Abstract
Byline: Nicole B Sur, Univ of Miami Neurology, Miami, FL; Hao Ying; Negar Asdaghi, UNIVERSITY OF MIAMI MILLER SCHOOL, Miami, FL; Hannah Gardener, Univ of Miami Med Sch, Miami, FL; Lili Zhou, Univ of Miami, Miami, FL; Carolina M Gutierrez, UNIVERISTY OF MIAMI MILLER SCH, Miami, FL; Ralph L Sacco, UNIVERSITY OF MIAMI, Miami, FL; Jose G Romano, U Miami, Pinecrest, FL; Tatjana Rundek, MILLER SCHL OF MEDICINE UNIV M, Miami, FL Background: Acute ischemic stroke (AIS) is a devastating consequence of atrial fibrillation (AF), which is preventable with oral anticoagulants (OACs). The goal of this study was to evaluate contemporary trends and disparities in OAC use at hospital discharge in patients with AIS and AF in the era of direct oral anticoagulants (DOACs). Methods: Data on 34,715 cases admitted to hospital for AIS with AF were obtained from the Florida Stroke Registry, 2017-2021. Baseline sociodemographics, medical history, stroke and hospital characteristics and anticoagulant status were compared by OAC use at discharge. Multivariable logistic regression was used to identify predictors of OAC non-use after AIS with AF after adjusting for confounders. Temporal trends in the frequency of OAC use at hospital discharge was assessed from 2010-2021. Results: From 2017-2021, a total of 21,011 (61%) patients with AIS and AF were discharged on OAC (median age 77 years; 49% female; 74% white, 13% black, 13% Hispanic). The rate of DOAC use increased from 43% to 59%, and the rate of warfarin use declined from 13% to 6% from 2017-2021. The overall use of OAC at hospital discharge increased by 9% from 2017-2021, and by 13% from 2010-2021. After adjustment, stroke hospital designation was the strongest predictor of OAC non-use with 4-fold higher odds of OAC non-use at discharge from an Acute Stroke Ready Hospital compared with a Comprehensive Stroke Center (P=0.012). Increasing age, male sex, renal insufficiency, lower CHA2DS2-VASc, NIHSS [greater than or equal] 5, mRS 3-5, ambulation status, and discharge destination were significant predictors of OAC non-use after AIS with AF. Conclusion: OAC use increased by 13% over the last decade in patients with AIS and AF in Florida. Previously identified race/ethnic disparities did not persist in 2017-2021; however, sex, stroke hospital designation, stroke severity, medical comorbidities, functional disability, and ambulation status had a significant impact on OAC use after AIS with AF.
