Who Gets Stroke Prevention? Stroke Prevention in Atrial Fibrillation Patients in the Inpatient Setting

Gallagher, Robyn; Roach, Kellie; Sadler, Leonie; Belshaw, Julie; Kirkness, Ann; Zhang, Ling; Proctor, R.; Neubeck, Lis

doi:10.1016/j.hlc.2014.12.010

Cited by 5 publications

(6 citation statements)

References 33 publications

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“…Underuse of anticoagulant therapy among high-risk groups has been frequently reported. 5,16,20,21 In our study, only half of the patients in the high-risk group were receiving anticoagulant treatment. There was an apparent preference for lone antiplatelet therapy, with nearly one-third of our high-risk population receiving this therapy.…”

Section: Discussionmentioning

confidence: 74%

“…14,15 Data regarding predictors of anticoagulant prescribing among patients with AF are limited in the Australian context. A prospective study conducted across a local health district in Sydney 16 revealed that the likelihood of receiving anticoagulant therapy among patients with NVAF increased by being classified at high risk of stroke. Another study, involving a single hospital site, revealed that patients aged 80 years or older were less likely to be prescribed anticoagulation compared to antiplatelet therapy.…”

Section: Introductionmentioning

confidence: 99%

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Anticoagulant Use in Patients With Nonvalvular Atrial Fibrillation: Has Prescribing Improved?

Bista

Chalmers

Peterson

et al. 2016

Clin Appl Thromb Hemost

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Discordance between international guideline recommendations and anticoagulant prescribing patterns among patients with nonvalvular atrial fibrillation (NVAF) has been frequently reported. This study was designed to compare the anticoagulant utilization pattern to earlier data in the same population and identify predictors of anticoagulant prescribing among patients with NVAF. We reviewed patients with NVAF admitted to Tasmania's 3 major hospitals between January 2011 and June 2012 and compared the anticoagulant utilization pattern to earlier data. Patients were excluded if they had only 1 episode of NVAF that reverted spontaneously or upon cardioversion. Multivariate logistic regression analysis was used to identify predictors of anticoagulant prescribing. Overall, 53.8% of patients received anticoagulant treatment compared to 40.4% 15 years ago. Among eligible patients at high-risk of stroke, 52.5% were receiving anticoagulant therapy (vs 42.1% 15 years ago). Approximately 10% of patients with a CHADS score ≥2 were not receiving any antithrombotic treatment, reduced from 18.2% in the earlier cohort, whereas anticoagulant use increased among those at low risk (score 0) to 48.5% from 14.2%. Younger age (odds ratio [OR] 0.99, 95% confidence interval [CI] 0.97-1.0; P = .04); CHADS = 1, relative to 0 (OR 1.68, 95% CI 1.07-2.63; P = .02); CHF (OR 1.56, 95% CI 1.12-2.15; P = .008); and embolic disease history (OR 1.77, 95% CI 1.09-2.86; P = .02) were significant predictors of anticoagulant prescribing. While there has been improvement over the past 15 years, suboptimal use of anticoagulant therapy among high-risk patients with NVAF remains common. There is significant potential for improvement in the quality of stroke prophylaxis in patients with NVAF.

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Section: Discussionmentioning

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Anticoagulant Use in Patients With Nonvalvular Atrial Fibrillation: Has Prescribing Improved?

Bista

Chalmers

Peterson

et al. 2016

Clin Appl Thromb Hemost

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“…Local guidelines and other contextual factors may influence anticoagulant prescribing. 11 At present, there are no up-to-date Australian guidelines for the management of AF; thus, international guidelines are the basis of its management, and data regarding predictors of antithrombotic prescribing among patients with AF are as yet limited in Australia. The absence of robust national AF management guidelines might have influenced underutilization or overutilization of anticoagulant therapy in our population.…”

Section: Discussionmentioning

confidence: 99%

“…6 At present, there are limited data available on the characteristics, clinical management, and outcomes of patients with AF from an Australian perspective. The available literature suggests that there is underutilization of anticoagulant therapy, 10,11 although these data comes from relatively small observational trials in selected patient groups. 10,12 The Commonwealth Review of Anticoagulation Therapies in AF in Australia identified that stroke prevention in individuals with AF requires improvement and highlighted a range of issues to be addressed related to the assessment of patients for stroke and bleeding risk, appropriate choice of antithrombotic agent(s) in patients with multiple comorbidities, and the monitoring of patients.…”

Section: Introductionmentioning

confidence: 99%

Patient Characteristics and Antithrombotic Prescribing Patterns in Patients With Atrial Fibrillation in Tasmania

