title: Outcomes for people with atrial fibrillation in an Australian national audit of stroke care.
abstract: BACKGROUND
  Atrial fibrillation is associated with poorer outcomes poststroke. It is unclear how the quality of stroke care in hospitals influences outcomes in these patients.
  
  
  OBJECTIVE
  The study aims to compare outcomes in stroke patients with and without atrial fibrillation and identify hospital processes of care associated with poor outcomes.
  
  
  METHODS
  Data were collected using retrospective, consecutive medical record audits from participating hospitals in the 2009 and 2011 National Stroke Foundation acute services audit program. Patient characteristics, stroke severity, and hospital management data were compared for those with and without atrial fibrillation. Multiple regression analyses for outcomes of in-hospital death, dependency at discharge (modified Rankin Score 3-5), and discharge destination were undertaken, adjusted for patient clustering by hospital.
  
  
  RESULTS
  Atrial fibrillation status was known for 5473 (80%) cases; 2049 had atrial fibrillation. Atrial fibrillation was independently associated with in-hospital mortality (aOR 1.46, 95% CI 1.06, 2.02). Management on a stroke unit (aOR 0.57, 95% CI 0.40, 0.80) and having a swallow assessment within 24 h (aOR 0.71, 95% CI 0.51, 0.98) were associated with increased survival among all stroke types, as was receiving aspirin within 48 h poststroke (aOR 0.65, 95% CI 0.44, 0.97), for patients with an ischemic stroke. Stroke patients with atrial fibrillation were less likely to receive important processes of care associated with reduced mortality.
  
  
  CONCLUSIONS
  Hospital processes of care can influence outcomes in stroke patients with atrial fibrillation. The greater in-hospital mortality experienced by stroke patients with atrial fibrillation may be attenuated by admission to a stroke unit, and for ischemic stroke, early administration of aspirin.
authors.affiliation: Translational Public Health Unit, Stroke & Ageing Research Centre, Department of Medicine, Monash Medical Centre, Southern Clinical School, Monash University, Clayton, Victoria, Australia.
authors.forename: Nadine
authors.initials: N
authors.lastname: Andrew
authors.forename: Monique
authors.initials: M
authors.lastname: Kilkenny
authors.forename: Dawn
authors.initials: D
authors.lastname: Harris
authors.forename: Chris
authors.initials: C
authors.lastname: Price
authors.forename: Dominique A
authors.initials: DA
authors.lastname: Cadilhac
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D001315:Australia / Q000453:epidemiology; D019468:Disease Management; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D016896:Treatment Outcome
keywords: atrial fibrillation; outcomes; quality of care; stroke care; stroke delivery; stroke units