Adherence to Guidelines for Antithrombotic Terapy in Patients with Atrial Fibrillation According to CHADS2 Score before and afer Stroke: A Multicenter Observational Study from Korea
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background and Purpose A substantial proportion of patients with atrial fbrillation (AF) are not treated optimally; however, the inappropriateness of drug therapy has never been evaluated before or afer a stroke event. We investigated the adherence to guidelines for therapy in AF patients hospitalized with acute ischemic stroke (AIS) before stroke onset and at discharge, with the aim of identifying the factors associated with inappropriate therapy. Methods AIS patients with AF hospitalized within 7 days of onset were identifed from a prospective nine-center stroke registry database. Two cohorts were defned: patients diagnosed with AF prior to the stroke event (admission cohort) and patients diagnosed with AF at discharge from hospital (discharge cohort). Any of the following conditions were regarded as nonadherence to guidelines in this study: use of anticoagulant or nonuse of antithrombotics with CHADS2 score=0, nonuse of antithrombotics with CHADS2 score=1, or nonuse of anticoagulant with CHADS2 score ≥2. Results Overall, 406 patients were enrolled in the admission cohort and 518 in the discharge cohort. Te rates of nonadherence before a stroke event and at discharge were 77.8% and 33.3%, respectively. Tese rates varied widely for both cohorts, with interhospital diferences being statistically signifcant. Multivariable analysis revealed that old age, stroke history, and congestive heart failure were associated with nonadherence before stroke. At discharge, males, coronary heart disease, inappropriate antithrombotic use before stroke, and functional disability at discharge were associated with nonadherence. Conclusions Tis study shows that antithrombotic use in AIS patients with AF might be not optimal before and afer stroke in Korea.
Abstract
Background and Purpose A substantial proportion of patients with atrial fbrillation (AF) are not treated optimally; however, the inappropriateness of drug therapy has never been evaluated before or afer a stroke event. We investigated the adherence to guidelines for therapy in AF patients hospitalized with acute ischemic stroke (AIS) before stroke onset and at discharge, with the aim of identifying the factors associated with inappropriate therapy. Methods AIS patients with AF hospitalized within 7 days of onset were identifed from a prospective nine-center stroke registry database. Two cohorts were defned: patients diagnosed with AF prior to the stroke event (admission cohort) and patients diagnosed with AF at discharge from hospital (discharge cohort). Any of the following conditions were regarded as nonadherence to guidelines in this study: use of anticoagulant or nonuse of antithrombotics with CHADS2 score=0, nonuse of antithrombotics with CHADS2 score=1, or nonuse of anticoagulant with CHADS2 score ≥2. Results Overall, 406 patients were enrolled in the admission cohort and 518 in the discharge cohort. Te rates of nonadherence before a stroke event and at discharge were 77.8% and 33.3%, respectively. Tese rates varied widely for both cohorts, with interhospital diferences being statistically signifcant. Multivariable analysis revealed that old age, stroke history, and congestive heart failure were associated with nonadherence before stroke. At discharge, males, coronary heart disease, inappropriate antithrombotic use before stroke, and functional disability at discharge were associated with nonadherence. Conclusions Tis study shows that antithrombotic use in AIS patients with AF might be not optimal before and afer stroke in Korea.
