title: Guideline-adherent therapy for stroke prevention in atrial fibrillation in different health care settings: Results from RAMSES study.
abstract: OBJECTIVE
  No studies have been conducted in Turkey to compare the quality of stroke prevention therapies provided in different healthcare settings in patients with atrial fibrillation (AF). Therefore, we aimed to evaluate possible differences between secondary (SH) and tertiary hospital (TH) settings in the effectiveness of implementing AF treatment strategies.
  
  
  METHODS
  Baseline characteristics of 6273 patients with non-valvular AF enrolled in the RAMSES (ReAl-life Multicentre Survey Evaluating Stroke Prevention Strategies in Turkey) study were compared.
  
  
  RESULTS
  Of the study population, 3312 (52.8%) patients were treated in THs and 2961 (47.2%) patients were treated in SHs. Patients treated in the SH setting were older (70.8±9.8 vs. 68.7±11.4years, p<0.001), had a lower socioeconomic status, had a higher CHA2DS2VASc and HASBLED scores (3.4±1.4 vs. 3.1±1.7, p<0.001 and 1.7±1.0 vs. 1.6±1.1, p<0.001 respectively), and had more comorbidities than patients treated in THs. Inappropriate oral anticoagulant use was more prevalent in SHs than THs (31.4% vs. 25.6%, p<0.001). When over- and undertreatment rates were compared among hospital types, overtreatment was more prevalent in THs (7.6% vs. 0.9%, p<0.001) while undertreatment was more common in SHs (30.5% vs. 17.9%, p<0.001).
  
  
  CONCLUSIONS
  This study demonstrates the marked disparity between patient groups with AF presenting at SHs and THs. The use of guideline-recommended therapy is not adequate in either type of centre, overtreatment was more prevalent in THs and undertreatment was more prevalent in SHs.
authors.affiliation: Mugla Sitki Kocman University, Faculty of Medicine, Department of Cardiology, Turkey. Electronic address: basaran_ozcan@yahoo.com.
authors.forename: Özcan
authors.initials: Ö
authors.lastname: Başaran
authors.affiliation: Mugla Sitki Kocman University, Faculty of Medicine, Department of Cardiology, Turkey.
authors.forename: Volkan
authors.initials: V
authors.lastname: Dogan
authors.affiliation: Mugla Sitki Kocman University, Faculty of Medicine, Department of Cardiology, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Biteker
authors.affiliation: Şanlıurfa Balıklıgöl State Hospital, Department of Cardiology, Turkey.
authors.forename: Fatma Özpamuk
authors.initials: FÖ
authors.lastname: Karadeniz
authors.affiliation: Siyami Ersek Heart Education and Research Hospital, Department of Cardiology, Turkey.
authors.forename: Ahmet İlker
authors.initials: Aİ
authors.lastname: Tekkesin
authors.affiliation: Tuzla State Hospital, Department of Cardiology, Turkey.
authors.forename: Yasin
authors.initials: Y
authors.lastname: Çakıllı
authors.affiliation: Siyami Ersek Heart Education and Research Hospital, Department of Cardiology, Turkey.
authors.forename: Ceyhan
authors.initials: C
authors.lastname: Türkkan
authors.affiliation: Bandırma State Hospital, Department of Cardiology, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Hamidi
authors.affiliation: Yozgat State Hospital, Department of Cardiology, Turkey.
authors.forename: Vahit
authors.initials: V
authors.lastname: Demir
authors.affiliation: Gaziemir State Hospital, Department of Cardiology, Turkey.
authors.forename: Mustafa Ozan
authors.initials: MO
authors.lastname: Gürsoy
authors.affiliation: Ankara Keçiören Education and Research Hospital, Department of Cardiology, Turkey.
authors.forename: Müjgan Tek
authors.initials: MT
authors.lastname: Öztürk
authors.affiliation: Şişli Hamidiye Etfal Education and Research Hospital, Department of Cardiology, Turkey.
authors.forename: Gökhan
authors.initials: G
authors.lastname: Aksan
authors.affiliation: Mersin Private Dogus Hospital, Department of Cardiology, Turkey.
authors.forename: Sabri
authors.initials: S
authors.lastname: Seyis
authors.affiliation: Mersin Toros State Hospital, Department of Cardiology, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ballı
authors.affiliation: Gaziantep 25 Aralık State Hospital, Department of Cardiology, Turkey.
authors.forename: Mehmet Hayri
authors.initials: MH
authors.lastname: Alıcı
authors.affiliation: Kocaeli Derince Education and Research Hospital, Department of Cardiology, Turkey.
authors.forename: Serdar
authors.initials: S
authors.lastname: Bozyel
authors.affiliation: Kartal Kosuyolu Heart Education and Research Hospital, Turkey.
authors.forename: Cevat
authors.initials: C
authors.lastname: Kırma
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control*; D062606:Tertiary Care Centers; D014421:Turkey
chemical_list: D000925:Anticoagulants
keywords: Atrial fibrillation; Guideline adherence; Oral anticoagulant therapy; Stroke prevention