Pre-stroke anticoagulation for atrial fibrillation in primary English speakers and non-primary English speakers: a multicentre retrospective cohort study

Stephen Bacchi; Joshua G Kovoor; Rudy Goh; Aashray K Gupta; Sheryn Tan; Christopher D Ovenden; Minh-Son To; Andrew Moey; Prashanthan Sanders; Derek P Chew; David Schultz; Pramesh Kovoor; Timothy Kleinig; Jim Jannes

doi:10.1111/imj.16253

Pre-stroke anticoagulation for atrial fibrillation in primary English speakers and non-primary English speakers: a multicentre retrospective cohort study

Intern Med J. 2024 Apr;54(4):620-625. doi: 10.1111/imj.16253. Epub 2023 Oct 20.

Authors

Stephen Bacchi^{1

2

3}, Joshua G Kovoor^{2

3}, Rudy Goh^{2

3

4}, Aashray K Gupta^{2

5}, Sheryn Tan^{2

3}, Christopher D Ovenden^{2

3}, Minh-Son To¹, Andrew Moey⁴, Prashanthan Sanders^{2

3}, Derek P Chew¹, David Schultz¹, Pramesh Kovoor⁶, Timothy Kleinig^{2

3}, Jim Jannes^{2

3}

Affiliations

¹ College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
² University of Adelaide, Adelaide, South Australia, Australia.
³ Royal Adelaide Hospital, Adelaide, South Australia, Australia.
⁴ Lyell McEwin Hospital, Adelaide, South Australia, Australia.
⁵ Gold Coast University Hospital, Gold Coast, Queensland, Australia.
⁶ Westmead Private Hospital, Sydney, New South Wales, Australia.

PMID: 37860995
DOI: 10.1111/imj.16253

Abstract

Background: 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.

Aims: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: CHADS2VASC; cardio‐embolism; equity; linguistic diversity; prevention.

Publication types

Multicenter Study

MeSH terms

Anticoagulants / therapeutic use
Atrial Fibrillation* / complications
Atrial Fibrillation* / drug therapy
Atrial Fibrillation* / epidemiology
Australia
Brain Ischemia* / complications
Humans
Ischemic Stroke* / complications
Ischemic Stroke* / drug therapy
Retrospective Studies
Risk Factors
Stroke* / complications
Stroke* / epidemiology
Stroke* / prevention & control

Substances

Anticoagulants