation initiation in eligible patients compared with other quality improvement programs or patient cohorts with stroke.14, 15 Hospitals treating larger number of ischemic patients with stroke or those that are certified by TJC have higher
Acknowledgements
Funding/Support: The Get With The Guidelines–Stroke (GWTG-Stroke) Program is provided by the American Heart Association/American Stroke Association. The GWTG-Stroke Program is currently supported, in part, by a charitable contribution from Ortho-McNeil. The GWTG-Stroke has been funded in the past through support from Boeringher-Ingelheim, Merck, Bristol-Myers Squib/Sanofi Pharmaceutical Partnership, and the American Heart Association Pharmaceutical Roundtable.
Role of the sponsors: The industry
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Cited by (31)
Racial and sex differences in optimizing anticoagulation therapy for patients with atrial fibrillation
2022, American Heart Journal Plus: Cardiology Research and PracticeRacial and Ethnic Differences in the Management of Atrial Fibrillation
2021, CJC OpenCitation Excerpt :Several groups have highlighted major racial differences in care in relation to stroke prevention in AF. Historical studies and Medicare data have shown that NHB and Hispanic patients with AF were significantly less likely to be prescribed vitamin K antagonists than were other ethnic groups, despite having higher stroke-risk scores, and they were also frequently lost to international normalized ratio (INR) monitoring.39,44,49,52-54 Similarly, Black race was associated with a significantly decreased time in therapeutic range, compared with NHW race, even after adjusting for medication compliance and monitoring frequency.55
Temporal trends of atrial fibrillation and/or rheumatic heart disease-related ischemic stroke, and anticoagulant use in Chinese population: An 8-year study
2021, International Journal of CardiologyCitation Excerpt :Since 2017, the costs of dabigatran and rivaroxaban can be covered by China's social health insurance and future studies may reflect higher use of these anticoagulants. Our current analysis identified that factors associated with not being discharged on anticoagulation were similar to what other groups have identified as having a high risk of bleeding complications such as older age, and more serious stroke (higher NIHSS score on admission) [40–42]. Interestingly, patients with symptomatic HT as well as non-symptomatic HT were less likely to receive anticoagulants at discharge in our population.
Racial and ethnic differences in the prevalence, management, and outcomes in patients with atrial fibrillation: A systematic review
2018, Heart RhythmCitation Excerpt :Additional studies indicate that newly diagnosed NHB patients with AF are significantly less likely to receive or fill a warfarin prescription upon discharge.11,31 Similarly, Lewis et al32 found that NHBs (OR 0.77; 95% CI 0.69–0.86; P < .001) and Hispanics (OR 0.81; 95% CI 0.68–0.95; P = .0103) had a lower odds of warfarin prescription at discharge relative to NHWs. In a national survey of patients with AF, UREGs were half as likely as NHWs to be prescribed warfarin,33 and among Medicare beneficiaries, the adjusted OR for warfarin prescription in NHBs was 0.69 (95% CI 0.60–0.81) and 0.50 in Hispanics (95% CI 0.41–0.62) relative to NHWs.34
Registries in Atrial Fibrillation: From Trials to Real-Life Clinical Practice
2017, American Journal of MedicineCitation Excerpt :Contemporary registries also demonstrate that by performance improvement efforts, any treatment gaps can be identified and bridged.38,39,41,59,61,65,68 In the GWTG program, as a result of tailored feedback and clinical decision support, anticoagulation rates reached 95%.68 However, despite best efforts, guideline-adherent thromboprophylaxis is still suboptimal.
Oral Anticoagulant Use in Atrial Fibrillation-Associated Ischemic Stroke: A Retrospective, Multicenter Survey in Northwestern China
2017, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :OATs are substantially underused in patients with AFAIS in northwestern China compared to western countries. In 2011, Lewis et al (America) reported that among all patients with AFAIS eligible for anticoagulation and without documented contraindications, 94.0% were treated with anticoagulation by the time of hospital discharge.23 In Germany, Haeusler et al reported that 76.4% of all stroke patients with AF and without warfarin contraindications were prescribed anticoagulation for secondary stroke prevention.24