College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
University of Adelaide, Adelaide, South Australia, Australia.
Intern Med J. 2024 Apr;54(4):620-625. doi: 10.1111/imj.16253. Epub 2023 Oct 20.
Anticoagulation can prevent most strokes in individuals with atrial fibrillation (AF); however, many people presenting with stroke and known AF are not anticoagulated. Language barriers and poor health literacy have previously been associated with decreased patient medication adherence. The association between language barriers and initiation of anticoagulation therapy for AF is uncertain.
The aims of this study were to determine whether demographic factors, including non-English primary language, were (1) associated with not being initiated on anticoagulation for known AF prior to admission with stroke, and (2) associated with non-adherence to anticoagulation in the setting of known AF prior to admission with stroke.
A multicentre retrospective cohort study was conducted for consecutive individuals admitted to the three South Australian tertiary hospitals with stroke units over a 5-year period.
There were 6829 individuals admitted with stroke. These cases included 5835 ischaemic stroke patients, 1333 of whom had pre-existing AF. Only 40.0% presenting with ischaemic stroke in the setting of known pre-existing AF were anticoagulated. When controlling for demographics, socioeconomic status and past medical history (including the components of the CHADS2VASC score and anticoagulation contraindications), having a primary language other than English was associated with a lower likelihood of having been commenced on anticoagulant for known pre-stroke AF (odds ratio: 0.52, 95% confidence interval: 0.36-0.77, P = 0.001), but was not associated with a differing likelihood of anticoagulation adherence.
A significant proportion of patients with stroke have pre-existing unanticoagulated AF; these rates are substantially higher if the primary language is other than English. Targeted research and interventions to minimise evidence-treatment gaps in this cohort may significantly reduce stroke burden.
抗凝治疗可以预防大多数房颤（AF）患者的中风；然而，许多出现中风且已知有 AF 的患者并未接受抗凝治疗。先前的研究表明，语言障碍和健康素养较差与患者的药物依从性降低有关。语言障碍与 AF 患者开始抗凝治疗之间的关联尚不确定。
本研究旨在确定人口统计学因素（包括非英语为母语）是否与以下情况相关：（1）在因中风入院前已知有 AF 但未开始抗凝治疗；（2）在因中风入院前已知有 AF 的情况下，与抗凝治疗不依从相关。
对在 5 年内连续入住南澳大利亚三所设有中风病房的三级医院的中风患者进行了一项多中心回顾性队列研究。
共纳入 6829 名因中风入院的患者。这些病例包括 5835 例缺血性中风患者，其中 1333 例患者有预先存在的 AF。在已知存在预先存在的 AF 的情况下，只有 40.0%的缺血性中风患者接受了抗凝治疗。在控制人口统计学、社会经济状况和既往病史（包括 CHADS2VASC 评分的组成部分和抗凝禁忌证）后，母语为非英语与更不可能因已知的中风前 AF 而开始使用抗凝剂有关（比值比：0.52，95%置信区间：0.36-0.77，P=0.001），但与抗凝药物的依从性无关。
很大一部分中风患者有未接受抗凝治疗的预先存在的 AF；如果患者的母语不是英语，这一比例会大幅增加。针对这一人群的目标研究和干预措施可能会显著减少中风负担，从而减少证据与治疗之间的差距。
