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Trends in the prevalence and management of pre-stroke atrial fibrillation, the South London Stroke Register, 1995-2014

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ABSTRACT

Background: Previous studies have found low use of anticoagulation prior to stroke, in people with atrial fibrillation (AF). This study examined data on patients with AF-related stroke from a population-based stroke register, and sought to examine changes in management of AF prior to stroke, and reasons for suboptimal treatment, in those who were known to be at a high risk of stroke.

Methods: The South London Stroke Register (SLSR) is an ongoing population-based register recording first-in-a-lifetime stroke. Trends in the prevalence of AF, and antithrombotic medication prescribed before the stroke, were investigated from 1995 to 2014. Multivariable logistic regression analyses were conducted to assess the factors associated with appropriate management.

Results: Of the 5041 patients on the register, 816 (16.2%) were diagnosed with AF before their stroke. AF related stroke increased substantially among Black Carribean and Black African patients, comprising 5% of the overall cohort in 1995–1998, increasing to 25% by 2011–2014 (p<0.001). Anticoagulant prescription in AF patients at high-risk of stroke (CHADS2 score [> = 2]) increased from 9% (1995–1998) to 30% (2011–2014) (p<0.001). Antiplatelet prescription was more commonly prescribed throughout all time periods (43% to 64% of high-risk patients.) Elderly patients (>65) were significantly less likely to be prescribed an anticoagulant, with ethnicity, gender and deprivation showing no association with anticoagulation.

Conclusions: Most AF-related strokes occurred in people who could have been predicted to be at high risk before their stroke, yet were not prescribed optimal preventative treatment. The elderly,despite being at highest stroke risk, were rarely prescribed anticoagulants.

No MeSH data available.


Trends in the management of high-risk AF patients (CHADS2≥2).
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pone.0175980.g001: Trends in the management of high-risk AF patients (CHADS2≥2).

Mentions: Fig 1 demonstrates trends in the management of AF patients at high-risk of stroke, according to the CHADS2 score. Anticoagulation rates in the high-risk group increased with time (p<0.001). 9.3% were prescribed an anticoagulant in 1995–1998, increasing to 14.5% in 1999–2002 and steadily further until 30.4% in 2011–2014. From 1995 to 2014 there was no significant trend in antiplatelet prescription (p = 0.143), which ranged from 43.0% in 1995–1998 to 62.4% during the period 2003–2006. Since then, whilst antiplatelet prescription rates remained noticeably higher than anticoagulation rates, they fell to 53.3% in 2007–2010, and 48.04% in 2011–2014.


Trends in the prevalence and management of pre-stroke atrial fibrillation, the South London Stroke Register, 1995-2014
Trends in the management of high-risk AF patients (CHADS2≥2).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5391932&req=5

pone.0175980.g001: Trends in the management of high-risk AF patients (CHADS2≥2).
Mentions: Fig 1 demonstrates trends in the management of AF patients at high-risk of stroke, according to the CHADS2 score. Anticoagulation rates in the high-risk group increased with time (p<0.001). 9.3% were prescribed an anticoagulant in 1995–1998, increasing to 14.5% in 1999–2002 and steadily further until 30.4% in 2011–2014. From 1995 to 2014 there was no significant trend in antiplatelet prescription (p = 0.143), which ranged from 43.0% in 1995–1998 to 62.4% during the period 2003–2006. Since then, whilst antiplatelet prescription rates remained noticeably higher than anticoagulation rates, they fell to 53.3% in 2007–2010, and 48.04% in 2011–2014.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Previous studies have found low use of anticoagulation prior to stroke, in people with atrial fibrillation (AF). This study examined data on patients with AF-related stroke from a population-based stroke register, and sought to examine changes in management of AF prior to stroke, and reasons for suboptimal treatment, in those who were known to be at a high risk of stroke.

Methods: The South London Stroke Register (SLSR) is an ongoing population-based register recording first-in-a-lifetime stroke. Trends in the prevalence of AF, and antithrombotic medication prescribed before the stroke, were investigated from 1995 to 2014. Multivariable logistic regression analyses were conducted to assess the factors associated with appropriate management.

Results: Of the 5041 patients on the register, 816 (16.2%) were diagnosed with AF before their stroke. AF related stroke increased substantially among Black Carribean and Black African patients, comprising 5% of the overall cohort in 1995&ndash;1998, increasing to 25% by 2011&ndash;2014 (p&lt;0.001). Anticoagulant prescription in AF patients at high-risk of stroke (CHADS2 score [&gt; = 2]) increased from 9% (1995&ndash;1998) to 30% (2011&ndash;2014) (p&lt;0.001). Antiplatelet prescription was more commonly prescribed throughout all time periods (43% to 64% of high-risk patients.) Elderly patients (&gt;65) were significantly less likely to be prescribed an anticoagulant, with ethnicity, gender and deprivation showing no association with anticoagulation.

Conclusions: Most AF-related strokes occurred in people who could have been predicted to be at high risk before their stroke, yet were not prescribed optimal preventative treatment. The elderly,despite being at highest stroke risk, were rarely prescribed anticoagulants.

No MeSH data available.