title: Secondary stroke prevention in atrial fibrillation: a challenge in the clinical practice.
abstract: BACKGROUND
  Despite clear evidence for the effectiveness of oral anticoagulation (OA) in patients with atrial fibrillation (AF), there is evidence for the underutilisation of this therapy in the secondary stroke prevention. We therefore investigate the link between the use of OA in stroke patients with AF and favourable clinical outcome following the acute event.
  
  
  METHODS
  The study population was determined by identifying the overlap of two different databases: a stroke registry and claims data of a health insurance company. Baseline data originated from the registry; documented dementia and the prescriptions for OA were derived from the insurance database. Patients with AF, minor physical impairment, and evidence of more than 30 days without further hospitalisation within the subsequent 90 days after the acute event were selected for the analysis.
  
  
  RESULTS
  1828 patients were selected (mean age 77.6 years), 1064 patients (58.2%) were female. 827 patients (45%) received a prescription for OA. The following factors were independently associated with no prescription for oral anticoagulants: increased age (OR: 0.54, CI: 0.46-0.63; P < 0.0001), female sex (OR: 0.77, CI: 0.63-0.94; P < 0.011), worsening disability status at discharge (OR: 0.88, CI: 0.81-0.96; P < 0.006), and documented dementia (OR: 0.54, CI: 0.39-0.73; P < 0.001). Conversely, treatment in a neurological department was associated with prescription for OA (OR: 1.47, CI: 1.19-1.81; P < 0.003).
  
  
  CONCLUSIONS
  In more than half of the patients with AF who suffered a stroke OA was not prescribed. The factors associated with reluctance in prescribing anticoagulants are increasing age, female sex, treatment at a non-neurological department, worsening disability, and dementia.
authors.forename: Christian
authors.initials: C
authors.lastname: Tanislav
authors.forename: Sonja
authors.initials: S
authors.lastname: Milde
authors.forename: Sabine
authors.initials: S
authors.lastname: Schwartzkopff
authors.forename: Nicole
authors.initials: N
authors.lastname: Sieweke
authors.forename: Heidrun Helga
authors.initials: HH
authors.lastname: Krämer
authors.forename: Martin
authors.initials: M
authors.lastname: Juenemann
authors.forename: Björn
authors.initials: B
authors.lastname: Misselwitz
authors.forename: Manfred
authors.initials: M
authors.lastname: Kaps
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D016208:Databases, Factual / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012042:Registries; D055502:Secondary Prevention; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants