Quality of Care for Atrial Fibrillation Among Patients Hospitalized for Heart Failure
Quality of Care for Atrial Fibrillation Among Patients Hospitalized for Heart Failure
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DOI：
10.1016/j.jacc.2009.04.091
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发表时间：
2009-09-29
影响因子：
24
通讯作者：
Fonarow, Gregg C.
中科院分区：
文献类型：
--
作者：
Piccini, Jonathan P.;Hernandez, Adrian F.;Fonarow, Gregg C.
目的本研究旨在评估房颤(AF)和心力衰竭(HF)患者出院时的护理质量和华法林的使用情况。背景房颤在心力衰竭患者中很常见，国家指南建议出院时使用华法林预防中风。方法我们分析了2005年1月至2008年3月期间255家参与美国心脏协会心力衰竭指南计划的医院的72,534例心力衰竭住院患者。结果在这组心衰患者中，20.5%(n=14901)入院时有房颤，13.7%(n=9918)入院时有房颤病史，但有规律的节律。有9.2%的患者记录了华法林治疗的禁忌症。在没有禁忌症的合格心力衰竭患者中，出院时华法林治疗的中位数为64.9%(四分位数范围为55.5至73.4)，在3.5年的研究期间没有改善。调整后，与出院时不使用华法林相关的主要因素包括年龄增加、非白人、贫血和南方的治疗。华法林的使用也与CHADS(2)(充血性心力衰竭、高血压、75岁、糖尿病、既往中风或短暂性脑缺血发作)的风险(CHADS21~6分，p<；0.0001)成反比。结论指南推荐的华法林在房颤和心力衰竭患者中的使用不是最理想的，并没有随着时间的推移而改善，而且随着年龄、种族、风险分布、地区和医院地点的不同而有显著差异。(J Am Coll心脏ol 2009；54：1280-9)(C)美国心脏病学会基金会2009
Objectives This study sought to examine quality of care and warfarin use at discharge in patients with atrial fibrillation (AF) and heart failure (HF).Background Atrial fibrillation is common in HF, and national guidelines recommend discharge on warfarin for stroke prophylaxis. However, the frequency and factors associated with the guideline adherence are poorly described.Methods We analyzed 72,534 HF admissions from January 2005 through March 2008 at 255 hospitals participating in the American Heart Association's Get With The Guidelines HF program. Multivariable logistic regression was used to identify independent factors associated with warfarin use at discharge.Results In this HF population, 20.5% (n = 14,901) had AF on admission, whereas another 13.7% (n = 9,918) had a prior history of AF but were in a regular rhythm at admission. Contraindications to warfarin therapy were documented in 9.2%. Among eligible HF patients without contraindications, the median prevalence of warfarin therapy at discharge was 64.9% (interquartile range 55.5 to 73.4) and did not improve during the 3.5 years of study. After adjustment, major factors associated with no warfarin use at discharge included increasing age, nonwhite race, anemia, and treatment in the south. Warfarin use also varied inversely with CHADS(2) (congestive heart failure, hypertension, age >75, diabetes, and prior stroke or transient ischemic attack) risk (70.9% to 59.5% for CHADS2 score 1 to 6, p < 0.0001).Conclusions Guideline-recommended warfarin use in patients with AF and HF is less than optimal, has not improved over time, and varies significantly according to age, race, risk profile, region, and hospital site. (J Am Coll Cardiol 2009; 54: 1280-9) (C) 2009 by the American College of Cardiology Foundation