TY - JOUR
T1 - Improvement in use of anticoagulation therapy in patients with ischemic stroke
T2 - Results from Get with the Guidelines-Stroke
AU - Lewis, William R.
AU - Fonarow, Gregg C.
AU - Grau-Sepulveda, Maria V.
AU - Smith, Eric E.
AU - Bhatt, Deepak L.
AU - Hernandez, Adrian F.
AU - Olson, Daiwai
AU - Peterson, Eric D.
AU - Schwamm, Lee H.
N1 - Funding Information:
Funding/Support: The Get With The Guidelines–Stroke (GWTG-Stroke) Program is provided by the American Heart Association/American Stroke Association. The GWTG-Stroke Program is currently supported, in part, by a charitable contribution from Ortho-McNeil. The GWTG-Stroke has been funded in the past through support from Boeringher-Ingelheim, Merck, Bristol-Myers Squib/Sanofi Pharmaceutical Partnership, and the American Heart Association Pharmaceutical Roundtable.
Funding Information:
Conflicts of interest: William Lewis, MD, received honoraria from Boston Scientific and Boehringer Ingelheim (Modest). Gregg C. Fonarow, MD, received research grants from NHLBI (significant) and honoraria from Medtronic (modest) and is a consultant of Novartis (significant) and Pfizer (modest). Eric E. Smith, MD, MPH, received a research grant: from the National Institutes of Health (R01 NS062028), Alberta Innovates–Health Solutions (funded by the Alberta Heritage Foundation for Medical Research), Canadian Institutes for Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, and the Hotchkiss Brain Institute, as well as honoraria from BMJ Group, QuantiaMD, and Canadian Conference on Dementia; he is also a member of the advisory board of Genentech. Deepak L. Bhatt, MD, MPH, received research grants from Astra Zeneca, Bristol-Myers Squibb, Eisai, Sanofi Aventis, and The Medicines Company. Adrian F. Hernandez, MD, received research grants from Johnson and Johnson. Eric D. Peterson, MD, MPH, is a principal investigator of a data analysis center for GWTG-Stroke, funded by the American Heart Association; received a research grant from Merck, Bristol-Myers Squibb, Sanofi Aventis, Eli Lilly, and Ortho-McNeil Pharmaceuticals; and is a consultant of Boehringer Ingleheim. DaiWai Olson, PhD, RN, received a research grant from Bristol-Myers Squibb. Other authors report no conflicts.
PY - 2011/10
Y1 - 2011/10
N2 - Background: Anticoagulation therapy reduces thromboembolic events in patients with atrial fibrillation (AF) and has a class I indication for ischemic stroke patients with AF and no contraindications. We determined the patient and hospital level characteristics associated with an increased use of anticoagulation, including participation in the Get With The Guidelines-Stroke (GWTG-Stroke) Program. Methods: We assessed the use of anticoagulation at hospital discharge in eligible AF patients with stroke or transient ischemic attack (TIA) at 1,354 participating hospitals between April 1, 2003, and April 1, 2010. Results: Patients with AF (n = 197,778) represented 20.5% of patients with ischemic stroke/TIA. Among patients with AF, 47.6% (n = 94,119) were deemed eligible for anticoagulation, and of these, 94.0% were discharged on therapy. Older patients, African American or Hispanic patients, and those with diabetes were less likely to receive anticoagulation. Hospitals with a higher volume of patients with stroke were more likely to treat with anticoagulation. The Joint Commission Primary Stroke Centers were also more likely to treat eligible patients (odds ratio 2.16, 95% CI 1.82-2.56, P <.0001). From 2003 to 2010, contraindications to anticoagulation therapy declined from 69.7% to 28.4% (P <.0001 for trend). Anticoagulation among eligible patients improved from 88.4% to 95.2% (P <.0001) for 7 years of participation. Time in GWTG-Stroke was associated with improved anticoagulation use (adjusted odds ratio per year in program, 1.11, 95% CI 1.06-1.16, P <.001). Conclusions: Use of anticoagulation among stroke patients with AF has increased to very high levels overall in GWTG-Stroke over time. Future efforts should focus on improving use among selected populations.
AB - Background: Anticoagulation therapy reduces thromboembolic events in patients with atrial fibrillation (AF) and has a class I indication for ischemic stroke patients with AF and no contraindications. We determined the patient and hospital level characteristics associated with an increased use of anticoagulation, including participation in the Get With The Guidelines-Stroke (GWTG-Stroke) Program. Methods: We assessed the use of anticoagulation at hospital discharge in eligible AF patients with stroke or transient ischemic attack (TIA) at 1,354 participating hospitals between April 1, 2003, and April 1, 2010. Results: Patients with AF (n = 197,778) represented 20.5% of patients with ischemic stroke/TIA. Among patients with AF, 47.6% (n = 94,119) were deemed eligible for anticoagulation, and of these, 94.0% were discharged on therapy. Older patients, African American or Hispanic patients, and those with diabetes were less likely to receive anticoagulation. Hospitals with a higher volume of patients with stroke were more likely to treat with anticoagulation. The Joint Commission Primary Stroke Centers were also more likely to treat eligible patients (odds ratio 2.16, 95% CI 1.82-2.56, P <.0001). From 2003 to 2010, contraindications to anticoagulation therapy declined from 69.7% to 28.4% (P <.0001 for trend). Anticoagulation among eligible patients improved from 88.4% to 95.2% (P <.0001) for 7 years of participation. Time in GWTG-Stroke was associated with improved anticoagulation use (adjusted odds ratio per year in program, 1.11, 95% CI 1.06-1.16, P <.001). Conclusions: Use of anticoagulation among stroke patients with AF has increased to very high levels overall in GWTG-Stroke over time. Future efforts should focus on improving use among selected populations.
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U2 - 10.1016/j.ahj.2011.07.019
DO - 10.1016/j.ahj.2011.07.019
M3 - Article
C2 - 21982662
AN - SCOPUS:80053649973
SN - 0002-8703
VL - 162
SP - 692-699.e2
JO - American heart journal
JF - American heart journal
IS - 4
ER -