Warfarin use among ambulatory patients with nonvalvular atrial fibrillation: The AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study
Warfarin use among ambulatory patients with nonvalvular atrial fibrillation: The AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study
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DOI：
10.7326/0003-4819-131-12-199912210-00004
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发表时间：
1999-12-21
影响因子：
39.2
通讯作者：
Singer, DE
中科院分区：
文献类型：
--
作者：
Go, AS;Hylek, EM;Singer, DE
背景资料：华法林可显著降低非瓣膜性房颤患者缺血性卒中的风险，但其在非卧床房颤患者中的应用尚未得到广泛研究。目的：评估非卧床非瓣膜性房颤患者使用华法林的比率和预测因素。设计：横断面研究。设置：大型健康维护组织。患者：1996年7月1日至1997年12月31日期间，13428例确诊为非瓣膜性房颤且已知华法林状态的患者。测量：数据来自自动化药房、实验室、临床-行政数据库用于确定确诊心房纤颤之前或之后3个月内华法林使用的患病率和决定因素。结果：在11082例无已知禁忌症的非瓣膜性房颤患者中，55%接受华法林治疗。年龄小于55岁的患者（44.3%）和年龄大于或等于85岁的患者（35.4%）的华法林使用率明显较低。只有59.3%有一个或多个卒中危险因素且无禁忌症的患者接受华法林治疗。在接受华法林治疗的“理想”候选人（年龄在65至74岁之间，无禁忌症，既往有卒中、高血压或两者兼有）中，62.1%有华法林使用证据。在我们的整个队列中，接受华法林治疗的最强预测因子是既往卒中史（校正比值比，2.55 [95% CI，2.23 - 2.92]），心力衰竭（比值比，1.63 [CI，1.51 - 1.77]），既往颅内出血（比值比，0.33 [CI，0.21 - 0.52]），年龄≥ 85岁（比值比，0.35 [CI，0.31 - 0.40]），和既往胃肠道出血结论：在一个大型的，当代队列的门诊房颤患者谁接受保健组织内，华法林的使用是相当高的比其他报道的研究。虽然医生不开华法林的原因尚不清楚，但许多明显合格的房颤患者和至少一个额外的卒中风险因素，特别是高血压，没有接受抗凝治疗。需要采取干预措施，在适当的候选人中增加华法林预防卒中的使用。
Background: Warfarin dramatically reduces the risk for ischemic stroke in nonvalvular atrial fibrillation, but its use among ambulatory patients with atrial fibrillation has not been widely studied.Objective: To assess the rates and predictors of warfarin use in ambulatory patients with nonvalvular atrial fibrillation.Design: Cross-sectional study.Setting: Large health maintenance organization.Patients: 13428 patients with a confirmed ambulatory diagnosis of nonvalvular atrial fibrillation and known warfarin status between 1 July 1996 and 31 December 1997.Measurements: Data from automated pharmacy, laboratory, and clinical-administrative databases were used to determine the prevalence and determinants of warfarin use in the 3 months before or after the identified diagnosis of atrial fibrillation.Results: Of 11082 patients with nonvalvular atrial fibrillation and no known contraindications, 55% received warfarin. Warfarin use was substantially lower in patients who were younger than 55 years of age (44.3%) and those who were 85 years of age or older (35.4%). Only 59.3% of patients with one or more risk factors for stroke and no contraindications were receiving warfarin. Among a subset of "ideal" candidates to receive warfarin (persons 65 to 74 years of age who had no contraindications and had previous stroke, hypertension, or both), 62.1% had evidence of warfarin use. Among our entire cohort, the strongest predictors of receiving warfarin were previous stroke (adjusted odds ratio, 2.55 [95% CI, 2.23 to 2.92]), heart failure (odds ratio, 1.63 [CI, 1.51 to 1.77]), previous intracranial hemorrhage (odds ratio, 0.33 [CI, 0.21 to 0.52]), age 85 years or older (odds ratio, 0.35 [CI, 0.31 to 0.40]), and previous gastrointestinal hemorrhage (odds ratio, 0.47 [CI, 0.40 to 0.57]).Conclusions: In a large, contemporary cohort of ambulatory patients with atrial fibrillation who received care within a health maintenance organization, warfarin use was considerably higher than in other reported studies. Although the reasons why physicians did not prescribe warfarin could not be elucidated, many apparently eligible patients with atrial fibrillation and at least one additional risk factor for stroke, especially hypertension, did not receive anticoagulation. Interventions are needed to increase the use of warfarin for stroke prevention among appropriate candidates.