Bista

Chalmers

Peterson

et al. 2015

Clin Appl Thromb Hemost

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Limited data are available on atrial fibrillation (AF) and its clinical management and outcomes from an Australian perspective. This study was designed to examine the patient characteristics and antithrombotic treatment patterns among patients with AF in Tasmania, Australia. This retrospective observational study reviewed and followed patients with AF admitted to Tasmania's 3 major hospitals between January 2011 and June 2012. Patients were excluded if they had only 1 episode of AF that reverted spontaneously or upon cardioversion without any documented recurrences. We reviewed the records of 2502 patients (≥18 years), and1469 were subsequently included in the study. The mean (±standard deviation [SD]) age of the patients was 76 (±12.3) years. The mean (± SD) CHADS score was 2.1 (±1.3), and 65.7% had a score ≥2. In total, only 55.6% of patients with CHADS score ≥2 were receiving anticoagulation and 9.9% were not receiving any antithrombotic treatment, whereas 85.4% of those at low risk (score 0) were on antithrombotic therapy. Hospitalization was associated with a significant increase in the rate of combination (antiplatelet plus anticoagulant) therapy ( P < .001). Suboptimal use of antithrombotic therapy highlights the need to improve AF management in our jurisdiction.

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“…We used a previously developed checklist to collect sociodemographic and clinical data [44]; the information comprised participants’ age, gender, country of birth, ethnicity, home language, education, marital and employment status, and admission diagnosis.…”

Section: Methodsmentioning

confidence: 99%

Mobile Technology Utilization Among Patients From Diverse Cultural and Linguistic Backgrounds Attending Cardiac Rehabilitation in Australia: Descriptive, Case-Matched Comparative Study

Zhang¹,

Ding²,

Neubeck³

et al. 2018

JMIR Cardio

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BackgroundBarriers to attending cardiac rehabilitation (CR), including cultural and linguistic differences, may be addressed by recent technological developments. However, the feasibility of using these approaches in culturally and linguistically diverse patients is yet to be determined.ObjectiveThis study aims to assess the use of mobile technologies and features, as well as confidence in utilization across patients speaking different languages at home (ie, English, Mandarin Chinese, and a language other than English and Mandarin [other]) and are both eligible and physically suitable for CR. In addition, the study aims to determine the sociodemographic correlates of the mobile technology/feature use, including language spoken at home in the three groups mentioned above.MethodsThis is a descriptive, case matched, comparative study. Age and gender-matched patients speaking English, Mandarin and other languages (n=30/group) eligible for CR were surveyed for their mobile technology and mobile feature use.Results‘Participants had a mean age of 66.7 years (SD 13, n=90, range 46-95), with 53.3% (48/90) male. The majority (82/90, 91.1%) used at least one technology device, with 87.8% (79/90) using mobile devices, the most common being smartphones (57/90, 63.3%), tablets (28/90, 31.1%), and text/voice-only phones (24/90, 26.7%). More English-speaking participants used computers than Mandarin or “other” language speaking participants (P=.003 and .02) and were more confident in doing so compared to Mandarin-speaking participants (P=.003). More Mandarin-speaking participants used smartphones compared with “other” language speaking participants (P=.03). Most commonly used mobile features were voice calls (77/82, 93.9%), text message (54/82, 65.9%), the internet (39/82, 47.6%), email (36/82, 43.9%), and videoconferencing (Skype or FaceTime [WeChat or QQ] 35/82, 42.7%). Less Mandarin-speaking participants used emails (P=.001) and social media (P=.007) than English-speaking participants. Speaking Mandarin was independently associated with using smartphone, emails, and accessing the web-based medication information (OR 7.238, 95% CI 1.262-41.522; P=.03, OR 0.089, 95% CI 0.016-0.490; P=.006 and OR 0.191, 95% CI 0.037-0.984; P=.05).ConclusionsThis study reveals a high usage of mobile technology among CR patients and provides further insights into differences in the technology use across CALD patients in Australia. The findings of this study may inform the design and implementation of future technology-based CR.

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Who Gets Stroke Prevention? Stroke Prevention in Atrial Fibrillation Patients in the Inpatient Setting

Cited by 5 publications

References 33 publications

Anticoagulant Use in Patients With Nonvalvular Atrial Fibrillation: Has Prescribing Improved?

Anticoagulant Use in Patients With Nonvalvular Atrial Fibrillation: Has Prescribing Improved?

Patient Characteristics and Antithrombotic Prescribing Patterns in Patients With Atrial Fibrillation in Tasmania

Mobile Technology Utilization Among Patients From Diverse Cultural and Linguistic Backgrounds Attending Cardiac Rehabilitation in Australia: Descriptive, Case-Matched Comparative Study

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