Abstract
Background: To determine association of discharge antiplatelet therapy prescription with 1-year outcomes among patients with AF admitted with acute ischemic stroke and discharged without oral anticoagulation. Methods: In a retrospective cohort study from the Get With The Guidelines-Stroke registry, we identified all Medicare fee-for-service beneficiaries 65 years or older with AF or atrial flutter admitted with acute ischemic stroke and discharged without oral anticoagulation from April 2003 through December 2014, and we determined association of discharge antiplatelet therapy prescription with 1-year outcomes using Medicare claims data. Primary outcomes were 1-year mortality and composite endpoint of major adverse cardiovascular/neurologic/bleeding events (MACNBE). Results: Of 64,228 subjects (median [interquartile range] age, 84 [78–89] years; 62.5% female), 54,621 (85.0%) were discharged with antiplatelet therapy, and 9607 (15.0%) were discharged with no antithrombotic therapy. The unadjusted rates of 1-year mortality were lower among patients receiving antiplatelet therapy (37.3%) than among those receiving no antithrombotic therapy (48.1%); unadjusted rates of MACNBE were lower for those receiving antiplatelet therapy (45.5%) compared with those receiving no antithrombotic therapy (55.2%). After adjusting for potential confounders, antiplatelet therapy prescription was associated with reduced 1-year mortality (adjusted hazard ratio [HR] 0.64, 95% confidence interval [CI] 0.62–0.66, P <.001) and MACNBE (adjusted HR 0.69, 95% CI 0.67–0.71, P <.001). Conclusions: Among Medicare beneficiaries with AF admitted for acute ischemic stroke but not discharged on oral anticoagulant therapy, antiplatelet therapy, compared with no antithrombotic therapy, was associated with reduced 1-year mortality and MACNBE.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 88-94 |
| Number of pages | 7 |
| Journal | International Journal of Cardiology |
| Volume | 321 |
| DOIs | |
| State | Published - Dec 15 2020 |
| Externally published | Yes |
Keywords
- Acute ischemic stroke
- Antiplatelet
- Atrial fibrillation
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
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In: International Journal of Cardiology, Vol. 321, 15.12.2020, p. 88-94.
Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - Antiplatelet patterns and outcomes in patients with atrial fibrillation not prescribed an anticoagulant after stroke
AU - Chang, Kay Won
AU - Xian, Ying
AU - Zhao, Xin
AU - Mi, Xiaojuan
AU - Matsouaka, Roland
AU - Schwamm, Lee H.
AU - Shah, Shreyansh
AU - Lytle, Barbara L.
AU - Smith, Eric E.
AU - Bhatt, Deepak L.
AU - Fonarow, Gregg C.
AU - Hsu, Jonathan C.
N1 - Funding Information: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr. Xian reported receiving research funding to Duke Clinical Research Institute from the American Heart Association , Daiichi Sankyo , Janssen Pharmaceuticals , and Genentech . Dr. Schwamm reported serving as a consultant for the Massachusetts Department of Public Health and Medtronic; serving on an independent international steering committee for Lundbeck; serving on an independent data and safety monitoring committee for Penumbra; receiving grants from the National Institute of Neurological Disorders and Stroke and Genentech ; serving as the principal investigator of an investigator-initiated study of extended-window intravenous thrombolysis funded by the National Institute of Neurological Disorders and Stroke, for which Genentech provides alteplase free of charge to Massachusetts General Hospital as well as supplemental per-patient payments to participating sites; and serving as chair of the American Heart Association/American Stroke Association Get With the Guidelines–Stroke (GWTG-Stroke) ClinicalWork Group. Dr. Smith reported serving on the steering committee of the GWTG program. Dr. Bhatt discloses the following relationships - Advisory Board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSoft; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic, Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi Sankyo), Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org ; Vice-Chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), HMP Global (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co-leader, funded by Bayer), Slack Publications (Chief Medical Editor, Cardiology Today's Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Abbott , Amarin , Amgen , AstraZeneca , Bayer , Boehringer Ingelheim , Bristol-Myers Squibb , Chiesi , Eisai , Ethicon , Forest