Changes in Use of Anticoagulation in Patients With Atrial Fibrillation Within a Primary Care Network Associated With the Introduction of Direct Oral Anticoagulants
Changes in Use of Anticoagulation in Patients With Atrial Fibrillation Within a Primary Care Network Associated With the Introduction of Direct Oral Anticoagulants
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DOI：
10.1016/j.amjcard.2017.05.055
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发表时间：
2017-09-01
影响因子：
2.8
通讯作者：
Atlas, Steven J.
中科院分区：
文献类型：
--
作者：
Ashburner, Jeffrey M.;Singer, Daniel E.;Atlas, Steven J.
心房颤动（AF）和决定抗凝是一个常见的问题面临的初级保健医生。口服抗凝剂（OAC）虽然在预防中风方面有明显的益处，但其应用仍不充分。在引入直接口服抗凝剂（DOACs）后，我们检查了2010年至2015年间OAC的使用情况，并特别评估了随着时间的推移是否有更多的患者抗凝。该研究队列包括18岁及以上的房颤成年患者，在2010年至2015年期间在18家诊所的初级保健网络中接受治疗。使用经过验证的电子健康记录算法分配每个日历年的AF状态。我们检查了所有房颤患者和卒中高危患者(CHA（2)DS(2)-VASc >= 2）的OAC使用情况。房颤患者的比例随着时间的推移而增加（2010年：4920例[3.5%]，2015年：6452例[4.0%]）。从2010年（57.0%）到2015年（57.4%），接受OAC治疗的患者比例没有增加（p = 0.41）。同样，在卒中高危患者中，抗凝血比例不随时间增加（2010年：61.1%，2015年：61.7%,p = 0.51）。在研究期间，DOAC的使用率从2010年的0.31%上升到2015年的18.3% （p < 0.001）。服用DOACs的患者更年轻，卒中风险更低。总之，这项研究表明，随着时间的推移，在初级保健网络中患有房颤的患者比例不断增加。doac的使用随着时间的推移而增加；然而，接受OAC治疗的患者比例并没有随着时间的推移而增加。(C) 2017爱思唯尔公司版权所有。
Atrial fibrillation (AF) and the decision to anticoagulate is a common problem faced by primary care physicians. Oral anticoagulation (OAC) is underused, despite its clear benefits with regard to stroke prevention. We examined OAC usage between 2010 and 2015, following the introduction of direct oral anticoagulants (DOACs) and specifically assessed whether more patients were anticoagulated over time. The study cohort included adult patients aged 18 and older with AF cared for in an 18-practice primary care network between 2010 and 2015. AF status was assigned each calendar year using a validated electronic health record algorithm. We examined OAC usage over time in all patients with AF, and in patients at high risk of stroke (CHA(2)DS(2)-VASc >= 2). The proportion of the population with AF increased over time (2010: 4,920 patients [3.5 %], 2015: 6,452 patients [4.0 %]). There was no increase in the proportion of patients prescribed any OAC treatment from 2010 (57.0%) to 2015 (57.4%) (p = 0.41). Similarly, in patients at high risk of stroke, the proportion anticoagulated did not increase over time (2010: 61.1%, 2015: 61.7%, p = 0.51). Over the study period, DOAC usage increased from 0.31% of all patients with AF in 2010 to 18.3% in 2015 (p < 0.001). Patients prescribed DOACs were younger, with lower risk of stroke. In conclusion, this study showed an increasing proportion of patients with AF over time in a primary care network. The use of DOACs increased over time; however, the proportion of patients treated with OAC did not increase over time. (C) 2017 Elsevier Inc. All rights reserved.