Title |
Use of vitamin K antagonists for secondary stroke prevention depends on the treating healthcare provider in Germany – results from the German AFNET registry
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Published in |
BMC Neurology, August 2015
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DOI | 10.1186/s12883-015-0371-8 |
Pubmed ID | |
Authors |
Karl Georg Haeusler, Andrea Gerth, Tobias Limbourg, Ulrich Tebbe, Michael Oeff, Karl Wegscheider, András Treszl, Ursula Ravens, Thomas Meinertz, Paulus Kirchhof, Günter Breithardt, Gerhard Steinbeck, Michael Nabauer |
Abstract |
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. 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. 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. 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. |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Slovenia | 1 | 2% |
Unknown | 65 | 98% |
Demographic breakdown
Readers by professional status | Count | As % |
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Researcher | 8 | 12% |
Student > Master | 7 | 11% |
Student > Ph. D. Student | 7 | 11% |
Student > Postgraduate | 6 | 9% |
Librarian | 5 | 8% |
Other | 17 | 26% |
Unknown | 16 | 24% |
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Psychology | 4 | 6% |
Mathematics | 4 | 6% |
Pharmacology, Toxicology and Pharmaceutical Science | 3 | 5% |
Agricultural and Biological Sciences | 2 | 3% |
Other | 11 | 17% |
Unknown | 20 | 30% |