title: Use of vitamin K antagonists for secondary stroke prevention depends on the treating healthcare provider in Germany - results from the German AFNET registry.
abstract: BACKGROUND
  Anticoagulation using vitamin K antagonists (VKAs) significantly reduces the risk of recurrent stroke in stroke patients with atrial fibrillation (AF) and is recommended by guidelines.
  
  
  METHODS
  The German Competence NETwork on Atrial Fibrillation established a nationwide prospective registry including 9,574 AF patients, providing the opportunity to analyse AF management according to German healthcare providers.
  
  
  RESULTS
  On enrolment, 896 (9.4 %) patients reported a prior ischaemic stroke or transient ischaemic attack. Stroke patients were significantly older, more likely to be female, had a higher rate of cardiovascular risk factors, and more frequently received anticoagulation (almost exclusively VKA) than patients without prior stroke history. Following enrolment, 76.4 % of all stroke patients without VKA contraindications received anticoagulation, which inversely associated with age (OR 0.95 per year; 95 % CI 0.92-0.97). General practitioners/internists (OR 0.40; 95 % CI 0.21-0.77) and physicians working in regional hospitals (OR 0.47; 95 % CI 0.29-0.77) prescribed anticoagulation for secondary stroke prevention less frequently than physicians working at university hospitals (reference) and office-based cardiologists (OR 1.40; 95 % CI 0.76-2.60). The impact of the treating healthcare provider was less evident in registry patients without prior stroke.
  
  
  CONCLUSIONS
  In the AFNET registry, anticoagulation for secondary stroke prevention was prescribed in roughly three-quarters of AF patients, a significantly higher rate than in primary prevention. We identified two factors associated with withholding oral anticoagulation in stroke survivors, namely higher age and-most prominently-treatment by a general practitioner/internist or physicians working at regional hospitals.
authors.affiliation: Center for Stroke Research Berlin and Department of Neurology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, D-12200, Berlin, Germany. georg.haeusler@charite.de.
authors.forename: Karl Georg
authors.initials: KG
authors.lastname: Haeusler
authors.affiliation: Medical Hospital I, Ludwig-Maximilians-University, Munich, Germany. andrea.Gerth@med.uni-muenchen.de.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gerth
authors.affiliation: Institut für Herzinfarktforschung, Ludwigshafen, Germany. limbourg@herzinfarktforschung.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Limbourg
authors.affiliation: Department of Cardiology, Hospital Detmold, Detmold, Germany. ulrich.tebbe@klinikum-lippe.de.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Tebbe
authors.affiliation: Department of Medicine I, Brandenburg Municipal Hospital, Brandenburg, Germany. oeff@klinikum-brandenburg.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Oeff
authors.affiliation: Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. karl.wegscheider@t-online.de.
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.affiliation: Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. andras.treszl@hotmail.de.
authors.forename: András
authors.initials: A
authors.lastname: Treszl
authors.affiliation: Department of Pharmacology and Toxicology, Medical Faculty, Dresden University of Technology, Dresden, Germany. ravens@Rcs1.urz.tu-dresden.de.
authors.forename: Ursula
authors.initials: U
authors.lastname: Ravens
authors.affiliation: Department of Cardiology/Angiology, University Hospital Eppendorf, Hamburg, Germany. tm@prof-meinertz.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Meinertz
authors.affiliation: Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany. p.kirchhof@bham.ac.uk.|University of Birmingham Centre for Cardiovascular Sciences and SWBH and UHB NHS Trusts, Birmingham, UK. p.kirchhof@bham.ac.uk.
authors.forename: Paulus
authors.initials: P
authors.lastname: Kirchhof
authors.affiliation: Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany. g.breithardt@uni-muenster.de.
authors.forename: Günter
authors.initials: G
authors.lastname: Breithardt
authors.affiliation: Medical Hospital I, Ludwig-Maximilians-University, Munich, Germany. g.steinbeck@kardiozentrum-starnberg.de.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Steinbeck
authors.affiliation: Medical Hospital I, Ludwig-Maximilians-University, Munich, Germany. michael.nabauer@med.uni-muenchen.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Nabauer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D002309:Cardiology / Q000706:statistics & numerical data; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data; D005858:Germany; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006761:Hospitals; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D055502:Secondary Prevention / Q000706:statistics & numerical data*; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D017741:Survivors; D014812:Vitamin K / Q000037:antagonists & inhibitors*; D014859:Warfarin / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D014812:Vitamin K; D014859:Warfarin