Abstract
Introduction: Several studies have observed suboptimal prescribing of oral anticoagulants (OAC) in patients with atrial fibrillation (AF). This occurs especially in older patients, despite higher risk for first or recurrent stroke. The decision not to recommend anticoagulation may be influenced by a wide range of factors.
Aims: To determine the patient factors (age, gender, living circumstances and comorbidities) associated with post-stroke OAC prescribing in a national cohort of stroke survivors with atrial fibrillation.
Methods: A retrospective cohort observational study, using a linked dataset of the Scottish Stroke Care Audit (2010-15), Prescribing Information System and the Scottish Morbidity Record. Multivariate logistic regression analysis was done to calculate the odds of OAC prescribing within six months post-stroke, adjusting for the following patient factors: age, gender, deprivation, year of admission, stroke subtype, stroke severity (six simple variables), comorbidity count and concomitant medication use.
Results: Overall, 8129 stroke survivors had confirmed AF; 4817 (59.3%) were prescribed OAC within the six months post-stroke. Older patients were less likely to be prescribed an OAC (adjusted Odds Ratio (aOR) 0.97, 95% Confidence Interval (CI) 0.96-0.98). There was no significant difference between male and female OAC prescribing (aOR 0.92, CI 0.79 - 1.07) or whether living alone before stroke (aOR 0.928, CI 0.78 - 1.08). Independent in activities of daily living before stroke (aOR 2.09, CI 1.69 - 2.59) and orientated at baseline assessment (aOR 1.51, CI 1.25 - 1.84) were both associated with more OAC prescriptions. Patients who lived in less deprived areas were more likely to be prescribed an OAC. Number of comorbidities significantly influenced prescribing; patients with 1-3 comorbidities (aOR 0.71, CI 0.60 - 0.84), and ≥ 4 comorbidities (aOR 0.46, CI 0.34 - 0.625) respectively were less likely to be prescribed an OAC compared to patients with no comorbidities.
Conclusions: Lower OAC prescribing in older age may also reflect prior dependence, social deprivation and multiple comorbidities. Promoting appropriate stroke prevention in higher risk patients who may still benefit from OAC requires ongoing attention.
Aims: To determine the patient factors (age, gender, living circumstances and comorbidities) associated with post-stroke OAC prescribing in a national cohort of stroke survivors with atrial fibrillation.
Methods: A retrospective cohort observational study, using a linked dataset of the Scottish Stroke Care Audit (2010-15), Prescribing Information System and the Scottish Morbidity Record. Multivariate logistic regression analysis was done to calculate the odds of OAC prescribing within six months post-stroke, adjusting for the following patient factors: age, gender, deprivation, year of admission, stroke subtype, stroke severity (six simple variables), comorbidity count and concomitant medication use.
Results: Overall, 8129 stroke survivors had confirmed AF; 4817 (59.3%) were prescribed OAC within the six months post-stroke. Older patients were less likely to be prescribed an OAC (adjusted Odds Ratio (aOR) 0.97, 95% Confidence Interval (CI) 0.96-0.98). There was no significant difference between male and female OAC prescribing (aOR 0.92, CI 0.79 - 1.07) or whether living alone before stroke (aOR 0.928, CI 0.78 - 1.08). Independent in activities of daily living before stroke (aOR 2.09, CI 1.69 - 2.59) and orientated at baseline assessment (aOR 1.51, CI 1.25 - 1.84) were both associated with more OAC prescriptions. Patients who lived in less deprived areas were more likely to be prescribed an OAC. Number of comorbidities significantly influenced prescribing; patients with 1-3 comorbidities (aOR 0.71, CI 0.60 - 0.84), and ≥ 4 comorbidities (aOR 0.46, CI 0.34 - 0.625) respectively were less likely to be prescribed an OAC compared to patients with no comorbidities.
Conclusions: Lower OAC prescribing in older age may also reflect prior dependence, social deprivation and multiple comorbidities. Promoting appropriate stroke prevention in higher risk patients who may still benefit from OAC requires ongoing attention.
| Original language | English |
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| Title of host publication | Stroke |
| DOIs | |
| Publication status | Published - 12 Feb 2020 |