Laboratories , Idorsia , Ironwood , Ischemix , Lilly , Medtronic , PhaseBio , Pfizer , Regeneron , Roche , Sanofi Aventis , Synaptic , The Medicines Company ; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald's Heart Disease); Site Co-Investigator: Biotronik, Boston Scientific, St. Jude Medical (now Abbott), Svelte; Trustee: American College of Cardiology; Unfunded Research: FlowCo, Merck, Novo Nordisk, PLx Pharma, Takeda. Dr. Fonarow reported receiving research support from the Patient-Centered Outcomes Research Institute ; serving as a steering committee member for GWTG; and being an employee of the Regents of the University of California, which has a patent on endovascular devices. Dr. Hsu reported receiving honoraria from Medtronic, Abbott, Boston Scientific, Biotronik, Biosense-Webster, Janssen Pharmaceuticals, and Bristol-Myers Squibb; receiving research grants from Biotronik and Biosense-Webster . No other disclosures were reported. Funding Information: This work was supported by the American Heart Association / American Stroke Association (AHA/ASA) Young Investigator Database Research Seed Grant to XYZ. The GWTG-Stroke program is provided by the AHA/ASA. GWTG-Stroke is sponsored, in part, by Medtronic and has been funded in the past through support from Boeringher-Ingelheim , Merck , Bristol-Myers Squib / Sanofi Pharmaceutical Partnership , Janseen Pharmaceutical Companies of Johnson & Johnson , and the AHA Pharmaceutical Roundtable . Funding Information: This work was supported by the American Heart Association/American Stroke Association (AHA/ASA) Young Investigator Database Research Seed Grant to XYZ. The GWTG-Stroke program is provided by the AHA/ASA. GWTG-Stroke is sponsored, in part, by Medtronic and has been funded in the past through support from Boeringher-Ingelheim, Merck, Bristol-Myers Squib/Sanofi Pharmaceutical Partnership, Janseen Pharmaceutical Companies of Johnson & Johnson, and the AHA Pharmaceutical Roundtable.All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr. Xian reported receiving research funding to Duke Clinical Research Institute from the American Heart Association, Daiichi Sankyo, Janssen Pharmaceuticals, and Genentech. Dr. Schwamm reported serving as a consultant for the Massachusetts Department of Public Health and Medtronic; serving on an independent international steering committee for Lundbeck; serving on an independent data and safety monitoring committee for Penumbra; receiving grants from the National Institute of Neurological Disorders and Stroke and Genentech; serving as the principal investigator of an investigator-initiated study of extended-window intravenous thrombolysis funded by the National Institute of Neurological Disorders and Stroke, for which Genentech provides alteplase free of charge to Massachusetts General Hospital as well as supplemental per-patient payments to participating sites; and serving as chair of the American Heart Association/American Stroke Association Get With the Guidelines–Stroke (GWTG-Stroke) ClinicalWork Group. Dr. Smith reported serving on the steering committee of the GWTG program. Dr. Bhatt discloses the following relationships - Advisory Board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSoft; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic, Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi Sankyo), Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Vice-Chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), HMP Global (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co-leader, funded by Bayer), Slack Publications (Chief Medical Editor, Cardiology Today's Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Abbott, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi Aventis, Synaptic, The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald's Heart Disease); Site Co-Investigator: Biotronik, Boston Scientific, St. Jude Medical (now Abbott), Svelte; Trustee: American College of Cardiology; Unfunded Research: FlowCo, Merck, Novo Nordisk, PLx Pharma, Takeda. Dr. Fonarow reported receiving research support from the Patient-Centered Outcomes Research Institute; serving as a steering committee member for GWTG; and being an employee of the Regents of the University of California, which has a patent on endovascular devices. Dr. Hsu reported receiving honoraria from Medtronic, Abbott, Boston Scientific, Biotronik, Biosense-Webster, Janssen Pharmaceuticals, and Bristol-Myers Squibb; receiving research grants from Biotronik and Biosense-Webster. No other disclosures were reported. Publisher Copyright: © 2020 Elsevier B.V.
