Management of atrial fibrillation by primary care physicians in Germany: baseline results of the ATRIUM registry.
Management of atrial fibrillation by primary care physicians in Germany: baseline results of the ATRIUM registry.
复制标题
德国初级保健医生对房颤的管理：中庭注册中心的基线结果。
DOI：
10.1007/s00392-011-0320-5
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发表时间：
2011-10
期刊：
影响因子：
--
通讯作者：
ATRIUM investigators
中科院分区：
文献类型：
--
作者：
Meinertz T;Kirch W;Rosin L;Pittrow D;Willich SN;Kirchhof P;ATRIUM investigators
与心脏病专家环境中的调查相比，初级保健患者中房颤（AF）的表现和管理研究较少。前瞻性ATRIUM（房颤发病后的门诊患者登记）收集了来自730名医生的房颤患者的数据，这些医生代表德国所有初级保健医生的随机样本。ATRIUM入组了3，667例患者（平均年龄，72 ± 9岁; 58%为男性，平均CHADS 2评分2.2 ± 1.3），994例（27.1%）为阵发性，944例（25.7%）为持续性或长期持续性，1，525例（41.6%）为永久性AF（204例患者未指定AF类型）。自首次诊断AF以来的平均持续时间为61 ± 66个月（中位数42，四分位数间距14-88）。报告的症状包括心悸（43%）、呼吸急促（49%）、疲劳（49%）、头晕（37%）和心绞痛（20%）。最常见的伴随疾病为高血压（84%）、心力衰竭（43%）、冠状动脉疾病（345%）、糖尿病（35%）和慢性肾脏疾病（20%）。11%的患者存在既往心肌梗死，10%存在既往卒中，10%存在既往短暂性脑缺血发作。93%的患者使用抗血栓药物（口服抗凝剂，83%）。75%的患者报告了心率控制治疗，33%的患者报告了节律控制治疗，通常加用心率控制。节律和心率控制药物包括β受体阻滞剂（75%）、钙拮抗剂（15%）、洋地黄（29%）、IA型钠通道阻滞剂（奎尼丁，1.0%）或IC型钠通道阻滞剂（氟卡尼或普罗帕酮，5%）和钾通道阻滞剂（包括胺碘酮）（11%）。在入组前一年，46%的患者进行了心脏复律（23%通过药物，22%通过电），5%进行了导管消融，10%接受了起搏器或除颤器。高比例（44%）的患者在入组前一年住院。在初级保健中管理的AF患者通常接受符合指南的治疗，包括抗血栓治疗、心率控制和节律控制（上文给出的数字）。尽管有这种明显的依从性，但几乎一半的患者在入组前一年住院，这表明所应用的治疗不足以稳定患者，使其远离医院。
In contrast to surveys in cardiologist settings, presentation and management of atrial fibrillation (AF) in primary care patients is less well studied. The prospective ATRIUM (Outpatient Registry Upon Morbidity of Atrial Fibrillation) collected data from patients with AF seen by 730 physicians representing a random sample of all primary care physicians in Germany. ATRIUM enrolled 3,667 patients (mean age, 72 ± 9 years; 58% male, mean CHADS2 score 2.2 ± 1.3), 994 (27.1%) with paroxysmal, 944 (25.7%) with persistent or long-standing persistent and 1,525 (41.6%) with permanent AF (no AF type was specified in 204 patients). Mean duration since initial diagnosis of AF was 61 ± 66 months (median 42, interquartile range 14–88). Reported symptoms included palpitations (43%), shortness of breath (49%), fatigue (49%), dizziness (37%) and angina (20%). Most common concomitant conditions were hypertension (84%), heart failure (43%), coronary artery disease (345%), diabetes (35%) and chronic kidney disease (20%). Prior myocardial infarction was present in 11% of patients, prior stroke in 10% and prior transient ischemic attack in 10%. Antithrombotic medication was used by 93% of the patients (oral anticoagulants, 83%). Rate control therapy was reported in 75% and rhythm control therapy in 33%, often added to rate control. Drugs for rhythm and rate control included ß-blockers (75%), calcium antagonists (15%), digitalis (29%), sodium channel blockers of type IA (quinidine, 1.0%) or IC (flecainide or propafenone, 5%), and potassium channel blockers including amiodarone (11%). In the year prior to enrollment, 46% of the patients had been cardioverted (23% by drugs, 22% electrically), catheter ablation had been performed in 5%, and 10% received a pacemaker or defibrillator. A high proportion (44%) of the patients were hospitalized in the year prior to enrollment. Patients with AF managed in primary care often receive guideline-conforming therapy including antithrombotic therapy, rate control and rhythm control (numbers given above). Despite this apparent adherence, almost half of the patients were hospitalized in the year prior to enrollment, suggesting that the therapies applied do not stabilize patients sufficiently to keep them out of hospital.
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影响因子：
158.5
作者：
Hohnloser, Stefan H.;Crijns, Harry J. G. M.;Connolly, Stuart J.
通讯作者：
Connolly, Stuart J.
影响因子：
39.3
作者：
Frykman, V;Beerman, B;Rosenqvist, M
通讯作者：
Rosenqvist, M
影响因子：
6.1
作者：
Goudevenos, JA;Vakalis, JN;Sideris, DA
通讯作者：
Sideris, DA
DOI：
10.1093/europace/eun369
发表时间：
2009-04
期刊：
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
影响因子：
--
作者：
Nabauer M;Gerth A;Limbourg T;Schneider S;Oeff M;Kirchhof P;Goette A;Lewalter T;Ravens U;Meinertz T;Breithardt G;Steinbeck G
通讯作者：
Steinbeck G
影响因子：
5.7
作者：
Stewart, S;Hart, CL;McMurray, JJV
通讯作者：
McMurray, JJV