Anticoagulation treatment for the reduction of stroke in atrial fibrillation:: a cohort study to examine the gap between guidelines and routine medical practice
Anticoagulation treatment for the reduction of stroke in atrial fibrillation:: a cohort study to examine the gap between guidelines and routine medical practice
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DOI：
10.1007/s11239-006-0002-8
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发表时间：
2007-08-01
影响因子：
4
通讯作者：
Willich, Stefan N.
中科院分区：
文献类型：
--
作者：
McBride, Doreen;Brueggenjuergen, Bernd;Willich, Stefan N.
背景房颤（AF）是最常见的心律失常，影响6%的65岁以上人群，平均每年有4.5%的卒中风险，可以通过适当的抗凝治疗来降低。一项多中心的观察性研究，管理和结果在德国（莫卡）的房颤护理进行了评估，目前的抗凝治疗模式在房颤患者在德国。方法房颤患者招募2003年12月至2004年6月在医生的做法。临床数据包括国际标准化比值（INR）值和抗凝策略，从医生病历中获得，并在3个月和6个月时进行患者随访，记录住院、用药和并发症。主要结果的措施包括抗凝方法，实践指南的遵守和时间内推荐的抗凝wave.Results 361例AF患者（平均年龄71 +/- 9，61%男性）被招募在45个医生的做法。90%的患者在AF诊断后的某个时间接受了维生素K拮抗剂（VKA）治疗，88%的患者仍在接受治疗。10%的患者接受阿司匹林作为抗凝治疗。超过70%的患者至少每月监测一次。56%的INR值在推荐目标范围内，14%低于推荐目标范围，30%高于推荐目标范围。指南建议与实际做法之间存在40%的差距。年轻的患者（< 60岁），没有记录的中风危险因素与VKA过度治疗和患者年龄超过75岁，没有禁忌症抗凝治疗undertreated.Conclusions本研究提出了“现实生活”的数据，在治疗房颤患者在德国，并确定了潜在的提高抗凝治疗的质量。
Background Atrial fibrillation (AF) is the most common heart arrhythmia, affecting 6% of people over 65 years, and carries a 4.5% average annual stroke risk, which can be reduced by appropriate anticoagulation. A multi-centre observational study, Management and Outcomes in the Care of Atrial fibrillation in Germany (MOCA) was conducted to evaluate the current anticoagulation treatment pattern in patients with AF in Germany.Methods Patients with AF were recruited from December 2003 to June 2004 in physician practices. Clinical data including International Normalised Ratio (INR) values and anticoagulation strategy were obtained from the physician chart and the patient follow-up, documenting hospitalisations, medications, and complications, was conducted at three and six months. Main outcome measures included anticoagulation methods, practice guidelines adherence and time within recommended anticoagulation range.Results 361 patients with AF (mean age 71 +/- 9, 61% male) were recruited in 45 physician practices. 90% of all patients had been treated with Vitamin K-Antagonists (VKA) at some time since AF-diagnosis, 88% were still treated. 10% of patients received aspirin as their anticoagulation therapy. Monitoring occurred at least once a month in over 70% of patients. Monitored INR values were 56% of the time within, 14% below and 30% over the recommended target range. A gap of 40% existed between the guideline recommendations and actual practice. Younger patients (< 60 years of age) with no documented risk factors for stroke were over-treated with VKAs and patients older than 75 years without contraindications for anticoagulation were under-treated.Conclusions This study presents 'real-life' data in treating patients with AF in Germany and identifies the potential to advance the quality of care with respect to anticoagulation.