Management of Atrial Fibrillation in Older Patients by Morbidity Burden: Insights From Get With The Guidelines-Atrial Fibrillation.
Management of Atrial Fibrillation in Older Patients by Morbidity Burden: Insights From Get With The Guidelines-Atrial Fibrillation.
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DOI：
10.1161/jaha.120.017024
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发表时间：
2020-12
影响因子：
5.4
通讯作者：
Al-Khatib SM
中科院分区：
文献类型：
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作者：
Dalgaard F;Xu H;Matsouaka RA;Russo AM;Curtis AB;Rasmussen PV;Ruwald MH;Fonarow GC;Lowenstern A;Hansen ML;Pallisgaard JL;Alexander KP;Alexander JH;Lopes RD;Granger CB;Lewis WR;Piccini JP;Al-Khatib SM
关于房颤患者口服抗凝剂（OACs）治疗决策与多药耐药的关系，目前还缺乏相关知识。我们在2013年至2019年期间使用指南-房颤登记研究对住院房颤患者进行了一项横断面研究。我们确定了≥65岁且有资格接受OAC治疗的患者。使用16个可用的合并症类别，按发病负担对患者进行分层。采用多变量logistic回归模型，通过发病率负担来确定出院时接受OAC处方的几率。我们纳入了34174例患者，中位（四分位距）年龄为76（71-83）岁，56.6%为女性，41.9%在入院时未接受抗凝治疗。在这些患者中，38.6%有0 - 2种合并症，50.7%有3 - 5种合并症，10.7%有≥6种合并症。总体出院OAC处方较高（85.6%）。多发性骨髓瘤患者的患病率从2014年的59.7%增加到2019年的64.3%（P趋势=0.002）。以0 - 2种合并症为参照，OAC处方的校正比值比（95%CI）为3 - 5种合并症患者0.93（0.82，1.05），≥6种合并症患者0.72（0.60，0.86）。在有≥6种合并症的患者中，未开具OAC处方的最常见原因是频繁福尔斯/虚弱（31.0%）。在符合OAC治疗条件的房颤住院患者的当代护理质量数据库中，多发性房颤很常见。较高的发病率负担与较低的OAC处方几率相关。这强调了需要干预措施来改善房颤多病患者对指南推荐抗凝治疗的依从性。
Knowledge is scarce regarding how multimorbidity is associated with therapeutic decisions regarding oral anticoagulants (OACs) in patients with atrial fibrillation. We conducted a cross‐sectional study of hospitalized patients with atrial fibrillation using the Get With The Guidelines‐Atrial Fibrillation registry from 2013 to 2019. We identified patients ≥65 years and eligible for OAC therapy. Using 16 available comorbidity categories, patients were stratified by morbidity burden. A multivariable logistic regression model was used to determine the odds of receiving OAC prescription at discharge by morbidity burden. We included 34 174 patients with a median (interquartile range) age of 76 (71–83) years, 56.6% women, and 41.9% were not anticoagulated at admission. Of these patients, 38.6% had 0 to 2 comorbidities, 50.7% had 3 to 5 comorbidities, and 10.7% had ≥6 comorbidities. The overall discharge OAC prescription was high (85.6%). The prevalence of patients with multimorbidity increased from 59.7% in 2014 to 64.3% in 2019 (P trend=0.002). Using 0 to 2 comorbidities as the reference, the adjusted odds ratio (95% CI) of OAC prescription were 0.93 (0.82, 1.05) for patients with 3 to 5 comorbidities and 0.72 (0.60, 0.86) for patients with ≥6 comorbidities. In those with ≥6 comorbidities, the most common reason for nonprescription of OACs were frequent falls/frailty (31.0%). In a contemporary quality‐of‐care database of hospitalized patients with atrial fibrillation eligible for OAC therapy, multimorbidity was common. A higher morbidity burden was associated with a lower odds of OAC prescription. This highlights the need for interventions to improve adherence to guideline‐recommended anticoagulation in multimorbid patients with atrial fibrillation.