Trends in the prevalence and management of pre-stroke atrial fibrillation, the South London Stroke Register, 1995-2014Reportar como inadecuado




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Background

Previous studies have found low use of anticoagulation prior to stroke, in people with atrial fibrillation AF. This study examined data on patients with AF-related stroke from a population-based stroke register, and sought to examine changes in management of AF prior to stroke, and reasons for suboptimal treatment, in those who were known to be at a high risk of stroke.

Methods

The South London Stroke Register SLSR is an ongoing population-based register recording first-in-a-lifetime stroke. Trends in the prevalence of AF, and antithrombotic medication prescribed before the stroke, were investigated from 1995 to 2014. Multivariable logistic regression analyses were conducted to assess the factors associated with appropriate management.

Results

Of the 5041 patients on the register, 816 16.2% were diagnosed with AF before their stroke. AF related stroke increased substantially among Black Carribean and Black African patients, comprising 5% of the overall cohort in 1995–1998, increasing to 25% by 2011–2014 p<0.001. Anticoagulant prescription in AF patients at high-risk of stroke CHADS2 score > = 2 increased from 9% 1995–1998 to 30% 2011–2014 p<0.001. Antiplatelet prescription was more commonly prescribed throughout all time periods 43% to 64% of high-risk patients. Elderly patients >65 were significantly less likely to be prescribed an anticoagulant, with ethnicity, gender and deprivation showing no association with anticoagulation.

Conclusions

Most AF-related strokes occurred in people who could have been predicted to be at high risk before their stroke, yet were not prescribed optimal preventative treatment. The elderly,despite being at highest stroke risk, were rarely prescribed anticoagulants.



Autor: Vageesh Jain , Iain J. Marshall, Siobhan L. Crichton, Christopher McKevitt, Anthony G. Rudd, Charles D. A. Wolfe

Fuente: http://plos.srce.hr/



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