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Anticoagulant and antiplatelet therapy for stroke prevention in atrial fibrillation patients in the clinical practice of a single district hospital in Poland.

BACKGROUND AND AIM: Retrospective evaluation of stroke risk in all patients with atrial fibrillation (AF) admitted to cardiology, internal medicine, and neurology wards in a single Polish district hospital in 2006 and 2010 using two risk stratification schemes, CHADS₂ vs. CHA₂DS₂VASc risk scores and identification of independent predictors of guideline-compliant oral anticoagulant (OAC) treatment.

METHODS: We analysed case records of 613 patients with AF (including 300 patients in 2006 and 313 patients in 2010) treated in a district hospital - the John Paul II Western Hospital (Szpital Zachodni) in Grodzisk Mazowiecki, to evaluate their stroke risk and therapy prescribed at discharge.

RESULTS: The mean patient age in the overall study population (49% of men) was 74.3 years (74.8, 77.5, and 71.9 years, respectively, in patients with paroxysmal, permanent and persistent AF). Patients > 75 years old comprised 58.6% of the study group, and those < 65 years old comprised 16.6% of the study group. The most common concomitant diseases were hypertension (65.9%), chronic heart failure (61.7%), coronary artery disease (43.1%), at least moderate mitral and/or tricuspid regurgitation (36.4%), and peripheral arterial disease (36%). Indications for OAC treatment were present in 85% (using the CHADS₂ score) or 95% (using the CHA₂DS₂VASc score) patients but this therapy was prescribed at discharge in only 39% of the study group (240 patients). Compared to patients who were not prescribed OAC, those prescribed OAC treatment were younger, more often male, with permanent AF, valvular heart disease, and hypertension. In patients without OAC treatment at discharge, the following conditions were found more frequently than in patients prescribed OAC treatment: paroxysmal AF(49.8% vs. 33.3% in OAC patients), established coronary artery disease (46.1% vs. 38.3%), previous myocardial infarction (27%vs. 18.7%), prior coronary revascularisation (11.2% vs. 6.6%), alcohol abuse (4.2% vs. 0.8%), renal failure (31.6% vs. 21.6%), and stroke or transient ischaemic attack (TIA; 19.3% vs. 12%). In multivariate logistic regression analysis, we identified 5 independent predictive factors associated with prescribing OAC at discharge, including persistent AF vs. paroxysmal AF (odd sratio [OR] = 5.27), permanent AF vs. paroxysmal AF (OR = 1.86), hypertension (OR = 1.50), previous stroke and/or TIA (OR = 0.59), and age > 75 years vs. < 65 years (OR = 0.53).

CONCLUSIONS: Despite a high stroke risk as determined by both scores, only 39% of patients received OAC. In the studied population, independent predictors for prescribing OAC at discharge included arterial hypertension (in accordance with the guidelines) and younger patient age, no history of stroke/TIA, and AF other than paroxysmal. The practice of OAC and/or antiplatelet therapy use in AF patients discharged from a Polish district hospital was not compliant with the current ESC guidelines either in 2006 or in 2010.

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