Trends in the prevalence and management of pre-stroke atrial fibrillation, the South London Stroke Register, 1995-2014.
Trends in the prevalence and management of pre-stroke atrial fibrillation, the South London Stroke Register, 1995-2014.
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DOI：
10.1371/journal.pone.0175980
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Wolfe CDA
中科院分区：
文献类型：
--
作者：
Jain V;Marshall IJ;Crichton SL;McKevitt C;Rudd AG;Wolfe CDA
先前的研究发现，在患有心房颤动（AF）的人中，中风前抗凝剂的使用率很低。本研究检查了来自基于人群的卒中登记的AF相关卒中患者的数据，并试图检查卒中前AF管理的变化，以及已知卒中高风险患者接受次优治疗的原因。南伦敦卒中登记中心（SLSR）是一个正在进行的基于人群的登记中心，记录首次发生的卒中。研究了1995年至2014年期间AF患病率和卒中前处方的抗血栓药物的趋势。进行多变量logistic回归分析，以评估与适当管理相关的因素。在登记的5041例患者中，816例（16.2%）在卒中前被诊断为AF。在加勒比黑人和非洲黑人患者中，AF相关卒中显著增加，1995-1998年占整个队列的5%，到2011-2014年增加到25%（p<0.001）。卒中高危（CHADS 2评分[> = 2]）AF患者的抗凝处方从9%（1995-1998）增加至30%（2011-2014）（p<0.001）。在所有时间段内，抗血小板处方更常见（43%至64%的高危患者）。老年患者（>65岁）使用抗凝剂的可能性显著降低，种族、性别和剥夺与抗凝无关。大多数AF相关中风发生在中风前可能被预测为高风险的人群中，但没有得到最佳的预防治疗。尽管老年人中风风险最高，但很少使用抗凝剂。
Previous studies have found low use of anticoagulation prior to stroke, in people with atrial fibrillation (AF). This study examined data on patients with AF-related stroke from a population-based stroke register, and sought to examine changes in management of AF prior to stroke, and reasons for suboptimal treatment, in those who were known to be at a high risk of stroke. The South London Stroke Register (SLSR) is an ongoing population-based register recording first-in-a-lifetime stroke. Trends in the prevalence of AF, and antithrombotic medication prescribed before the stroke, were investigated from 1995 to 2014. Multivariable logistic regression analyses were conducted to assess the factors associated with appropriate management. Of the 5041 patients on the register, 816 (16.2%) were diagnosed with AF before their stroke. AF related stroke increased substantially among Black Carribean and Black African patients, comprising 5% of the overall cohort in 1995–1998, increasing to 25% by 2011–2014 (p<0.001). Anticoagulant prescription in AF patients at high-risk of stroke (CHADS2 score [> = 2]) increased from 9% (1995–1998) to 30% (2011–2014) (p<0.001). Antiplatelet prescription was more commonly prescribed throughout all time periods (43% to 64% of high-risk patients.) Elderly patients (>65) were significantly less likely to be prescribed an anticoagulant, with ethnicity, gender and deprivation showing no association with anticoagulation. Most AF-related strokes occurred in people who could have been predicted to be at high risk before their stroke, yet were not prescribed optimal preventative treatment. The elderly,despite being at highest stroke risk, were rarely prescribed anticoagulants.