Atrial fibrillation and anticoagulation in patients hospitalised for stroke in the REGIONS Care Study

AIM: To describe atrial fibrillation (AF) patient characteristics and anticoagulation patterns in stroke patients in Aotearoa. METHODS: Reducing Ethnic and Geographic Inequities to Optimise New Zealand Stroke (REGIONS) Care study is a prospective, nation-wide observational study of consecutive adult stroke patients admitted to hospital between 1 May and 31 October 2018. AF and anticoagulation prescribing, intracerebral haemorrhage (ICH) and differences by Māori ethnicity and hospital location are described. RESULTS: Of 2,379 patients, 807 (34.3%) had a diagnosis of AF. AF patients were older than non-AF patients (mean 79.9 [SD 11] versus 72.5 [14.2], p<0.0001). AF was diagnosed before stroke in 666 patients (82.5%), of whom 442 (66.4%) were taking an anticoagulant. The most common documented reasons for non-anticoagulation were prior bleeding (20.5%), patient preference (18.1%), frailty, comorbidities/side effects (13.2%) and falls (6.8%). The ICH rate was similar for AF patients on versus not on an anticoagulant (adjusted odds ratio [aOR] 0.99, 95% confidence interval [CI] 0.55-1.80). Rates and reasons for oral anticoagulant non-prescribing were similar for Māori, non-Māori, urban and non-urban populations. CONCLUSIONS: Although anticoagulation prescribing in AF has improved, one third of stroke patients with known AF were not taking an anticoagulant prior to admission and the majority did not appear to have an absolute contraindication offering a multidisciplinary opportunity for improvement. There were no significant differences for Māori and non-urban populations in anticoagulant prescribing.