Trends in Oral Anticoagulant Use Among 436 864 Patients With Atrial Fibrillation in Community Practice, 2011 to 2020.
Trends in Oral Anticoagulant Use Among 436 864 Patients With Atrial Fibrillation in Community Practice, 2011 to 2020.
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DOI：
10.1161/jaha.122.026723
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发表时间：
2022-11-15
影响因子：
5.4
通讯作者：
Peterson, Eric D.
中科院分区：
文献类型：
--
作者：
Navar, Ann Marie;Kolkailah, Ahmed A.;Overton, Robert;Shah, Nishant P.;Rousseau, Justin F.;Flaker, Greg C.;Pignone, Michael P.;Peterson, Eric D.
在非瓣膜性房颤（AF）和卒中风险升高的患者中，指南建议直接口服抗凝剂（DOAC）而不是华法林预防卒中。过去十年中DOAC使用的变化没有得到很好的描述。我们基于来自美国88个卫生系统的电子健康记录数据（贡献给Cerner真实的世界数据），评估了2011年至2020年CHA 2DS 2 ‐VASc评分≥2的AF成人患者使用DOAC和华法林的趋势。按照年龄、性别、人种和种族以及卫生系统水平描述了DOAC和华法林随时间的使用情况。我们确定了436864例有卒中风险的房颤患者（中位年龄78岁; 52.1%为男性）。从2011年到2020年，总体抗凝率从56.3%增加到64.7%，因为DOAC的使用稳步增加（从4.7%增加到47.9%），而华法林的使用下降（从52.4%下降到17.7%）。不同年龄、性别、种族和民族的DOAC摄入量相似，但因卫生系统而异。2020年，接受DOAC治疗的AF患者的卫生系统水平比例中位数为49%（四分位数范围，40%-54%）。在过去的十年中，由于DOAC在很大程度上取代了华法林，AF患者的抗凝率略有增加，但仍存在显著差距：三分之一的高风险AF患者未使用任何抗凝剂。虽然DOAC的采用在主要人口统计学群体中基本一致，但卫生系统之间的使用仍然存在很大差异，这表明提供者和系统因素对DOAC使用的影响大于患者层面的因素。
Among patients with nonvalvular atrial fibrillation (AF) and an elevated stroke risk, guidelines recommend direct oral anticoagulants (DOACs) over warfarin for stroke prevention. Changes in DOAC use over the past decade have not been well described. We evaluated trends in use of DOACs and warfarin from 2011 to 2020 among adults with AF and a CHA2DS2‐VASc score ≥2 based on electronic health record data from 88 health systems in the United States contributing to Cerner Real World Data. The use of DOACs and warfarin was described over time, by age, sex, race, and ethnicity, and at the health‐system level. We identified 436 864 patients with AF at risk for stroke (median age, 78 years; 52.1% men). From 2011 to 2020, overall anticoagulation rates increased from 56.3% to 64.7%, as DOAC use increased steadily (from 4.7% to 47.9%), while warfarin use declined (from 52.4% to 17.7%). DOAC uptake was similar across age, sex, and race and ethnicity groups but varied by health system. In 2020, the median health‐system‐level proportion of patients with AF on a DOAC was 49% (interquartile range, 40%–54%). Over the past decade, anticoagulation rates for patients with AF have increased modestly as DOACs largely replaced warfarin, though significant gaps remain: One in 3 high‐risk patients with AF is not on any anticoagulant. While DOAC adoption was generally consistent across major demographic groups, use between health systems remained highly variable, suggesting that provider and system factors influence DOAC uptake use more than patient‐level factors.