Improvement in use of anticoagulation therapy in patients with ischemic stroke

Results from Get with the Guidelines-Stroke

William R. Lewis, Gregg C. Fonarow, Maria V. Grau-Sepulveda, Eric E. Smith, Deepak L. Bhatt, Adrian F. Hernandez, Daiwai Olson, Eric D. Peterson, Lee H. Schwamm

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background: Anticoagulation therapy reduces thromboembolic events in patients with atrial fibrillation (AF) and has a class I indication for ischemic stroke patients with AF and no contraindications. We determined the patient and hospital level characteristics associated with an increased use of anticoagulation, including participation in the Get With The Guidelines-Stroke (GWTG-Stroke) Program. Methods: We assessed the use of anticoagulation at hospital discharge in eligible AF patients with stroke or transient ischemic attack (TIA) at 1,354 participating hospitals between April 1, 2003, and April 1, 2010. Results: Patients with AF (n = 197,778) represented 20.5% of patients with ischemic stroke/TIA. Among patients with AF, 47.6% (n = 94,119) were deemed eligible for anticoagulation, and of these, 94.0% were discharged on therapy. Older patients, African American or Hispanic patients, and those with diabetes were less likely to receive anticoagulation. Hospitals with a higher volume of patients with stroke were more likely to treat with anticoagulation. The Joint Commission Primary Stroke Centers were also more likely to treat eligible patients (odds ratio 2.16, 95% CI 1.82-2.56, P <.0001). From 2003 to 2010, contraindications to anticoagulation therapy declined from 69.7% to 28.4% (P <.0001 for trend). Anticoagulation among eligible patients improved from 88.4% to 95.2% (P <.0001) for 7 years of participation. Time in GWTG-Stroke was associated with improved anticoagulation use (adjusted odds ratio per year in program, 1.11, 95% CI 1.06-1.16, P <.001). Conclusions: Use of anticoagulation among stroke patients with AF has increased to very high levels overall in GWTG-Stroke over time. Future efforts should focus on improving use among selected populations.

Original languageEnglish (US)
JournalAmerican Heart Journal
Volume162
Issue number4
DOIs
StatePublished - Oct 2011

Fingerprint

Stroke
Guidelines
Atrial Fibrillation
Therapeutics
Transient Ischemic Attack
Odds Ratio
Hispanic Americans
African Americans
Joints

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Lewis, W. R., Fonarow, G. C., Grau-Sepulveda, M. V., Smith, E. E., Bhatt, D. L., Hernandez, A. F., ... Schwamm, L. H. (2011). Improvement in use of anticoagulation therapy in patients with ischemic stroke: Results from Get with the Guidelines-Stroke. American Heart Journal, 162(4). https://doi.org/10.1016/j.ahj.2011.07.019

Improvement in use of anticoagulation therapy in patients with ischemic stroke : Results from Get with the Guidelines-Stroke. / Lewis, William R.; Fonarow, Gregg C.; Grau-Sepulveda, Maria V.; Smith, Eric E.; Bhatt, Deepak L.; Hernandez, Adrian F.; Olson, Daiwai; Peterson, Eric D.; Schwamm, Lee H.

In: American Heart Journal, Vol. 162, No. 4, 10.2011.

Research output: Contribution to journalArticle

Lewis, WR, Fonarow, GC, Grau-Sepulveda, MV, Smith, EE, Bhatt, DL, Hernandez, AF, Olson, D, Peterson, ED & Schwamm, LH 2011, 'Improvement in use of anticoagulation therapy in patients with ischemic stroke: Results from Get with the Guidelines-Stroke', American Heart Journal, vol. 162, no. 4. https://doi.org/10.1016/j.ahj.2011.07.019
Lewis, William R. ; Fonarow, Gregg C. ; Grau-Sepulveda, Maria V. ; Smith, Eric E. ; Bhatt, Deepak L. ; Hernandez, Adrian F. ; Olson, Daiwai ; Peterson, Eric D. ; Schwamm, Lee H. / Improvement in use of anticoagulation therapy in patients with ischemic stroke : Results from Get with the Guidelines-Stroke. In: American Heart Journal. 2011 ; Vol. 162, No. 4.
@article{b395e69b5164483eb91475cc458b71a7,
title = "Improvement in use of anticoagulation therapy in patients with ischemic stroke: Results from Get with the Guidelines-Stroke",
abstract = "Background: Anticoagulation therapy reduces thromboembolic events in patients with atrial fibrillation (AF) and has a class I indication for ischemic stroke patients with AF and no contraindications. We determined the patient and hospital level characteristics associated with an increased use of anticoagulation, including participation in the Get With The Guidelines-Stroke (GWTG-Stroke) Program. Methods: We assessed the use of anticoagulation at hospital discharge in eligible AF patients with stroke or transient ischemic attack (TIA) at 1,354 participating hospitals between April 1, 2003, and April 1, 2010. Results: Patients with AF (n = 197,778) represented 20.5{\%} of patients with ischemic stroke/TIA. Among patients with AF, 47.6{\%} (n = 94,119) were deemed eligible for anticoagulation, and of these, 94.0{\%} were discharged on therapy. Older patients, African American or Hispanic patients, and those with diabetes were less likely to receive anticoagulation. Hospitals with a higher volume of patients with stroke were more likely to treat with anticoagulation. The Joint Commission Primary Stroke Centers were also more likely to treat eligible patients (odds ratio 2.16, 95{\%} CI 1.82-2.56, P <.0001). From 2003 to 2010, contraindications to anticoagulation therapy declined from 69.7{\%} to 28.4{\%} (P <.0001 for trend). Anticoagulation among eligible patients improved from 88.4{\%} to 95.2{\%} (P <.0001) for 7 years of participation. Time in GWTG-Stroke was associated with improved anticoagulation use (adjusted odds ratio per year in program, 1.11, 95{\%} CI 1.06-1.16, P <.001). Conclusions: Use of anticoagulation among stroke patients with AF has increased to very high levels overall in GWTG-Stroke over time. Future efforts should focus on improving use among selected populations.",
author = "Lewis, {William R.} and Fonarow, {Gregg C.} and Grau-Sepulveda, {Maria V.} and Smith, {Eric E.} and Bhatt, {Deepak L.} and Hernandez, {Adrian F.} and Daiwai Olson and Peterson, {Eric D.} and Schwamm, {Lee H.}",
year = "2011",
month = "10",
doi = "10.1016/j.ahj.2011.07.019",
language = "English (US)",
volume = "162",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Improvement in use of anticoagulation therapy in patients with ischemic stroke