참고문헌 (30)
- Lip GY, "Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation", Chest, 137, pp.263~272 (2010)
- Singer DE, "Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)", Chest, 133(6 Suppl), pp.546S~592S (2008)
- Fuster V, "ACC", AHA, American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society, pp.Circulation, 2006[DOI]
- "Clinical Practice Guidelines for Stroke. Revision" (2013)[URL]
- Goldstein LB, "Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association", American Stroke Association, 2011, pp.42, 517~584
- ACTIVE Writing Group of the ACTIVE Investigators, "Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial", Lancet, 367, pp.1903~1912 (2006)
- van Walraven C, "Oral anticoagulants vs aspirin in nonvalvular atrial fibrillation:an individual patient meta-analysis", JAMA, 288, pp.2441~2448 (2002)
- van Walraven C, "Effect of age on stroke prevention therapy in patients with atrial fibrillation: the atrial fibrillation investigators", Stroke, 40, pp.1410~1416 (2009)
- Kowey PR, "Warfarin and aspirin use in atrial fibrillation among practicing cardiologist (from the AFFECTS Registry)", Am J Cardiol, 105, pp.1130~1134 (2010)
- Friberg L, "Stroke prophylaxis in atrial fibrillation: who gets it and who does not? Report from the Stockholm Cohort-study on Atrial Fibrillation (SCAFstudy)", Eur Heart J, 27, pp.1954~1964 (2006)
- Monte S, "Antithrombotic treatment is strongly underused despite reducing overall mortality among high-risk elderly patients hospitalized with atrial fibrillation", Eur Heart J, 27, pp.2217~2223 (2006)
- Hylek EM, "Translating the results of randomized trials into clinical practice:the challenge of warfarin candidacy among hospitalized elderly patients with atrial fibrillation", Stroke, 37, pp.1075~1080 (2006)
- Gladstone DJ, "Potentially preventable strokes in high-risk patients with atrial fibrillation who are not adequately anticoagulated", Stroke, 40, pp.235~240 (2009)
- Schwammenthal Y, "Anticoagulation remains underused in prevention of stroke associated with atrial fibrillation: insights from two consecutive national surveys", Int J Cardiol, 152, pp.356~361 (2011)
- Kim BJ, "Current status of acute stroke management in Korea: a report on a multicenter, comprehensive acute stroke registry", Int J Stroke, 9, pp.514~518 (2014)
- Gage BF, "Validation of clinical classification schemes for predicting stroke:results from the National Registry of Atrial Fibrillation", JAMA, 285, pp.2864~2870 (2001)
- Hart RG, "Current status of stroke risk stratification in patients with atrial fibrillation", Stroke, 40, pp.2607~2610 (2009)
- Ahmad O, "Atrial fibrillation and anticoagulation in a stroke unit population", Intern Med J, 39, pp.752~756 (2009)
- Gandolfo C, "Stroke due to atrial fibrillation and the attitude to prescribing anticoagulant prevention in Italy. A prospective study of a consecutive stroke population admitted to a comprehensive stroke unit", J Neurol, 255, pp.796~802 (2008)
- Sun MC, "In-hospital case management to increase anticoagulation therapy for stroke patients with atrial fibrillation: a hospital-based registry", J Formos Med Assoc, 112, pp.263~268 (2013)
- Lopes RD, "Antithrombotic therapy use at discharge and 1 year in patients with atrial fibrillation and acute stroke: results from the AVAIL Registry", Stroke, 42, pp.3477~3483 (2011)
- Srivastava A, "Examining warfarin underutilization rates in patients with atrial fibrillation:detailed chart review essential to capture contraindications to warfarin therapy", Thromb J, 6, pp.6~ (2008)
- Meiltz A, "Atrial fibrillation management by practice cardiologists: a prospective survey on the adherence to guidelines in the real world", Europace, 10, pp.674~680 (2008)
- Nieuwlaat R, "Antithrombotic treatment in real-life atrial fibrillation patients:a report from the Euro Heart Survey on Atrial Fibrillation", Eur Heart J, 27, pp.3018~3026 (2006)
- Atarashi H, "Present status of anticoagulation treatment in Japanese patients with atrial fibrillation: a report from the J-RHYTHM Registry", Circ J, 75, pp.1328~1333 (2011)
- "J Thromb Thrombolysis", 2014, 171~176
- Fuster V, "2011 ACCF", AHA, AHA, pp.ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation, American Heart Association Task Force on practice guidelines[DOI]
- Partington SL, "Pre-admission warfarin use in patients with acute ischemic stroke and atrial fibrillation: the appropriate use and barriers to oral anticoagulant therapy", Thromb Res, 120, pp.663~669 (2007)
- Deplanque D, "Secondary prevention of stroke in patients with atrial fibrillation:factors influencing the prescription of oral anticoagulation at discharge", Cerebrovasc Dis, 21, pp.372~379 (2006)
- You JJ, "Antithrombotic therapy for atrial fibrillation: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines", Chest, 141(2 Suppl), pp.e531S~e575S (2012)