Key result
Prestroke dementia did not influence OAC prescription before stroke; instead, OAC use was independently associated with cardiologist follow-up and younger age.
Why the study?
Does prestroke dementia influence the prescription of oral anticoagulation before stroke in patients with nonvalvular atrial fibrillation?
Observational (n=204)
Yes
Does prestroke dementia influence the prescription of oral anticoagulation before stroke in patients with nonvalvular atrial fibrillation?
Under-prescription of oral anticoagulation in NVAF patients prior to stroke is driven by lack of cardiology follow-up and older age, rather than the presence of prestroke dementia.
Answers are grounded in this paper and cite their sources.
Cardiology referral and younger age may drive pre-stroke OAC in NVAF independent of dementia; supports targeted access efforts but leaves causal impact open.
Background and purpose: Oral anticoagulation (OAC) decreases the risk of stroke in patients with nonvalvular atrial fibrillation (NVAF), but remains underused in practice. The aim of this study was to test the hypothesis that prestroke dementia influenced the nonprescription of OAC before stroke. Methods: This is an ancillary study of Stroke in Atrial Fibrillation Ensemble II, an observational study conducted in patients with a previously known NVAF, consecutively admitted for an acute stroke to French and Italian centers. Prestroke dementia was evaluated by the clinical physician and validated by an Informant Questionnaire for Cognitive Decline in the Elderly score of ≧104 in patients with a reliable informant. Results: Of 204 patients, 24 patients met criteria for prestroke dementia according to GP’s opinion. The only variables independently associated with OAC before stroke were follow-up by a cardiologist (adjusted OR: 3.33; 95% CI: 1.47–7.53) and a younger age of patients (adjusted OR: 0.94; 95% CI: 0.89–0.99). Variables independently associated with any antithrombotic drug therapy before stroke were follow-up by a general practitioner (adjusted OR: 2.78; 95% CI: 1.09–7.11), and by a cardiologist (adjusted OR: 3.15; 95% CI: 1.48–6.69). Conclusion: In daily practice, the under-prescription of OAC in patients with NVAF mainly depends on co-morbidity and on characteristics of the physician, not on prestroke dementia.
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Lefebvre et al. (2006) conducted an observational in Nonvalvular atrial fibrillation (NVAF) with acute stroke (n=204). Prestroke dementia vs. No prestroke dementia was evaluated on Oral anticoagulation (OAC) prescription before stroke. Prestroke dementia did not influence OAC prescription before stroke; instead, OAC use was independently associated with cardiologist follow-up and younger age.
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