Differences and trends in stroke prevention anticoagulation in primary care vs cardiology specialty management of new atrial fibrillation: The Retrospective Evaluation and Assessment of Therapies in AF (TREAT-AF) study
Differences and trends in stroke prevention anticoagulation in primary care vs cardiology specialty management of new atrial fibrillation: The Retrospective Evaluation and Assessment of Therapies in AF (TREAT-AF) study
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DOI：
10.1016/j.ahj.2012.10.010
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发表时间：
2013-01-01
影响因子：
4.8
通讯作者：
Heidenreich, Paul A.
中科院分区：
文献类型：
--
作者：
Turakhia, Mintu P.;Hoang, Donald D.;Heidenreich, Paul A.
背景心房颤动和扑动（AF，统称）导致卒中。我们评估是否治疗专业影响华法林处方的患者新诊断的AF。方法在美国退伍军人健康管理局的AF研究，我们使用的健康记录和索赔数据，以确定新诊断的AF患者在2004年10月和2008年11月之间，至少有一个内科/初级保健或心脏病门诊就诊后90天内诊断。结果在符合纳入标准的141，642例患者中，平均年龄为72.3 ± 10.2岁，1.48%为女性，25.8%有心脏病门诊治疗。接受心脏病治疗的患者有更多的合并症和更高的平均CHADS 2评分（1.8 vs 1.6，P <0.0001）。心脏病治疗患者的华法林使用率高于仅接受初级保健治疗的患者（68.6% vs 48.9%，P <0.0001）。经协变量和研究中心水平调整后，心脏病治疗与华法林使用显著相关（比值比[OR] 2.05，95%CI 1.99-2.11）。这些结果在一系列调整模型（OR 2.05-2.20）、倾向匹配（OR 1.98）和亚组分析（OR 1.58-2.11）中一致。2004年至2008年，仅接受初级保健的患者中华法林的使用有所下降（51.6%-44.0%，P <0.0001），而华法林治疗与心脏病护理的校正比值（相对于初级保健）从2004年到2008年有所增加结论在新诊断的房颤患者中，不同专科的抗凝治疗存在较大差异。观察到风险调整后华法林使用的5年趋势不同。治疗专业影响中风预防护理，并可能影响临床结果。(Am Heart J 2013;165：93-101.e1.）
Background Atrial fibrillation and flutter (AF, collectively) cause stroke. We evaluated whether treating specialty influences warfarin prescription in patients with newly diagnosed AF.Methods In the TREAT-AF study, we used Veterans Health Administration health record and claims data to identify patients with newly diagnosed AF between October 2004 and November 2008 and at least 1 internal medicine/primary care or cardiology outpatient encounter within 90 days after diagnosis. The primary outcome was prescription of warfarin.Results In 141,642 patients meeting the inclusion criteria, the mean age was 72.3 +/- 10.2 years, 1.48% were women, and 25.8% had cardiology outpatient care. Cardiology-treated patients had more comorbidities and higher mean CHADS2 scores (1.8 vs 1.6, P < .0001). Warfarin use was higher in cardiology-treated vs primary care only-treated patients (68.6% vs 48.9%, P < .0001). After covariate and site-level adjustment, cardiology care was significantly associated with warfarin use (odds ratio [OR] 2.05, 95% CI 1.99-2.11). These findings were consistent across a series of adjusted models (OR 2.05-2.20), propensity matching (OR 1.98), and subgroup analyses (OR 1.58-2.11). Warfarin use in primary-care-only patients declined from 2004 to 2008 (51.6%-44.0%, P < .0001), whereas the adjusted odds of warfarin receipt with cardiology care (vs primary care) increased from 2004 to 2008 (1.88-2.24, P < .0001).Conclusion In patients with newly diagnosed AF, we found large differences in anticoagulation use by treating specialty. A divergent 5-year trend of risk-adjusted warfarin use was observed. Treating specialty influences stroke prevention care and may impact clinical outcomes. (Am Heart J 2013;165:93-101.e1.)