Newly detected atrial fibrillation and compliance with antithrombotic guidelines
Newly detected atrial fibrillation and compliance with antithrombotic guidelines
复制标题
DOI：
10.1001/archinte.167.3.246
复制
发表时间：
2007-02-12
影响因子：
--
通讯作者：
Heckbert, Susan R.
中科院分区：
文献类型：
--
作者：
Glazer, Nicole L.;Dublin, Sascha;Heckbert, Susan R.
背景：指南建议使用抗血栓治疗来预防心房颤动（AF）患者的卒中，但尚未在新发现的 AF 患者中广泛研究遵守此类指南的情况。我们的目标是评估抗血栓指南的依从性，并确定与华法林使用相关的患者特征。方法：在一项大型健康计划中对新发现的 AF（患者年龄，30-84 岁）进行了一项基于人群的研究。从病历中提取心血管疾病危险因素、合并症、药物使用和国际标准化比率。根据美国胸科医师学会 (ACCP) 标准，对患者进行栓塞风险分层。我们分析了 AF 患者在 AF 后 6 个月内接受华法林或阿司匹林（≥ 325 mg/d）的比例。相对风险回归估计了危险因素和患者特征与华法林使用之间的关联。结果：总体而言，73% 新发现 AF 的患者 (418/572) 有证据表明在 AF 发作后使用了抗血栓药物。在 76% (437/572) 的卒中高危 AF 患者中，59% (257/437) 使用华法林，28% (123/437) 使用阿司匹林，24% (104/437) 两者均未使用。华法林使用的主要预测因素是 AF 分类；与短暂性房颤相比，间歇性或持续性房颤使用华法林的相对风险分别为 2.8（95% 置信区间，2.23.6）和 2.9（95% 置信区间，2.2-3.7）。结论：四分之三的新发现房颤患者接受了抗血栓治疗，但许多中风高风险患者没有接受华法林治疗。心房颤动分类（而不是中风危险因素）与华法林的使用密切相关。
Background: Guidelines recommend the use of antithrombotic therapy for stroke prevention in patients with atrial fibrillation (AF), but compliance with such guidelines has not been widely studied among patients with newly detected AF. Our objective was to assess compliance with antithrombotic guidelines and to identify patient characteristics associated with warfarin use.Methods: A population-based study of newly detected AF (patient age, 30-84 years) was conducted within a large health plan. Cardiovascular disease risk factors, comorbid conditions, medication use, and international normalized ratios were abstracted from the medical record. Patients were stratified by embolic risk according to American College of Chest Physicians (ACCP) criteria. We analyzed the proportion of patients with AF receiving warfarin or aspirin (>= 325 mg/d) during the 6 months following AF. Relative risk regression estimated the association of risk factors and patient characteristics with warfarin use.Results: Overall, 73% of patients (418/572) with newly detected AF had evidence of antithrombotic use after AF onset. Among the 76% (437/572) of patients with AF at high risk for stroke, 59% (257/437) used warfarin, 28% (123/437) used aspirin, and 24% (104/437) used neither. The major predictor of warfarin use was AF classification; intermittent or sustained AF had relative risks for warfarin use of 2.8 (95% confidence interval, 2.23.6) and 2.9 ( 95% confidence interval, 2.2-3.7), respectively, compared with transitory AF.Conclusions: Three quarters of the patients with newly detected AF received antithrombotic therapy, yet many at high risk of stroke did not receive warfarin. Atrial fibrillation classification, rather than stroke risk factors, was strongly associated with warfarin use.