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

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.

• Authors: Karl Georg Haeusler, Andrea Gerth, Tobias Limbourg, Ulrich Tebbe, Michael Oeff, Karl Wegscheider, András Treszl, Ursula Ravens, Thomas Meinertz, Paulus Kirchhof, Günter Breithardt, Gerhard Steinbeck, Michael Nabauer, AFNET registry investigators
• Journal: BMC neurology (BMC Neurol) Vol. 15 Pg. 129 (Aug 05 2015) ISSN: 1471-2377 [Electronic] England
• PMID: 26242880 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)

Chemical References

• Anticoagulants
• Vitamin K
• Warfarin

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anticoagulants (therapeutic use)
• Atrial Fibrillation (complications, drug therapy)
• Cardiology (statistics & numerical data)
• Female
• General Practitioners (statistics & numerical data)
• Germany
• Guideline Adherence (statistics & numerical data)
• Hospitals
• Hospitals, University (statistics & numerical data)
• Humans
• Internal Medicine (statistics & numerical data)
• Ischemic Attack, Transient (etiology, prevention & control)
• Male
• Middle Aged
• Practice Guidelines as Topic
• Practice Patterns, Physicians' (statistics & numerical data)
• Prospective Studies
• Registries
• Risk Factors
• Secondary Prevention (statistics & numerical data)
• Stroke (etiology, prevention & control)
• Survivors
• Vitamin K (antagonists & inhibitors)
• Warfarin (therapeutic use)
• Young Adult