Hospitalized patients with atrial fibrillation and a high risk of stroke are not being provided with adequate anticoagulation
Hospitalized patients with atrial fibrillation and a high risk of stroke are not being provided with adequate anticoagulation
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DOI：
10.1016/j.jacc.2005.06.077
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发表时间：
2005-11-01
影响因子：
24
通讯作者：
Colgan, KJ
中科院分区：
文献类型：
--
作者：
Waldo, AL;Becker, RC;Colgan, KJ
本研究的目的是确定华法林在房颤（AF）患者中使用的治疗间隔和预测因素，该研究纳入了一项国家多中心研究。国家抗凝基准结果报告（NABOR）是一项绩效改进计划，旨在对参与医院的抗凝预防、治疗和结果进行基准测试。方法对美国21所教学医院、13所社区医院和4所退伍军人管理医院的住院患者进行回顾性队列研究，随机选择ICD-9-CM编码为房颤（427.31）的患者。结果945例患者中，平均年龄为71.5（±13.5）岁；43%年龄在75岁以下，54.5%为男性，67%有高血压病史。大多数患者（86%）有中风高危因素，其中只有55%的患者接受华法林治疗。21%的高危患者未开华法林或阿司匹林，包括18%既往有中风、短暂性脑缺血发作或全身性栓塞事件的患者。年龄0 ~ 80岁（p = 0.008）和感知出血风险（p = 0.022）是华法林使用的负向预测因子。持续性/永久性房颤（p < 0.001）、卒中史、短暂性脑缺血发作或全身栓塞（p = 0.014）是华法林使用的阳性预测因子，而高危分层则不是。结论：本研究证实了华法林的使用不足，但也在几个方面补充了已发表的报道。研究表明，国际指南中作为治疗指南的风险分层对华法林的使用影响不大，年龄在80岁至80岁之间和房颤分型（永久性/持续性）是影响华法林使用的因素。
OBJECTIVES The purpose of this study was to determine both treatment gaps and predictors of warfarin use in atrial fibrillation (AF) patients enrolled in a national multicenter study.BACKGROUND The National Anticoagulation Benchmark Outcomes Report (NABOR) is a performance improvement program designed to benchmark anticoagulation prophylaxis, treatment, and outcomes among participating hospitals.METHODS A retrospective cohort study of inpatients was performed at 21 teaching, 13 community, and 4 Veterans Administration hospitals in the U.S. Patients with an ICD-9-CM code for AF (427.31) were randomly selected.RESULTS Among the 945 patients studied, the mean age was 71.5 (+/- 13.5) years; 43% were > 75 years of age, 54.5% were men, and 67% had a history of hypertension. Most (86%) had factors that stratified them as at high risk of stroke, and only 55% of those received warfarin. Neither warfarin nor aspirin were prescribed in 21% of high-risk patients, including 18% of those with a previous stroke, transient ischemic attack, or systemic embolic event. Age > 80 years (p = 0.008) and perceived bleeding risk (p = 0.022) were negative predictors of warfarin use. Persistent/permanent AF (p < 0.001) and history of stroke, transient ischemic attack, or systemic embolus (p = 0.014) were positive predictors of warfarin use, whereas high-risk stratification was not.CONCLUSIONS This study confirms the under-use of warfarin, but also adds to published reports in several regards. It showed that risk stratification, the guidepost for treatment in international guidelines, had little effect on warfarin use, and that age > 80 years and AF classification (permanent/persistent) are factors that influence warfarin use.