J Clin Neurol.  2016 Jan;12(1):34-41. 10.3988/jcn.2016.12.1.34.

Adherence to Guidelines for Antithrombotic Therapy in Patients with Atrial Fibrillation According to CHADS2 Score before and after Stroke: A Multicenter Observational Study from Korea

• Kim WJ
• Park JM
• Kang K
• Cho YJ
• Hong KS
• Lee SJ
• Ko Y
• Lee KB
• Park TH
• Lee J
• Cha JK
• Kim DH
• Yu KH
• Lee BC
• Oh MS
• Lee J
• Lee J
• Jang MS
• Han MK
• Bae HJ

• KMID: 2364917
• DOI: http://doi.org/10.3988/jcn.2016.12.1.34

Abstract

BACKGROUND AND PURPOSE
A substantial proportion of patients with atrial fibrillation (AF) are not treated optimally; however, the inappropriateness of drug therapy has never been evaluated before or after a stroke event. We investigated the adherence to guidelines for therapy in AF patients hospitalized with acute ischemic stroke (AIS) before stroke onset and at discharge, with the aim of identifying the factors associated with inappropriate therapy.
METHODS
AIS patients with AF hospitalized within 7 days of onset were identified from a prospective nine-center stroke registry database. Two cohorts were defined: patients diagnosed with AF prior to the stroke event (admission cohort) and patients diagnosed with AF at discharge from hospital (discharge cohort). Any of the following conditions were regarded as nonadherence to guidelines in this study: use of anticoagulant or nonuse of antithrombotics with CHADS2 score=0, nonuse of antithrombotics with CHADS2 score=1, or nonuse of anticoagulant with CHADS2 score > or =2.
RESULTS
Overall, 406 patients were enrolled in the admission cohort and 518 in the discharge cohort. The rates of nonadherence before a stroke event and at discharge were 77.8% and 33.3%, respectively. These rates varied widely for both cohorts, with interhospital differences being statistically significant. Multivariable analysis revealed that old age, stroke history, and congestive heart failure were associated with nonadherence before stroke. At discharge, males, coronary heart disease, inappropriate antithrombotic use before stroke, and functional disability at discharge were associated with nonadherence.
CONCLUSIONS
This study shows that antithrombotic use in AIS patients with AF might be not optimal before and after stroke in Korea.

Keyword

atrial fibrillation; drug utilization review; cerebral infarction; guideline adherence

MeSH Terms

Atrial Fibrillation*
Cerebral Infarction
Cohort Studies
Coronary Disease
Drug Therapy
Drug Utilization Review
Guideline Adherence
Heart Failure
Humans
Korea*
Male
Morinda
Observational Study*
Prospective Studies
Stroke*

Figure

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  Fig. 1 Inappropriateness of antithrombotic use among participating centers in the admission and discharge cohorts.

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