PY - 2020/12/15
Y1 - 2020/12/15
N2 - Background: To determine association of discharge antiplatelet therapy prescription with 1-year outcomes among patients with AF admitted with acute ischemic stroke and discharged without oral anticoagulation. Methods: In a retrospective cohort study from the Get With The Guidelines-Stroke registry, we identified all Medicare fee-for-service beneficiaries 65 years or older with AF or atrial flutter admitted with acute ischemic stroke and discharged without oral anticoagulation from April 2003 through December 2014, and we determined association of discharge antiplatelet therapy prescription with 1-year outcomes using Medicare claims data. Primary outcomes were 1-year mortality and composite endpoint of major adverse cardiovascular/neurologic/bleeding events (MACNBE). Results: Of 64,228 subjects (median [interquartile range] age, 84 [78–89] years; 62.5% female), 54,621 (85.0%) were discharged with antiplatelet therapy, and 9607 (15.0%) were discharged with no antithrombotic therapy. The unadjusted rates of 1-year mortality were lower among patients receiving antiplatelet therapy (37.3%) than among those receiving no antithrombotic therapy (48.1%); unadjusted rates of MACNBE were lower for those receiving antiplatelet therapy (45.5%) compared with those receiving no antithrombotic therapy (55.2%). After adjusting for potential confounders, antiplatelet therapy prescription was associated with reduced 1-year mortality (adjusted hazard ratio [HR] 0.64, 95% confidence interval [CI] 0.62–0.66, P <.001) and MACNBE (adjusted HR 0.69, 95% CI 0.67–0.71, P <.001). Conclusions: Among Medicare beneficiaries with AF admitted for acute ischemic stroke but not discharged on oral anticoagulant therapy, antiplatelet therapy, compared with no antithrombotic therapy, was associated with reduced 1-year mortality and MACNBE.
AB - Background: To determine association of discharge antiplatelet therapy prescription with 1-year outcomes among patients with AF admitted with acute ischemic stroke and discharged without oral anticoagulation. Methods: In a retrospective cohort study from the Get With The Guidelines-Stroke registry, we identified all Medicare fee-for-service beneficiaries 65 years or older with AF or atrial flutter admitted with acute ischemic stroke and discharged without oral anticoagulation from April 2003 through December 2014, and we determined association of discharge antiplatelet therapy prescription with 1-year outcomes using Medicare claims data. Primary outcomes were 1-year mortality and composite endpoint of major adverse cardiovascular/neurologic/bleeding events (MACNBE). Results: Of 64,228 subjects (median [interquartile range] age, 84 [78–89] years; 62.5% female), 54,621 (85.0%) were discharged with antiplatelet therapy, and 9607 (15.0%) were discharged with no antithrombotic therapy. The unadjusted rates of 1-year mortality were lower among patients receiving antiplatelet therapy (37.3%) than among those receiving no antithrombotic therapy (48.1%); unadjusted rates of MACNBE were lower for those receiving antiplatelet therapy (45.5%) compared with those receiving no antithrombotic therapy (55.2%). After adjusting for potential confounders, antiplatelet therapy prescription was associated with reduced 1-year mortality (adjusted hazard ratio [HR] 0.64, 95% confidence interval [CI] 0.62–0.66, P <.001) and MACNBE (adjusted HR 0.69, 95% CI 0.67–0.71, P <.001). Conclusions: Among Medicare beneficiaries with AF admitted for acute ischemic stroke but not discharged on oral anticoagulant therapy, antiplatelet therapy, compared with no antithrombotic therapy, was associated with reduced 1-year mortality and MACNBE.
KW - Acute ischemic stroke
KW - Antiplatelet
KW - Atrial fibrillation
UR - http://www.scopus.com/inward/record.url?scp=85089826719&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85089826719&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2020.08.011
DO - 10.1016/j.ijcard.2020.08.011
M3 - Article
C2 - 32805327
AN - SCOPUS:85089826719
SN - 0167-5273
VL - 321
SP - 88
EP - 94
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -