TY - JOUR
T1 - Shifting Perceptions of Risk and Reward
T2 - Use of Anticoagulation in Patients with Acute Brain Ischemia and Atrial Fibrillation: Nine-Year Data from a National Acute Stroke Registry (National Acute Stroke Israeli Survey [NASIS])
AU - Schwammenthal, Yvonne
AU - Tsabari, Rakefet
AU - Orion, David
AU - Merzlyak, Oleg
AU - Haratz, Salo
AU - Peretz, Shlomi
AU - Bornstein, Natan M.
AU - Ifergane, Gal
AU - Einhorn, Michal
AU - Schwammenthal, Ehud
AU - Geva, Diklah
AU - Tanne, David
N1 - Publisher Copyright:
© 2017 American Heart Association, Inc.
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Background and Purpose-Despite overwhelming evidence for the benefits of anticoagulation in patients with brain ischemia and atrial fibrillation, vast underuse has been reported. Methods-Use of anticoagulation for secondary stroke prevention was assessed in the National Acute Stroke Israeli Survey registry (NASIS) of hospitalized patients with atrial fibrillation and acute brain ischemia. Logistic regression analysis was performed to evaluate the effects of clinical covariates on anticoagulation therapy at discharge, and anticoagulation use over time was assessed in subgroups of patients with identified barriers to anticoagulation utilization. Results-There were 1254 survivors of acute brain ischemia with atrial fibrillation (mean age 77.2±10.6 years; 57.7% female). Between 2004 and 2013, the proportion of patients discharged on anticoagulation increased from 55% to 76.2%, and among those without perceived contraindications from 70% to 96% (P<0.0001). Older age, greater stroke severity, earlier registry period, and presence of contraindications were independent predictors of withholding therapy. Increased anticoagulation use over the years was observed even in patients with barriers to anticoagulation use, including patients with potential contraindications (P<0.001). Conclusions-In survivors of acute brain ischemia with atrial fibrillation, we observed a substantial increase in anticoagulation utilization within less than a decade. This change was mainly driven by greater utilization of anticoagulation in subgroups with traditional clinical barriers to anticoagulation use, indicating a shift in physicians' perceptions of the risk-benefit ratio of anticoagulation.
AB - Background and Purpose-Despite overwhelming evidence for the benefits of anticoagulation in patients with brain ischemia and atrial fibrillation, vast underuse has been reported. Methods-Use of anticoagulation for secondary stroke prevention was assessed in the National Acute Stroke Israeli Survey registry (NASIS) of hospitalized patients with atrial fibrillation and acute brain ischemia. Logistic regression analysis was performed to evaluate the effects of clinical covariates on anticoagulation therapy at discharge, and anticoagulation use over time was assessed in subgroups of patients with identified barriers to anticoagulation utilization. Results-There were 1254 survivors of acute brain ischemia with atrial fibrillation (mean age 77.2±10.6 years; 57.7% female). Between 2004 and 2013, the proportion of patients discharged on anticoagulation increased from 55% to 76.2%, and among those without perceived contraindications from 70% to 96% (P<0.0001). Older age, greater stroke severity, earlier registry period, and presence of contraindications were independent predictors of withholding therapy. Increased anticoagulation use over the years was observed even in patients with barriers to anticoagulation use, including patients with potential contraindications (P<0.001). Conclusions-In survivors of acute brain ischemia with atrial fibrillation, we observed a substantial increase in anticoagulation utilization within less than a decade. This change was mainly driven by greater utilization of anticoagulation in subgroups with traditional clinical barriers to anticoagulation use, indicating a shift in physicians' perceptions of the risk-benefit ratio of anticoagulation.
KW - Atrial fibrillation
KW - Brain ischemia
KW - Odds ratio
KW - Stroke
KW - Survivors
UR - http://www.scopus.com/inward/record.url?scp=85014517867&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.116.015776
DO - 10.1161/STROKEAHA.116.015776
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AN - SCOPUS:85014517867
SN - 0039-2499
VL - 48
SP - 1092
EP - 1094
JO - Stroke
JF - Stroke
IS - 4
ER -