Use and effectiveness of warfarin in medicare beneficiaries with atrial fibrillation
Use and effectiveness of warfarin in medicare beneficiaries with atrial fibrillation
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DOI：
10.1161/01.str.0000208294.46968.a4
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发表时间：
2006-04-01
期刊：
影响因子：
8.3
通讯作者：
Gage, BF
中科院分区：
文献类型：
--
作者：
Birman-Deych, E;Radford, MJ;Gage, BF
背景和目的-超过200万的美国人患有心房颤动，如果不进行抗血栓治疗，他们的中风率会增加5倍。在随机对照试验中，与未进行抗血栓治疗相比，华法林预防了65%的缺血性卒中（风险比[HR]，0.35; 95%CI，0.26 - 0.48）。然而，华法林治疗在临床试验之外的有效性尚不清楚，特别是在黑人和西班牙裔人群中。我们的目标是量化使用华法林治疗，频率的国际标准化比率监测，并有效地预防中风的医疗保险受益人与房颤。方法-这是一个队列研究的医疗保险受益人与房颤谁住院之间的1998年3月和1999年4月在美国所有50个州。主要结果是事件住院缺血性中风的基础上，经验证的国际疾病分类，第9次修订，临床修改codes.Results -三分之二的理想抗凝候选人在出院时处方华法林。在未校正的分析中，华法林治疗每100患者年的卒中率在（非西班牙裔）白色医疗保险受益人中为5.2，在黑人受益人中为10.6，在西班牙裔受益人中为12.2。在调整共病条件后，与黑人或西班牙裔受益人相比，白色医疗保险受益人的华法林处方更频繁，监测更定期（P < 0.0001）。使用华法林与缺血性卒中减少35%相关（HR，0.65; 95%CI，0.55至0.76）相比，没有抗血栓治疗，但在黑人和西班牙裔受益人的有效性较低（P = 0.048）结论-使用，监测和华法林治疗的有效性是次优的医疗保险受益人，特别是在黑人和西班牙裔受益人。
Background and Purpose - More than 2 million Americans have atrial fibrillation, and without antithrombotic therapy, their stroke rate is increased 5-fold. In randomized controlled trials, warfarin prevented 65% of ischemic strokes ( hazard ratio [HR], 0.35; 95% CI, 0.26 to 0.48) compared with no antithrombotic therapy. However, the effectiveness of warfarin therapy outside of clinical trials is unknown, especially in black and Hispanic populations. Our goal was to quantify use of warfarin therapy, frequency of International Normalized Ratio monitoring, and effectiveness for stroke prophylaxis in Medicare beneficiaries with atrial fibrillation.Methods - This was a cohort study of Medicare beneficiaries with atrial fibrillation who were hospitalized between March 1998 and April 1999 in all 50 US states. The primary outcome was incident hospitalizations for ischemic stroke based on validated International Classification of Diseases, 9th Revision, Clinical Modification codes.Results - Two thirds of ideal anticoagulation candidates were prescribed warfarin on hospital discharge. In unadjusted analyses, the stroke rates per 100 patient years of warfarin therapy were 5.2 in (non-Hispanic) white Medicare beneficiaries, 10.6 in black beneficiaries, and 12.2 in Hispanic beneficiaries. After adjusting for comorbid conditions, warfarin prescription was more frequent and monitoring more regular in white Medicare beneficiaries than in black or Hispanic beneficiaries ( P < 0.0001). Warfarin use was associated with 35% fewer ischemic strokes ( HR, 0.65; 95% CI, 0.55 to 0.76) compared with no antithrombotic therapy but was less effective in black and Hispanic beneficiaries ( P for interaction = 0.048).Conclusions - The use, monitoring, and effectiveness of warfarin therapy are suboptimal in Medicare beneficiaries, especially in black and Hispanic beneficiaries.