title: Clinical consequences of hospital variation in use of oral anticoagulant therapy after first-time admission for atrial fibrillation.
abstract: OBJECTIVE
  To analyse how hospital factors influence the use of oral anticoagulants (OAC) in atrial fibrillation (AF) patients and address the clinical consequences of hospital variation in OAC use.
  
  
  METHODS
  By linkage of nationwide Danish administrative registers we conducted an observational study including all patients with a first-time hospitalization for AF between 1995 and 2004 as well as prescription claims for OAC. Multivariable logistic regression analysis was used to evaluate hospital factors associated with prescription of OAC therapy. Cox proportional-hazard models were used to estimate the risk of re-hospitalization for thromboembolism and haemorrhagic stroke with respect to discharge from a low, intermediate, or high OAC use hospital.
  
  
  RESULTS
  Overall 40,133 (37%) out of 108,504 patients received OAC; ranging from 17% to 50% between the hospitals with the lowest and highest OAC use, respectively. Cardiology departments had the highest use of OAC, but neither tertiary university hospitals nor high volume hospitals had higher OAC use than local community hospitals and low volume hospitals. Risk of a thromboembolic event was significantly increased amongst patients from hospitals with a low OAC use (hazard ratio 1.16, confidence interval 1.10-1.22). Notably, higher OAC use was not associated with a higher risk of haemorrhagic stroke.
  
  
  CONCLUSIONS
  In Denmark between 1995 and 2004, there was a major hospital variation in AF patients receiving OAC, and consequently, more thromboembolic events were observed amongst patients from low OAC use hospitals. Our study emphasizes the need for a continued vigilance on implementation of international AF management guidelines.
authors.affiliation: Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark. mlh@heart.dk
authors.forename: M L
authors.initials: ML
authors.lastname: Hansen
authors.forename: N
authors.initials: N
authors.lastname: Gadsbøll
authors.forename: S
authors.initials: S
authors.lastname: Rasmussen
authors.forename: G H
authors.initials: GH
authors.lastname: Gislason
authors.forename: F
authors.initials: F
authors.lastname: Folke
authors.forename: S S
authors.initials: SS
authors.lastname: Andersen
authors.forename: T K
authors.initials: TK
authors.lastname: Schramm
authors.forename: R
authors.initials: R
authors.lastname: Sørensen
authors.forename: E L
authors.initials: EL
authors.lastname: Fosbøl
authors.forename: S Z
authors.initials: SZ
authors.lastname: Abildstrøm
authors.forename: M
authors.initials: M
authors.lastname: Madsen
authors.forename: H E
authors.initials: HE
authors.lastname: Poulsen
authors.forename: L
authors.initials: L
authors.lastname: Køber
authors.forename: C
authors.initials: C
authors.lastname: Torp-Pedersen
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D013923:Thromboembolism / Q000453:epidemiology
chemical_list: D000925:Anticoagulants