Psychosocial risk factors for adverse outcomes in patients with nonvalvular atrial fibrillation receiving warfarin
Psychosocial risk factors for adverse outcomes in patients with nonvalvular atrial fibrillation receiving warfarin
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DOI：
10.1111/j.1525-1497.2005.0242.x
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发表时间：
2005-12-01
影响因子：
5.7
通讯作者：
Eckman, MH
中科院分区：
文献类型：
--
作者：
Schauer, DP;Moomaw, CJ;Eckman, MH
目的：我们的目的是确定不依从性的社会心理风险因素，以前被认为是华法林处方的负面预测因素，是否可以预测接受华法林治疗的非瓣膜性心房颤动患者的不良事件。回顾性队列分析。设置：俄亥俄州医疗补助管理数据库。患者：我们研究了俄亥俄州接受华法林治疗的非瓣膜性心房颤动的医疗补助受助人，以确定药物滥用史、精神疾病或社会因素（被认为是依从性障碍的条件）是否为不良事件的预测因素，包括中风、颅内出血和胃肠道出血。采用Cox比例风险模型计算各危险因素的多变量风险比。结果：1997年至2002年间，9345例患者被确定为患有非瓣膜性心房颤动并接受2种或2种以上华法林处方。在每100人-年的随访中，整个样本的事件发生率为1.5次中风、0.7次颅内出血和4.3次胃肠出血。药物滥用患者在华法林治疗期间发生颅内出血的调整风险比最高，为2.4(95%可信区间[CI]: 1.4, 4.0)，其次是精神疾病患者，调整风险比为1.5（95%可信区间[CI]: 1.04, 2.1）。患有精神疾病的受试者卒中的调整风险比为1.4 （95% CI: 1.1, 1.7）。在所有3个确定的风险组中，患者发生胃肠道出血的风险显著增加。结论：使用华法林治疗的非瓣膜性心房颤动患者，如果存在不遵守华法林的社会心理危险因素，则不良事件的风险增加。
OBJECTIVE: Our goal was to establish whether psychosocial risk factors for nonadherence, previously identified as negative predictors of warfarin prescribing, are predictors of adverse events for patients with nonvalvular atrial fibrillation receiving warfarin.DESIGN. Retrospective cohort analysis.SETTING: Ohio Medicaid administrative database.PATIENTS: We studied Ohio Medicaid recipients with nonvalvular atrial fibrillation receiving warfarin to determine whether a history of substance abuse, psychiatric illness, or social factors (identified as conditions perceived to be barriers to adherence) are predictors of adverse events, including stroke, intracranial hemorrhage, and gastrointestinal bleeding. Multivariable risk ratios were calculated for each risk factor using Cox proportional hazards models.RESULTS: 9,345 patients were identified as having nonvalvular atrial fibrillation and receiving 2 or more warfarin prescriptions between 1997 and 2002. The event rates for the sample as a whole were 1.5 strokes, 0.7 intracranial hemorrhages, and 4.3 gastrointestinal bleeds per 100 person-years of follow-up. Subjects with substance abuse had the highest adjusted risk ratio, 2.4 (95% confidence interval [CI]: 1.4, 4.0) for an intracranial hemorrhage while receiving warfarin, followed by subjects with psychiatric illness, adjusted risk ratio of 1.5 (95% CI: 1.04, 2.1). Subjects with psychiatric illness also had an adjusted risk ratio of 1.4 (95% CI: 1.1, 1.7) for stroke. Patients in all 3 identified risk groups were at a significantly increased risk of gastrointestinal bleeding.CONCLUSION: Patients with nonvalvular atrial fibrillation treated with warfarin who have psychosocial risk factors for nonadherence have an increased risk of adverse events.