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Observational Study
. 2015 Aug 5:15:129.
doi: 10.1186/s12883-015-0371-8.

Use of vitamin K antagonists for secondary stroke prevention depends on the treating healthcare provider in Germany - results from the German AFNET registry

Karl Georg Haeusler  1 , Andrea Gerth  2 , Tobias Limbourg  3 , Ulrich Tebbe  4 , Michael Oeff  5 , Karl Wegscheider  6 , András Treszl  7 , Ursula Ravens  8 , Thomas Meinertz  9 , Paulus Kirchhof  10   11 , Günter Breithardt  12 , Gerhard Steinbeck  13 , Michael Nabauer  14 ; AFNET registry investigators
Affiliations
Observational Study

Use of vitamin K antagonists for secondary stroke prevention depends on the treating healthcare provider in Germany - results from the German AFNET registry

Karl Georg Haeusler et al. BMC Neurol. .

Abstract

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.

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Figures

Fig. 1
Fig. 1
Factors associated with prescription of anticoagulants. Factors associated with prescription of anticoagulants before (a) and after (b) enrolment to the AFNET registry in AF patients with prior ischaemic stroke or TIA
See this image and copyright information in PMC

References

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