title: Adherence to Guidelines for Antithrombotic Therapy in Patients with Atrial Fibrillation According to CHADS2 Score before and after Stroke: A Multicenter Observational Study from Korea.
abstract: OBJECTIVE
  A substantial proportion of patients with atrial fibrillation (AF) are not treated optimally; however, the inappropriateness of drug therapy has never been evaluated before or after a stroke event. We investigated the adherence to guidelines for therapy in AF patients hospitalized with acute ischemic stroke (AIS) before stroke onset and at discharge, with the aim of identifying the factors associated with inappropriate therapy.
  
  
  METHODS
  AIS patients with AF hospitalized within 7 days of onset were identified from a prospective nine-center stroke registry database. Two cohorts were defined: patients diagnosed with AF prior to the stroke event (admission cohort) and patients diagnosed with AF at discharge from hospital (discharge cohort). Any of the following conditions were regarded as nonadherence to guidelines in this study: use of anticoagulant or nonuse of antithrombotics with CHADS2 score=0, nonuse of antithrombotics with CHADS2 score=1, or nonuse of anticoagulant with CHADS2 score ≥2.
  
  
  RESULTS
  Overall, 406 patients were enrolled in the admission cohort and 518 in the discharge cohort. The rates of nonadherence before a stroke event and at discharge were 77.8% and 33.3%, respectively. These rates varied widely for both cohorts, with interhospital differences being statistically significant. Multivariable analysis revealed that old age, stroke history, and congestive heart failure were associated with nonadherence before stroke. At discharge, males, coronary heart disease, inappropriate antithrombotic use before stroke, and functional disability at discharge were associated with nonadherence.
  
  
  CONCLUSIONS
  This study shows that antithrombotic use in AIS patients with AF might be not optimal before and after stroke in Korea.
authors.affiliation: Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
authors.forename: Wook Joo
authors.initials: WJ
authors.lastname: Kim
authors.affiliation: Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea.
authors.forename: Jong Moo
authors.initials: JM
authors.lastname: Park
authors.affiliation: Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea.
authors.forename: Kyusik
authors.initials: K
authors.lastname: Kang
authors.affiliation: Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea.
authors.forename: Yong Jin
authors.initials: YJ
authors.lastname: Cho
authors.affiliation: Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea.
authors.forename: Keun Sik
authors.initials: KS
authors.lastname: Hong
authors.affiliation: Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Korea.
authors.forename: Soo Joo
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Korea.
authors.forename: Youngchai
authors.initials: Y
authors.lastname: Ko
authors.affiliation: Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Kyung Bok
authors.initials: KB
authors.lastname: Lee
authors.affiliation: Department of Neurology, Seoul Medical Center, Seoul, Korea.
authors.forename: Tai Hwan
authors.initials: TH
authors.lastname: Park
authors.affiliation: Department of Neurology, Yeungnam University Hospital, Daegu, Korea.
authors.forename: Jun
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Neurology, College of Medicine, Dong-A University, Busan, Korea.
authors.forename: Jae Kwan
authors.initials: JK
authors.lastname: Cha
authors.affiliation: Department of Neurology, College of Medicine, Dong-A University, Busan, Korea.
authors.forename: Dae Hyun
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Neurology, Hallym University College of Medicine, Anyang, Korea.
authors.forename: Kyung Ho
authors.initials: KH
authors.lastname: Yu
authors.affiliation: Department of Neurology, Hallym University College of Medicine, Anyang, Korea.
authors.forename: Byung Chul
authors.initials: BC
authors.lastname: Lee
authors.affiliation: Department of Neurology, Hallym University College of Medicine, Anyang, Korea.
authors.forename: Mi Sun
authors.initials: MS
authors.lastname: Oh
authors.affiliation: Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
authors.forename: Juneyoung
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Biostatistics, Clinical Research Center, Asan Medical Center, Seoul, Korea.
authors.forename: Jisung
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Myung Suk
authors.initials: MS
authors.lastname: Jang
authors.affiliation: Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Moon Ku
authors.initials: MK
authors.lastname: Han
authors.affiliation: Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea. braindoc@snu.ac.kr.
authors.forename: Hee Joon
authors.initials: HJ
authors.lastname: Bae
keywords: atrial fibrillation; cerebral infarction; drug utilization review; guideline adherence