Prevalence and quality of warfarin use for patients with atrial fibrillation in the long-term care setting
Prevalence and quality of warfarin use for patients with atrial fibrillation in the long-term care setting
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DOI：
10.1001/archinte.161.20.2458
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发表时间：
2001-11-12
影响因子：
--
通讯作者：
Radford, MJ
中科院分区：
文献类型：
--
作者：
McCormick, D;Gurwitz, JH;Radford, MJ
背景：基于证据的临床实践指南建议，对于大多数无出血性并发症危险因素的心房颤动（AF）患者，无论年龄大小，均可使用华法林钠预防卒中。方法：对康乃狄克州长期照护机构便利样本（n=21）的所有居民的医疗记录进行回顾。确定所有AF患者（AF患者）和华法林治疗理想候诊患者（即无出血危险因素的AF患者）接受华法林治疗的百分比；对于接受华法林治疗的患者，还评估了在国际标准化比率（INR）值（2.0-3.0）治疗范围内的天数百分比。在多变量模型中评估华法林与卒中和出血危险因素之间的关系。结果：2587名长期护理居民中有429人（17%）存在心房颤动。总体而言，42%的房颤患者接受华法林治疗。然而，83名理想候选人中只有44名（53%）接受了这种治疗。在接受华法林治疗的居民中，只有51%的时间维持INR值的治疗范围。在研究样本中，接受华法林治疗的几率随着出血危险因素的增加而降低，随着卒中危险因素的增加而增加（无显著趋势）。结论：房颤在长期护理机构的居民中非常常见。即使在明显理想的候选药物中，华法林治疗在房颤患者中风预防中的应用也不足。在长期护理环境中，华法林治疗的处方决定和监测需要改进。
Background: Evidence-based clinical practice guidelines recommend the use of warfarin sodium for stroke prevention in most patients with atrial fibrillation (AF) who do not have risk factors for hemorrhagic complications, irrespective of age.Methods: The medical records of all residents of a convenience sample of long-term care facilities in Connecticut (n=21) were reviewed. The percentages of all patients with AF (AF patients) and ideal candidates for warfarin therapy (ie, AF patients with no risk factors for hemorrhage) who received warfarin were determined; for patients receiving warfarin, the percentage of days spent in the therapeutic range of international normalized ratio (INR) values (2.0-3.0) was also assessed. The relationship between receipt of warfarin and the presence of stroke and bleeding risk factors was assessed in multivariate models.Results: Atrial fibrillation was present in 429 (17%) of the 2587 long-term care residents. Overall, 42% of AF patients were receiving warfarin. However, only 44 (53%) of 83 ideal candidates were receiving this therapy. In residents who received warfarin therapy, the therapeutic range of INR values was maintained only 51% of the time. The odds of receiving warfarin in the study sample decreased with increasing number of risk factors for bleeding and increased (nonsignificant trend) with increasing number of stroke risk factors present.Conclusions: Atrial fibrillation is very common among residents of long-term care facilities. Even among apparently ideal candidates, warfarin therapy is underused for stroke prevention in patients with AF. Prescribing decisions and monitoring related to warfarin therapy in the long-term care setting warrant improvement.