Trends in the prevalence of diagnosed atrial fibrillation, its treatment with anticoagulation and predictors of such treatment in UK primary care
Trends in the prevalence of diagnosed atrial fibrillation, its treatment with anticoagulation and predictors of such treatment in UK primary care
复制标题
DOI：
10.1136/hrt.2005.069492
复制
发表时间：
2006-08-01
期刊：
影响因子：
5.7
通讯作者：
Cook, D. G.
中科院分区：
文献类型：
--
作者：
DeWilde, S.;Carey, I. M.;Cook, D. G.
目的：研究1994年至2003年确诊的心房颤动（AF）的患病率、口服抗凝剂治疗的趋势以及2003年抗凝剂治疗的预测因素。方法：分析131例全科医生的电子数据（每年约有100万名注册患者）为DIN-LINK数据库做出贡献。从1994年到2003年，男性“活动性”房颤的患病率从0.78%上升到1.31%，女性从0.79%上升到1.15%。服用抗凝剂的房颤患者比例在男性中从25%上升到53%，在女性中从21%上升到40%。大多数人接受抗血小板治疗。男性接受抗凝剂治疗的可能性更大，且中风风险增加。75岁以后随着年龄的增长而急剧下降。社会经济地位、城市化和地区没有影响。非甾体抗炎药、抗血小板药和溃疡愈合药与接受抗凝剂的可能性降低相关，消化性溃疡、慢性肠道疾病、贫血、精神病和依从性差也是如此。抗凝治疗与几种心血管合并症和药物相关，可能是由于二级护理治疗。然而，只有56.5%的患者在非常高的中风风险在2003年服用抗凝剂，而38.2%的患者在低风险的中风收到anticoagulants.Conclusions：这项研究证实了先前观察到的趋势，增加房颤患病率和华法林治疗。许多可能受益于抗凝治疗的患者仍然没有接受抗凝治疗，而其他中风风险较低的患者则接受抗凝治疗。妇女接受抗凝剂的可能性较低，这一点特别令人关切。
Objectives: To examine trends in the prevalence of diagnosed atrial fibrillation (AF), its treatment with oral anticoagulants between 1994 and 2003, and predictors of anticoagulant treatment in 2003.Methods: Analysis of electronic data from 131 general practices (about one million registered patients annually) contributing to the DIN-LINK database.Results: From 1994 to 2003 the prevalence of "active'' AF rose from 0.78% to 1.31% in men and from 0.79% to 1.15% in women. The proportion of patients with AF taking anticoagulants rose from 25% to 53% in men and from 21% to 40% in women. Most others received antiplatelets. The likelihood of receiving anticoagulants was greater for men and with increasing stroke risk. It decreased sharply with age after 75 years. Socioeconomic status, urbanisation and region had no influence. Non-steroidal anti-inflammatory drugs, antiplatelet drugs and ulcer healing drugs were associated with reduced likelihood of receiving anticoagulants, as were peptic ulcers, chronic gut disorders, anaemias, psychoses and poor compliance. Anticoagulant treatment was associated with several cardiovascular co-morbidities and drugs, possibly due to secondary care treatment. Nevertheless, only 56.5% of patients at very high risk of stroke were taking anticoagulants in 2003, whereas 38.2% of patients at low risk of stroke received anticoagulants.Conclusions: This study confirms previously observed trends of increasing AF prevalence and warfarin treatment. Many patients who may benefit from anticoagulation still do not receive it, whereas others at lower risk of stroke do. The lower likelihood of women receiving anticoagulants is of particular concern.