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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Use of vitamin K antagonists for secondary stroke prevention depends on the treating healthcare provider in Germany - results from the German AFNET registry. / Haeusler, K. G.; Gerth, A.; Limbourg, T.; Tebbe, U.; Oeff, M.; Wegscheider, K.; Treszl, A.; Ravens, U.; Meinertz, Thomas; Kirchhof, P.; Breithardt, G.; Steinbeck, G.; Nabauer, M.; investigators, Afnet registry.
in: BMC NEUROL, Jahrgang 15, 05.08.2015, S. Art. 129.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Use of vitamin K antagonists for secondary stroke prevention depends on the treating healthcare provider in Germany - results from the German AFNET registry
AU - Haeusler, K. G.
AU - Gerth, A.
AU - Limbourg, T.
AU - Tebbe, U.
AU - Oeff, M.
AU - Wegscheider, K.
AU - Treszl, A.
AU - Ravens, U.
AU - Meinertz, Thomas
AU - Kirchhof, P.
AU - Breithardt, G.
AU - Steinbeck, G.
AU - Nabauer, M.
AU - investigators, Afnet registry
N1 - Haeusler, Karl Georg Gerth, Andrea Limbourg, Tobias Tebbe, Ulrich Oeff, Michael Wegscheider, Karl Treszl, Andras Ravens, Ursula Meinertz, Thomas Kirchhof, Paulus Breithardt, Gunter Steinbeck, Gerhard Nabauer, Michael eng Research Support, Non-U.S. Gov't England 2015/08/06 06:00 BMC Neurol. 2015 Aug 5;15:129. doi: 10.1186/s12883-015-0371-8.
PY - 2015/8/5
Y1 - 2015/8/5
N2 - BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
AB - BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
U2 - 10.1186/s12883-015-0371-8
DO - 10.1186/s12883-015-0371-8
M3 - SCORING: Zeitschriftenaufsatz
VL - 15
SP - Art. 129
JO - BMC NEUROL
JF - BMC NEUROL
SN - 1471-2377
ER -