title: Who gets stroke prevention? Stroke prevention in atrial fibrillation patients in the inpatient setting.
abstract: BACKGROUND
  Current guidelines strongly recommend antithrombotic therapy, particularly warfarin, for stroke prevention in atrial fibrillation (AF) patients at high risk of stroke. Despite this, use of these medications is far from optimal. The aim of this study was to describe the use of stroke prevention medication in inpatients and identify factors associated with prescription in one local health district in Sydney, Australia.
  
  
  METHODS
  A prospective audit of medical records for patients admitted with an AF diagnosis to five hospitals in the health district and excluding cardiac surgery patients was undertaken. Patients were classified as high or low for stroke risk as well as for risk of bleeding and predictors were identified by logistic regression.
  
  
  RESULTS
  A total of 204 patients were enrolled from July 2012 to April 2013, with a mean age of 75 years (SD 13) and half (50%) were male. Valve disease was present in 17% and 15% received a procedure for their AF (cardioversion/ablation/pulmonary vein isolation). Patients were least likely to be prescribed warfarin/novel oral anticoagulant (NOAC) if they were non-valvular and did not undergo cardioversion/ablation (p=.03), and least likely to be prescribed aspirin if they had no AF procedure (p=.01). In non-valvular patients who did not have cardioversion/ablation the odds of being prescribed warfarin/NOAC were increased by being classified at high risk of stroke (OR 3.1, 95% CI 1.0 -9.5) and decreased if there was a prescription for aspirin (OR .3. 95% CI .1 -.6).
  
  
  CONCLUSIONS
  Overall use of stroke prevention medication indicates that gaps remain in translation of evidence into clinical practice.
authors.affiliation: Sydney Nursing School, Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006. Electronic address: robyn.gallagher@sydney.edu.au.
authors.forename: Robyn
authors.initials: R
authors.lastname: Gallagher
authors.affiliation: Ryde Hospital, Northern Sydney Local Health District, NSW.
authors.forename: Kellie
authors.initials: K
authors.lastname: Roach
authors.affiliation: Manly and Mona Vale Hospitals, Northern Sydney Local Health District, NSW.
authors.forename: Leonie
authors.initials: L
authors.lastname: Sadler
authors.affiliation: Hornsby Ku-ring-gai Health Service, Northern Sydney Local Health District, NSW.
authors.forename: Julie
authors.initials: J
authors.lastname: Belshaw
authors.affiliation: Royal North Shore Hospital, Northern Sydney Local Health District, NSW.
authors.forename: Ann
authors.initials: A
authors.lastname: Kirkness
authors.affiliation: Sydney Nursing School, Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006.
authors.forename: Ling
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Royal North Shore Hospital, Northern Sydney Local Health District, NSW.
authors.forename: Ross
authors.initials: R
authors.lastname: Proctor
authors.affiliation: Sydney Nursing School, Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006; The George Institute for Global Health, Camperdown, NSW 2050.
authors.forename: Lis
authors.initials: L
authors.lastname: Neubeck
mesh_terms: D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D001315:Australia / Q000453:epidemiology; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*
keywords: Antithrombotic; Atrial fibrillation; Bleeding risk classification; Stroke prevention; Stroke risk classification