Stroke prevention: Anticoagulation in medicare beneficiaries with atrial fibrillation

Abstracts

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and Medpro data files, were selected for the project. A total of 1,102 charts were reviewed and abstracted using a specially designed and validated data abstraction tool. Statewide, 31% of eligible patients were given coumadin. By region, the percentage of eligible patients given coumadin was 18% in the north, 41% in the central and 37% in the south. Statewide, 78% of patients on warfarin did not have documentation of receiving education; the numbers by region were 68% (north), 78% (central) and 85% (south). Statewide, only 39% of patients in the study had arrangements for follow-up testing. By region, those figures were 45% (north), 40% (central) and 33% (south). Possibilities and results of quality improvement will be presented and discussed. Stroke Prevention: Anticoagulation in Medicare Beneficiaries with Atrial Fibrillation. Michael Dick and Jan Atzenhoefer (Peer Reviews Systems, Westerville, OH)

Introduction: Chronic atrial fibrillation (AF) increases the risk of stroke by 4 to 6 times. Risk is further increased with hypertension (HTN), left ventricular (LV) dysfunction, prior thromboembolism, congestive heart failure (CHF), valvular heart disease, and thyrotoxicosis. Antiocagulation decreases the risk of stroke in these patients. A retrospective review of patients with AF was performed to determine the prevalence of anticoagulation. Methods: The records of Ohio Medicare patients admitted for a 6 month period with AF were reviewed. Patients were excluded who had an invasive procedure, an absolute contraindication, documentation for failure to anticoagulate, expired, or were transferred. Patients were stratified as high risk (above noted risk factors), or moderate risk (greater than or equal to 65 years). The presence of relative contraindications for anticoagulation was noted. Rates of anticoagulation were determined. Results: After exclusions, 200 patient records were analyzed. Overall, 174 patients were at high risk with no absolute contraindications; 66 (37.9%) were discharged on warfarin. Twenty six patients were at moderate risk with no contraindications; 4 (15%) were anticoagulated. Conclusions: Rates of anticoagulation are low, providing an opportunity for reduction of stroke rate in the Medicare population. Rehabilitation of Stroke: Acute and Long Term Care Sequential Weaning of an Articulating Ankle Foot Orthosis with a Posterior Check Strap in the Rehabilitation of a Stroke Victim. Sandra M. Ciccone, Cynthia A. Wertz, Fred Chen (Western Reserve Care Systems, Southside

Medical Center Youngstown, OH) By using articulation in an ankle foot orthosis (AFO), the discontinuation of the AFO can be done gradually to promote quality of gait and decrease dependency on the

orthosis as patient's motor function improves. We describe a sequential weaning of an AFO in a 62-year-old stroke victim with left hemiplegia. The patient presented with left lower extremity hypotonicity. When strength progressed to fair level at knee and hip, no ankle movement, the patient ambulated with an articulating AFO with posterior check strap. Progression of strength at hip and knee, called for discontinuation of the posterior check strap, thus allowing dorsiflexion in stance phase. Subsequently, the calf component of the AFO was removed as ankle and foot strength reached a fair plus level allowing the patient to utilize his own dorsiflexion for swing phase. The remaining foot component modified into a UCBL (University of California Berkeley Laboratory) provided control of residual foot supination tendency in swing phase and pronation in stance phase. Independent locomotor skill was achieved by using the UCBL and discontinuing the quad cane. The sequential weaning of an AFO is a potentially useful tool in the rehabilitation process and warrants further investigation to assess short and long-term benefits and disadvantages. Urinary Tract Infection During Stroke Rehabilitation. Karen A. Gist, Judith A. Goellner, Dorothy E Edwards, Alexander W. Dromerick (Jezoish Hospital of St. Louis, St.

Louis, MO) Background: Urinary tract infection (UTI) is the most common complication encountered during stroke rehabilitation. UTI may lead to more serious complications, interfere with therapies, prolong incontinence and increase costs. More knowledge about the natural history, risk factors and epidemiology of UTI will allow the design of rational strategies to minimize its occurrence. Purpose: To determine the frequency, timing, and neurologic risk factors for UTI during stroke rehabilitation. Methods: Data were collected prospectively on 120 consecutive patients admitted for stroke rehabilitation; 60 patients were included here. Patients underwent a standard nursing and neurologic evaluation including admission urinalysis, post-void residual determination by ultrasound, and medication review. Incontinence was scored using the Functional Independence Measure (FIM). Results: 19/60 patients were treated for UTI; 8 were treated within 48 hours of rehabilitation admission. The average time to UTI was 5.6 days and those treated for UTI were more likely to be incontinent at discharge (P > .03). Patients with motor/sensory/visual and motor/ sensory syndromes were more likely to develop UTI (P < .03, P < .003 respectively; odds ratio 4.2 and 5.9, respectively). Patients with cortical involvement on CT imaging were also more likely to develop UTI. Conclusion: Risk factors for UTI during rehabilitation include sensory and visual deficits and strokes which