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Acute stroke clinical care standard indicators: 5c-Oral anticoagulants prescribed for atrial fibrillation on separation from hospital

Identifying and definitional attributes

Metadata item type:Help on this termIndicator
Indicator type:Help on this termIndicator
Short name:Help on this termIndicator 5c-Oral anticoagulants prescribed for atrial fibrillation on separation from hospital
METeOR identifier:Help on this term627811
Registration status:Help on this termHealth, Candidate 04/04/2017
Description:Help on this term

Proportion of ischaemic stroke patients with atrial fibrillation prescribed oral anticoagulants, where not contraindicated, on separation from hospital.

Rationale:Help on this term

Non-valvular atrial fibrillation is a common arrhythmia and an important risk factor for stroke. The administration of oral anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in patients with a high stroke risk, such as those with atrial fibrillation, or prior transient ischaemic attack (TIA) or stroke (Furie et al. 2011).

Indicator set:Help on this termClinical care standard indicators: acute stroke Health, Candidate 14/03/2017
Outcome area:Help on this termMinimising risk of another stroke Health, Candidate 14/03/2017

Collection and usage attributes

Computation description:Help on this term

Both the numerator and the denominator include patients with a final diagnosis of ischaemic stroke and atrial fibrillation.

Atrial fibrillation includes patients where Episode of care—principal diagnosis, code (ICD-10-AM 9th edn) ANN{.N[N]} or Episode of care—additional diagnosis, code (ICD-10-AM 9th edn) ANN{.N[N]} is one of the following:

  • I48.0 Paroxysmal atrial fibrillation
  • I48.1 Persistent atrial fibrillation
  • I48.2 Chronic atrial fibrillation
  • I48.3 Typical atrial flutter (Type I atrial flutter)
  • I48.4 Atypical atrial flutter (Type II atrial flutter)
  • I48.9 Atrial fibrillation and atrial flutter, unspecified.

The diagnosis of atrial fibrillation is in addition to the diagnosis of ischaemic stroke.

The numerator requires evidence of prescription of oral anticoagulation therapy at the point of the patient being separated from hospital. Oral anticoagulants include warfarin, apixaban, rivaroxaban or dabigatran.

Both the numerator and the denominator exclude patients for whom oral anticoagulants are contraindicated (where the contraindication is clearly documented). Contraindications may include:

  • patient refusal
  • where there are limitations of therapy (i.e. advance care directive is enacted and/or the patient is on a palliative care pathway).

Presented as a percentage.

Computation:Help on this term

(Numerator ÷ denominator) x 100

Numerator:Help on this term

Number of patients with a final diagnosis of ischaemic stroke with documented atrial fibrillation who were prescribed oral anticoagulation therapy on separation from hospital.

Denominator:Help on this term

Number of patients with a final diagnosis of ischaemic stroke, with documented atrial fibrillation, separated from hospital.

Representational attributes

Representation class:Help on this termPercentage
Data type:Help on this termReal
Unit of measure:Help on this termEpisode
Format:Help on this term


Source and reference attributes

Submitting organisation:Help on this term

Australian Commission on Safety and Quality in Health Care

Reference documents:Help on this term

Furie KL, Kasner SE, Adams RJ, Albers GW, Bush RL, Fagan SC et al. 2011. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 42(1):227–276

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