Using an Atrial Fibrillation Decision Support Tool for Thromboprophylaxis in Atrial Fibrillation: Effect of Sex and Age.
Using an Atrial Fibrillation Decision Support Tool for Thromboprophylaxis in Atrial Fibrillation: Effect of Sex and Age.
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DOI：
10.1111/jgs.14099
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发表时间：
2016-05
影响因子：
6.3
通讯作者：
Kues J
中科院分区：
文献类型：
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作者：
Eckman MH;Lip GY;Wise RE;Speer B;Sullivan M;Walker N;Kissela B;Flaherty ML;Kleindorfer D;Baker P;Ireton R;Hoskins D;Harnett BM;Aguilar C;Leonard A;Arduser L;Steen D;Costea A;Kues J
在房颤(AF)患者中，女性与中风风险增加和接受口服抗凝治疗(OAT)的可能性降低有关。由于担心摔倒和虚弱，老年人接受燕麦片的可能性较小。这项研究评估了燕麦片在妇女和老年人中的适当性，寻找治疗不足或不必要的治疗模式。回顾性队列研究。学术保健系统的初级保健实践。在2013年3月至2014年2月期间，共发现1585例成人非瓣膜性房颤。房颤决策支持工具(AFDST)根据决策分析模型计算的质量调整后预期寿命预测提出治疗建议，决策分析模型整合了患者特定的中风和出血风险因素。45%(326/725)的女性和39%(338/860)的男性的治疗与AFDST推荐的治疗不一致(p=0.02)。虽然目前的治疗与推荐的治疗不一致，但有35%(89/258)的老年人(≥85岁)和43%(575/1328)的85岁以上的患者(P=0.01)接受阿司匹林作为唯一的抗血栓药物。医生应该理解女性是房颤相关卒中的重要危险因素，并将其纳入血栓预防的决策中。通过用阿司匹林代替口服抗凝治疗老年患者，我们使他们暴露在出血的显著风险中，而与降低房颤相关的卒中风险相比几乎没有好处。
Among patients with atrial fibrillation (AF), female gender has been associated with an increased risk of stroke and a decreased likelihood of receiving oral anticoagulant therapy (OAT). The elderly are less likely to receive OAT due to concerns about falling and frailty. This study assessed the appropriateness of OAT among women and the elderly, looking for patterns of under-treatment or unnecessary treatment. Retrospective cohort study. Primary care practices of an academic healthcare system. 1,585 adults with non-valvular AF seen between March 2013 and February 2014. Treatment recommendations were made by an Atrial Fibrillation Decision Support Tool (AFDST) based on projections for quality-adjusted life expectancy calculated by a decision analytic model that integrates patient-specific risk factors for stroke and hemorrhage. Treatment was discordant from AFDST-recommended treatment in 45% (326/725) of women and in 39% (338/860) of men (p = 0.02). While current treatment was discordant from recommended in 35% (89/258) of the elderly (age ≥ 85), and in 43% (575/1328) of patients < 85 years of age (p = 0.01) a large proportion of under-treated elderly patients were receiving aspirin as the sole antithrombotic agent. Physicians should understand that female gender is a significant risk factor for AF-related stroke and incorporate this into decision-making about thromboprophylaxis. By treating older patients with aspirin instead of oral anticoagulant therapy we are exposing them to a significant risk of bleeding with little to no benefit relative to reduction of AF-related stroke risk.