Predictors of oral anticoagulant non-prescription in patients with atrial fibrillation and elevated stroke risk.
Predictors of oral anticoagulant non-prescription in patients with atrial fibrillation and elevated stroke risk.
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DOI：
10.1016/j.ahj.2018.03.003
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发表时间：
2018-06
影响因子：
4.8
通讯作者：
Maddox TM
中科院分区：
文献类型：
--
作者：
Lubitz SA;Khurshid S;Weng LC;Doros G;Keach JW;Gao Q;Gehi AK;Hsu JC;Reynolds MR;Turakhia MP;Maddox TM
尽管有证据表明口服抗凝剂（OAC）有益，但许多房颤（AF）和卒中风险升高的患者并未接受口服抗凝剂（OAC）治疗。确定与OAC非处方相关的因素可能会改善护理。使用NCDR PINNACLE（一项美国的动态心脏病学登记研究），我们检查了2008年1月5日至2014年12月31日期间卒中风险升高（CHA 2DS 2-VASc ≥ 2）的非瓣膜性AF患者中与OAC非处方相关的因素。在674，841例患者中，57%接受OAC治疗（其中67%接受华法林治疗）。OAC处方在预先选择的年龄、卒中风险（CHA 2DS 2-VASc）和出血风险（HAS-BLED）分层中差异很大（28%-75%），通常表明高卒中和低出血风险的老年患者通常接受OAC治疗。与OAC非处方相关的其他因素包括可逆性AF病因;女性;肝脏、肾脏或血管疾病;医生与非医生提供者。抗血小板药物的使用很常见（57%），与OAC非处方药的最大风险相关（比值比[OR] 4.44，95%置信区间[CI] 4.39-4.49）。在该AF患者登记研究中，卒中升高和出血风险较低的老年患者通常接受OAC治疗。然而，多种因素与OAC非处方相关。具体来说，抗血小板药物的使用很普遍，并且与OAC非处方药的可能性最高相关。未来的研究是必要的，以了解供应商和患者的理由，可能是观察到的关联与OAC非处方。
Many patients with atrial fibrillation (AF) and elevated stroke risk are not prescribed oral anticoagulation (OAC) despite evidence of benefit. Identification of factors associated with OAC non-prescription could lead to improvements in care. Using NCDR PINNACLE, a United States-based ambulatory cardiology registry, we examined factors associated with OAC non-prescription in patients with non-valvular AF at elevated stroke risk (CHA2DS2-VASc ≥ 2) between January 5, 2008 and December 31, 2014. Among 674,841 patients, 57% were treated with OAC (67% of whom were treated with warfarin). OAC prescription varied widely (28%–75%) across preselected strata of age, stroke risk (CHA2DS2-VASc), and bleeding risk (HAS-BLED), generally indicating that older patients at high stroke and low bleeding risk are commonly treated with OAC. Other factors associated with OAC non-prescription included reversible AF etiology; female sex; liver, renal, or vascular disease; and physician versus non-physician provider. Antiplatelet use was common (57%) and associated with the greatest risk of OAC non-prescription (odds ratio [OR] 4.44, 95% confidence interval [CI] 4.39–4.49). In this registry of AF patients, older patients at elevated stroke and low bleeding risk were commonly treated with OAC. However, a variety of factors were associated with OAC non-prescription. Specifically, antiplatelet use was prevalent and associated with the highest likelihood of OAC non-prescription. Future studies are warranted to understand provider and patient rationale that may underlie observed associations with OAC non-prescription.
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影响因子：
39.2
作者：
Go, AS;Hylek, EM;Singer, DE
通讯作者：
Singer, DE
影响因子：
37.8
作者：
Corley, SD;Epstein, AE;Wyse, DG
通讯作者：
Wyse, DG
影响因子：
37.8
作者：
Gage, BF;van Walraven, C;Petersen, P
通讯作者：
Petersen, P
影响因子：
37.8
作者：
Dentali, Francesco;Riva, Nicoletta;Ageno, Walter
通讯作者：
Ageno, Walter
德国初级保健医生对房颤的管理：中庭注册中心的基线结果。
DOI：
10.1007/s00392-011-0320-5
发表时间：
2011-10
期刊：
Clinical research in cardiology : official journal of the German Cardiac Society
影响因子：
--
作者：
Meinertz T;Kirch W;Rosin L;Pittrow D;Willich SN;Kirchhof P;ATRIUM investigators
通讯作者：
ATRIUM investigators