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.

Files

Metadata

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

Versions

Analytics

Collections

This resource is currently not in any collection.

Work History

Version 1
published

  • Created

    July 19, 2022 10:24 by Researcher Metadata Database

  • Added 1-s2.0-S0022510X21001039-main.pdf

    July 19, 2022 10:24 by Researcher Metadata Database

  • Added Creator Johan Diaz

    July 19, 2022 10:24 by Researcher Metadata Database

  • Added Creator Eric Koza

    July 19, 2022 10:24 by Researcher Metadata Database

  • Added Creator Durgesh Chaudhary

    July 19, 2022 10:24 by Researcher Metadata Database

  • Added Creator Shima Shahjouei

    July 19, 2022 10:24 by Researcher Metadata Database

  • Added Creator Md Mobasshir Arshed Naved

    July 19, 2022 10:24 by Researcher Metadata Database

  • Added Creator Muhammad Taimur Malik

    July 19, 2022 10:24 by Researcher Metadata Database

  • Added Creator Jiang Li

    July 19, 2022 10:24 by Researcher Metadata Database

  • Added Creator Mohammad Adibuzzaman

    July 19, 2022 10:24 by Researcher Metadata Database

  • Added Creator Paul Griffin

    July 19, 2022 10:24 by Researcher Metadata Database

  • Added Creator Vida Abedi

    July 19, 2022 10:24 by Researcher Metadata Database

  • Added Creator Ramin Zand

    July 19, 2022 10:24 by Researcher Metadata Database

  • Published

    July 19, 2022 10:24 by Researcher Metadata Database

  • Updated Work Title, Subtitle, Description, and 1 more Show Changes

    February 08, 2024 09:40 by avs5190

    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
  • Updated

    April 04, 2024 10:21 by [unknown user]