T2 - Results from Get with the Guidelines-Stroke

AU - Lewis, William R.

AU - Fonarow, Gregg C.

AU - Grau-Sepulveda, Maria V.

AU - Smith, Eric E.

AU - Bhatt, Deepak L.

AU - Hernandez, Adrian F.

AU - Olson, Daiwai

AU - Peterson, Eric D.

AU - Schwamm, Lee H.

PY - 2011/10

Y1 - 2011/10

N2 - Background: Anticoagulation therapy reduces thromboembolic events in patients with atrial fibrillation (AF) and has a class I indication for ischemic stroke patients with AF and no contraindications. We determined the patient and hospital level characteristics associated with an increased use of anticoagulation, including participation in the Get With The Guidelines-Stroke (GWTG-Stroke) Program. Methods: We assessed the use of anticoagulation at hospital discharge in eligible AF patients with stroke or transient ischemic attack (TIA) at 1,354 participating hospitals between April 1, 2003, and April 1, 2010. Results: Patients with AF (n = 197,778) represented 20.5% of patients with ischemic stroke/TIA. Among patients with AF, 47.6% (n = 94,119) were deemed eligible for anticoagulation, and of these, 94.0% were discharged on therapy. Older patients, African American or Hispanic patients, and those with diabetes were less likely to receive anticoagulation. Hospitals with a higher volume of patients with stroke were more likely to treat with anticoagulation. The Joint Commission Primary Stroke Centers were also more likely to treat eligible patients (odds ratio 2.16, 95% CI 1.82-2.56, P <.0001). From 2003 to 2010, contraindications to anticoagulation therapy declined from 69.7% to 28.4% (P <.0001 for trend). Anticoagulation among eligible patients improved from 88.4% to 95.2% (P <.0001) for 7 years of participation. Time in GWTG-Stroke was associated with improved anticoagulation use (adjusted odds ratio per year in program, 1.11, 95% CI 1.06-1.16, P <.001). Conclusions: Use of anticoagulation among stroke patients with AF has increased to very high levels overall in GWTG-Stroke over time. Future efforts should focus on improving use among selected populations.

AB - Background: Anticoagulation therapy reduces thromboembolic events in patients with atrial fibrillation (AF) and has a class I indication for ischemic stroke patients with AF and no contraindications. We determined the patient and hospital level characteristics associated with an increased use of anticoagulation, including participation in the Get With The Guidelines-Stroke (GWTG-Stroke) Program. Methods: We assessed the use of anticoagulation at hospital discharge in eligible AF patients with stroke or transient ischemic attack (TIA) at 1,354 participating hospitals between April 1, 2003, and April 1, 2010. Results: Patients with AF (n = 197,778) represented 20.5% of patients with ischemic stroke/TIA. Among patients with AF, 47.6% (n = 94,119) were deemed eligible for anticoagulation, and of these, 94.0% were discharged on therapy. Older patients, African American or Hispanic patients, and those with diabetes were less likely to receive anticoagulation. Hospitals with a higher volume of patients with stroke were more likely to treat with anticoagulation. The Joint Commission Primary Stroke Centers were also more likely to treat eligible patients (odds ratio 2.16, 95% CI 1.82-2.56, P <.0001). From 2003 to 2010, contraindications to anticoagulation therapy declined from 69.7% to 28.4% (P <.0001 for trend). Anticoagulation among eligible patients improved from 88.4% to 95.2% (P <.0001) for 7 years of participation. Time in GWTG-Stroke was associated with improved anticoagulation use (adjusted odds ratio per year in program, 1.11, 95% CI 1.06-1.16, P <.001). Conclusions: Use of anticoagulation among stroke patients with AF has increased to very high levels overall in GWTG-Stroke over time. Future efforts should focus on improving use among selected populations.

UR - http://www.scopus.com/inward/record.url?scp=80053649973&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80053649973&partnerID=8YFLogxK

U2 - 10.1016/j.ahj.2011.07.019

DO - 10.1016/j.ahj.2011.07.019

M3 - Article

VL - 162

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

IS - 4

ER -