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Large variations in the use of oral anticoagulants in stroke patients with atrial fibrillation: A Swedish national perspective
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
Department of Clinical Neuroscience, Lund University, Lund, Sweden.
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2004 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 255, no 1, 22-32 p.Article in journal (Refereed) Published
Abstract [en]

Objectives. To explore nation-wide use of anticoagulation in stroke patients with atrial fibrillation, in routine clinical practice in Sweden.

Design.  Cross-sectional cohort study.

Setting. Patients included in Riks-Stroke, the Swedish national quality register for stroke care, during 2001.

Subjects. Hospitals with incomplete coverage were excluded, leaving 4538 stroke patients with atrial fibrillation amongst 18 276 stroke patients from 75 hospitals in six health care regions.

Main outcome measure.  Treatment with oral anticoagulants.

Results. At stroke onset, the proportion of patients with atrial fibrillation and first-ever stroke, receiving oral anticoagulants as primary prevention was 11.0% (range 8.4–13.5% between regions and 2.5–24.4% between hospitals). Younger age, male sex and diabetes at stroke onset independently predicted primary prevention with oral anticoagulants. The proportion of stroke patients with atrial fibrillation receiving oral anticoagulants as secondary prevention at discharge was 33.5% (range 29.9–40.6% between regions and 16.4–61.9% between hospitals). Independent predictors for secondary prevention were younger age, male sex and independent activities of daily life (ADL) function before the stroke, being discharged to home, being fully conscious on admission and health care region.

Conclusion.  There were variations between hospitals and regions that differences in age, sex, functional impairments and comorbidities could not fully explain. This indicates that evidence-based primary and secondary prevention of embolic stroke is insufficiently practised. Local factors seem to determine whether patients with atrial fibrillation gain access to optimal prevention of stroke or not.

Place, publisher, year, edition, pages
John Wiley & Sons, 2004. Vol. 255, no 1, 22-32 p.
Keyword [en]
Administration, Oral, Aged, Aged, 80 and over, Anticoagulants/*administration & dosage, Atrial Fibrillation/complications/*drug therapy, Attitude of Health Personnel, Cerebral Hemorrhage/complications, Cerebral Infarction/complications/prevention & control, Cerebrovascular Accident/complications/*prevention & control, Cohort Studies, Cross-Sectional Studies, Female, Hospitalization, Humans, Male, Middle Aged, Platelet Aggregation Inhibitors/therapeutic use, Recurrence, Risk Factors
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:umu:diva-12952DOI: 10.1046/j.0954-6820.2003.01253.xPubMedID: 14687235OAI: oai:DiVA.org:umu-12952DiVA: diva2:152623
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digitalisering@umu
Available from: 2007-04-25 Created: 2007-04-25 Last updated: 2015-04-10Bibliographically approved
In thesis
1. Stroke care in Sweden: Hospital care and patient follow-up based on Riks-Stroke, the National Quality Register for Stroke Care
Open this publication in new window or tab >>Stroke care in Sweden: Hospital care and patient follow-up based on Riks-Stroke, the National Quality Register for Stroke Care
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2003. 92 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 838
Keyword
stroke care, quality register, routine clinical practice, validation, sex differences, stroke units, atrial fibrillation, oral anticoagulants, post-stroke fatigue
National Category
Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-94114 (URN)91-7305-426-7 (ISBN)
Public defence
2003-05-28, Tandläkarhögskolan, sal B, 9 trp., Umeå universitet, Umeå, 13:00
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digitalisering@umu
Note

Diss. (sammanfattning) Umeå : Umeå universitet, 2003

Available from: 2014-10-17 Created: 2014-10-03 Last updated: 2015-04-08Bibliographically approved

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Glader, Eva-LottaStegmayr, BirgittaAsplund, Kjell

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