title: In-hospital case management to increase anticoagulation therapy for stroke patients with atrial fibrillation: a hospital-based registry.
abstract: OBJECTIVE
  Anticoagulation is underused for stroke patients with atrial fibrillation in Taiwan. An effective preventive measure is in great need of improvement.
  
  
  METHODS
  In-hospital case management was implemented to monitor the diagnosis of atrial fibrillation and the use of warfarin. Timely feedback to treating physicians was made. Change in performance after the implementation was analyzed.
  
  
  RESULTS
  A total of 2754 patients hospitalized for acute ischemic stroke or transient ischemic attack were included, 1216 before and 1538 after the intervention. The percentage of patients without electrocardiography examination decreased from 8.7% to 2.9% (p < 0.001). The diagnosis of atrial fibrillation increased from 11.5% (n = 140) to 15.9% (n = 244) (p = 0.001). The use of warfarin at discharge increased from 36.9% to 54.7% (p = 0.001). In-hospital case management was significantly related to the use of warfarin (odds ratio = 2.47, p < 0.001). The percentage of warfarin use was still significantly higher in the intervention group at 3 months of follow-up (45.9% vs. 27.8%, p = 0.002) and at 6 months of follow up (49.2% vs. 28.6%, p = 0.004). More patients' international normalized ratio was within the recommended range in the intervention group at 6 months' follow-up (30.5% vs. 9.1%, p = 0.039).
  
  
  CONCLUSIONS
  Our study indicates that in-hospital case management may be an effective strategy to improve anticoagulation for eligible stroke patients.
authors: Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan. sunmc@yahoo.com
authors: Mu-Chien
authors: MC
authors: Sun
authors: Pi-Ju
authors: PJ
authors: Hsiao
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D019090:Case Management; D005260:Female; D006761:Hospitals; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D012042:Registries; D020521:Stroke / Q000188:drug therapy*; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin