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

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 24h (aOR 0?71, 95 CI 0?51, 0?98) were associated with increased survival among all stroke types, as was receiving aspirin within 48h 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.