Outcomes for people with atrial fibrillation in an Australian national audit of stroke care

Authors

  • Nadine Andrew,

    Corresponding author
    1. Translational Public Health Unit, Stroke & Ageing Research Centre, Department of Medicine, Monash Medical Centre, Southern Clinical School, Monash University, Clayton, Victoria, Australia
    • Correspondence: Nadine Andrew, Translational Public Health Unit, Stroke & Ageing Research Centre, Department of Medicine, Monash Medical Centre, Southern Clinical School, Monash University, 1/43-51 Kanooka Grove, Clayton, Vic. 3168, Melbourne, Australia.

      E-mail: nadine.andrew@monash.edu

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  • Monique Kilkenny,

    1. Translational Public Health Unit, Stroke & Ageing Research Centre, Department of Medicine, Monash Medical Centre, Southern Clinical School, Monash University, Clayton, Victoria, Australia
    2. Florey Neuroscience Institutes, Melbourne Brain Centre, National Stroke Research Institute, Heidelberg, Victoria, Australia
    3. Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
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  • Dawn Harris,

    1. National Stroke Foundation (NSF), Melbourne, Victoria, Australia
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  • Chris Price,

    1. National Stroke Foundation (NSF), Melbourne, Victoria, Australia
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  • Dominique A. Cadilhac

    1. Translational Public Health Unit, Stroke & Ageing Research Centre, Department of Medicine, Monash Medical Centre, Southern Clinical School, Monash University, Clayton, Victoria, Australia
    2. Florey Neuroscience Institutes, Melbourne Brain Centre, National Stroke Research Institute, Heidelberg, Victoria, Australia
    3. Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
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  • Conflicts of interest: The authors declare no potential conflict of interest.
  • Sources of funding: Dominique Cadilhac is supported by a NHMRC/National Heart Foundation postdoctoral fellowship, grant number: 610302. Nadine Andrew, Dominique Cadilhac, and Monique Kilkenny were contracted by the National Stroke Foundation to undertake the statistical analyses for the National Stroke Audit: Acute Services.

Abstract

Background

Atrial fibrillation is associated with poorer outcomes poststroke. It is unclear how the quality of stroke care in hospitals influences outcomes in these patients.

Aims

The study aims to compare outcomes in stroke patients with and without atrial fibrillation and identify hospital processes of care associated with poor outcomes.

Methods

Data were collected using retrospective, consecutive medical record audits from participating hospitals in the 2009 and 2011 National Stroke Foundation acute services audit program. Patient characteristics, stroke severity, and hospital management data were compared for those with and without atrial fibrillation. Multiple regression analyses for outcomes of in-hospital death, dependency at discharge (modified Rankin Score 3–5), and discharge destination were undertaken, adjusted for patient clustering by hospital.

Results

Atrial fibrillation status was known for 5473 (80%) cases; 2049 had atrial fibrillation. Atrial fibrillation was independently associated with in-hospital mortality (aOR 1·46, 95% CI 1·06, 2·02). Management on a stroke unit (aOR 0·57, 95% CI 0·40, 0·80) and having a swallow assessment within 24 h (aOR 0·71, 95% CI 0·51, 0·98) were associated with increased survival among all stroke types, as was receiving aspirin within 48 h poststroke (aOR 0·65, 95% CI 0·44, 0·97), for patients with an ischemic stroke. Stroke patients with atrial fibrillation were less likely to receive important processes of care associated with reduced mortality.

Conclusions

Hospital processes of care can influence outcomes in stroke patients with atrial fibrillation. The greater in-hospital mortality experienced by stroke patients with atrial fibrillation may be attenuated by admission to a stroke unit, and for ischemic stroke, early administration of aspirin.

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