Recent national patterns of warfarin use in atrial fibrillation.
Recent national patterns of warfarin use in atrial fibrillation.
复制标题
近期全国使用华法林治疗心房颤动的模式。
DOI：
10.1161/01.cir.97.13.1231
复制
发表时间：
1998
期刊：
影响因子：
37.8
通讯作者：
Singer,DE
中科院分区：
文献类型：
--
作者：
Stafford,RS;Singer,DE
背景--对选定人群的研究表明，抗凝治疗在房颤中的应用不足，非临床因素影响了这种卒中预防治疗的应用。我们希望研究最近的国家趋势和预测因素华法林钠的使用在atrialfibrillation.Methods和Results-A从1989年至1996年全国门诊医疗调查的办公室访问的全国代表性样本。我们选择了1125例房颤患者就诊，其中877例就诊于心脏病专家和初级保健医生，这些患者没有明显的抗凝禁忌症。主要结果指标是报告华法林的访视比例。我们分析了华法林使用的趋势，并对华法林使用的预测因素进行了统计学评估。在无禁忌症的房颤患者中，华法林的使用从1989年的13%增加到1993年的40%（P <0.001）。然而，在1993年至1996年期间，华法林的使用没有变化。独立于其他因素，华法林是显着更有可能被报道的患者中风史和居住在South. Conclusions以外的患者华法林使用心房颤动最近没有增加，表明这种高效的治疗实施不足。需要识别和解决现实世界临床实践中的抗凝障碍。
Background—Studies of selected populations suggest that anticoagulation in atrial fibrillation is underused and that nonclinical factors influence the use of this stroke-preventing therapy. We wished to examine recent national trends and predictors of warfarin sodium use in atrial fibrillation.Methods and Results—A nationally representative sample of office visits from the 1989 to 1996 National Ambulatory Medical Care Surveys was used. We selected 1125 visits by patients with atrial fibrillation, including 877 visits to cardiologists and primary care physicians in which apparent contraindications for anticoagulation were absent. The principal outcome measure was the proportion of visits with warfarin reported. We analyzed trends in warfarin use and statistically evaluated the predictors of warfarin use. Warfarin use increased from 13% of atrial fibrillation visits in 1989 to 40% in 1993 (Pfor trend <.001) in patients without contraindications. Between 1993 and 1996, however, there was no change in warfarin use. Independent of other factors, warfarin was significantly more likely to be reported in patients with a history of stroke and in patients residing outside of the South.Conclusions—Warfarin use in atrial fibrillation has not increased recently, indicating inadequate implementation of this highly effective therapy. Barriers to anticoagulation in real-world clinical practice need to be identified and addressed.