Adherence to anticoagulant guideline for atrial fibrillation: A large care gap among stroke patients in a rural population

Objective: This study aimed to investigate the prevalence and factors associated with oral anticoagulant undertreatment of atrial fibrillation (AF) among a cohort of rural patients with stroke outcomes and examine how undertreatment may influence a patient's one-year survival after stroke.

Methods: This retrospective cohort study examined ischemic stroke patients with pre-stroke AF diagnosis from September 2003 to May 2019 and divided them into proper treatment and undertreatment group. Analysis included chi-square test, variance analysis, Kruskal-Wallis test, logistic regression, Kaplan-Meier estimator, and Cox proportional-hazards model.

Results: Out of 1062 ischemic stroke patients with a pre-stroke AF diagnosis, 1015 patients had a CHA2DS2-VASc score ≥2, and 532 (52.4%) of those were undertreated. Median time from AF diagnosis to index stroke was significantly lower among undertreated patients (1.9 years vs. 3.6 years, p < 0.001). Other thromboembolism, excluding stroke, TIA, and myocardial infarction (OR 0.41, p < 0.001), the number of encounters per year (OR 0.90, p < 0.001), and the median time between AF diagnosis and stroke event (OR 0.86, p < 0.001) were negatively associated with undertreatment. Kaplan-Meier estimator showed no statistical difference in the one-year survival probability between groups (log-rank test, p = 0.29), while the Cox-Hazard model showed that age (HR 1.05, p < 0.001) and history of congestive heart failure (HR 1.88, p < 0.001) increased the risk of mortality.

Conclusions: More than half of our rural stroke patients with a pre-index AF diagnosis were not on guideline-recommended treatment. The study highlights a large care gap and an opportunity to improve AF management.

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Work Title Adherence to anticoagulant guideline for atrial fibrillation: A large care gap among stroke patients in a rural population
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Open Access
Creators
  1. Johan Diaz
  2. Eric Koza
  3. Durgesh Chaudhary
  4. Shima Shahjouei
  5. Md Mobasshir Arshed Naved
  6. Muhammad Taimur Malik
  7. Jiang Li
  8. Mohammad Adibuzzaman
  9. Paul Griffin
  10. Vida Abedi
  11. Ramin Zand
License In Copyright (Rights Reserved)
Work Type Article
Publisher
  1. Journal of the Neurological Sciences
Publication Date March 20, 2021
Publisher Identifier (DOI)
  1. https://doi.org/10.1016/j.jns.2021.117410
Deposited July 19, 2022

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Version 1
published

  • Created
  • Added 1-s2.0-S0022510X21001039-main.pdf
  • Added Creator Johan Diaz
  • Added Creator Eric Koza
  • Added Creator Durgesh Chaudhary
  • Added Creator Shima Shahjouei
  • Added Creator Md Mobasshir Arshed Naved
  • Added Creator Muhammad Taimur Malik
  • Added Creator Jiang Li
  • Added Creator Mohammad Adibuzzaman
  • Added Creator Paul Griffin
  • Added Creator Vida Abedi
  • Added Creator Ramin Zand
  • Published
  • Updated Work Title, Subtitle, Description, and 1 more Show Changes
    Work Title
    • Adherence to anticoagulant guideline for atrial fibrillation
    • Adherence to anticoagulant guideline for atrial fibrillation: A large care gap among stroke patients in a rural population
    Subtitle
    • A large care gap among stroke patients in a rural population
    Description
    • <p>Objective: This study aimed to investigate the prevalence and factors associated with oral anticoagulant undertreatment of atrial fibrillation (AF) among a cohort of rural patients with stroke outcomes and examine how undertreatment may influence a patient's one-year survival after stroke. Methods: This retrospective cohort study examined ischemic stroke patients with pre-stroke AF diagnosis from September 2003 to May 2019 and divided them into proper treatment and undertreatment group. Analysis included chi-square test, variance analysis, Kruskal-Wallis test, logistic regression, Kaplan-Meier estimator, and Cox proportional-hazards model. Results: Out of 1062 ischemic stroke patients with a pre-stroke AF diagnosis, 1015 patients had a CHA<sub>2</sub>DS<sub>2</sub>-VASc score ≥2, and 532 (52.4%) of those were undertreated. Median time from AF diagnosis to index stroke was significantly lower among undertreated patients (1.9 years vs. 3.6 years, p &lt; 0.001). Other thromboembolism, excluding stroke, TIA, and myocardial infarction (OR 0.41, p &lt; 0.001), the number of encounters per year (OR 0.90, p &lt; 0.001), and the median time between AF diagnosis and stroke event (OR 0.86, p &lt; 0.001) were negatively associated with undertreatment. Kaplan-Meier estimator showed no statistical difference in the one-year survival probability between groups (log-rank test, p = 0.29), while the Cox-Hazard model showed that age (HR 1.05, p &lt; 0.001) and history of congestive heart failure (HR 1.88, p &lt; 0.001) increased the risk of mortality. Conclusions: More than half of our rural stroke patients with a pre-index AF diagnosis were not on guideline-recommended treatment. The study highlights a large care gap and an opportunity to improve AF management.</p>
    • Objective: This study aimed to investigate the prevalence and factors associated with oral anticoagulant undertreatment of atrial fibrillation (AF) among a cohort of rural patients with stroke outcomes and examine how undertreatment may influence a patient's one-year survival after stroke.
    • Methods: This retrospective cohort study examined ischemic stroke patients with pre-stroke AF diagnosis from September 2003 to May 2019 and divided them into proper treatment and undertreatment group. Analysis included chi-square test, variance analysis, Kruskal-Wallis test, logistic regression, Kaplan-Meier estimator, and Cox proportional-hazards model.
    • Results: Out of 1062 ischemic stroke patients with a pre-stroke AF diagnosis, 1015 patients had a CHA<sub>2</sub>DS<sub>2</sub>-VASc score ≥2, and 532 (52.4%) of those were undertreated. Median time from AF diagnosis to index stroke was significantly lower among undertreated patients (1.9 years vs. 3.6 years, p &lt; 0.001). Other thromboembolism, excluding stroke, TIA, and myocardial infarction (OR 0.41, p &lt; 0.001), the number of encounters per year (OR 0.90, p &lt; 0.001), and the median time between AF diagnosis and stroke event (OR 0.86, p &lt; 0.001) were negatively associated with undertreatment. Kaplan-Meier estimator showed no statistical difference in the one-year survival probability between groups (log-rank test, p = 0.29), while the Cox-Hazard model showed that age (HR 1.05, p &lt; 0.001) and history of congestive heart failure (HR 1.88, p &lt; 0.001) increased the risk of mortality.
    • Conclusions: More than half of our rural stroke patients with a pre-index AF diagnosis were not on guideline-recommended treatment. The study highlights a large care gap and an opportunity to improve AF management.</p>
    Publication Date
    • 2021-05-15
    • 2021-03-20