Atrial fibrillation decision support tool: Population perspective.
Atrial fibrillation decision support tool: Population perspective.
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DOI：
10.1016/j.ahj.2017.08.016
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发表时间：
2017-12
影响因子：
4.8
通讯作者：
Kues J
中科院分区：
文献类型：
--
作者：
Eckman MH;Costea A;Attari M;Munjal J;Wise RE;Knochelmann C;Flaherty ML;Baker P;Ireton R;Harnett BM;Leonard AC;Steen D;Rose A;Kues J
对心房颤动或心房扑动 (AF) 患者进行适当的血栓预防仍然是全国性的挑战。最近出现的直接口服抗凝剂（DOAC）与华法林相比具有相当的疗效和更高的安全性，改变了中风危险因素与抗凝益处之间的平衡。我们的目的是研究 DOAC 作为华法林替代品对现实世界 AF 患者群体口服抗凝治疗 (OAT) 净效益的影响。阵发性或持续性非瓣膜性房颤患者的回顾性队列研究。我们更新了心房颤动决策支持工具 (AFDST)，将 DOAC 作为治疗选择。该工具根据个体患者的中风和大出血风险因素概况，使用决策分析模型为每种治疗策略计算的质量调整生命年 (QALY)，生成针对患者的具体建议。该环境包括美国中西部一个学术健康中心的住院和门诊场所。研究涉及 5,121 名患有非瓣膜性 AF 的成年人，他们在 1 年期间（2016 年 1 月至 12 月）接受过门诊或住院治疗。结果衡量指标是 QALY 的净临床效益。当 DOAC 作为一种治疗选择时，AFDST 建议 4,134 名 (81%) 患者接受 OAT，而 489 名 (9%) 患者不接受抗血栓治疗或阿司匹林。无法对 498 名 (10%) 患者强烈推荐 OAT。当华法林是唯一选择时，建议 3,228 名患者 (63%) 推荐 OAT，而 973 名患者 (19%) 不接受抗血栓治疗或阿司匹林。无法对 920 名 (18%) 患者强烈推荐 OAT。如果将治疗改为 AFDST 推荐的治疗方法，总共可以获得 1,508 QALY。 DOAC 的可用性增加了现实世界 AF 患者队列中推荐口服抗凝治疗的患者比例，并且当所有患者均按照 AFDST 的建议接受血栓预防时，与当前治疗相比，预计 QALY 增加了 1,500 以上。
Appropriate thromboprophylaxis for patients with atrial fibrillation or atrial flutter (AF) remains a national challenge. The recent availability of direct oral anticoagulants (DOACs) with comparable efficacy and improved safety compared with warfarin alters the balance between risk factors for stroke and benefit of anticoagulation. Our objective was to examine the impact of DOACs as an alternative to warfarin on the net benefit of oral anticoagulant therapy (OAT) in a real-world population of AF patients. Retrospective cohort study of patients with paroxysmal or persistent nonvalvular AF. We updated an Atrial Fibrillation Decision Support Tool (AFDST) to include DOACs as treatment options. The tool generates patient–specific recommendations based upon individual patient risk factor profiles for stroke and major bleeding, using quality-adjusted life years (QALYs) calculated for each treatment strategy by a decision analytic model. The setting included inpatient and ambulatory sites in an academic health center in the mid-western United States. Study involved 5,121 adults with nonvalvular AF seen for any ambulatory visit or inpatient hospitalization over the 1-year period (January through December 2016). Outcome measure was net clinical benefit in QALYs. When DOACs are a therapeutic option, the AFDST recommends OAT for 4,134 (81%) patients, and no antithrombotic therapy or aspirin for 489 (9%). A strong recommendation for OAT could not be made in 498 (10%) patients. When warfarin is the only option, OAT is recommended for 3,228 (63%) patients, and no antithrombotic therapy or aspirin for 973 (19%). A strong recommendation for OAT could not be made in 920 (18%) patients. In total, 1,508 QALYs could be gained were treatment changed to that recommended by the AFDST. Availability of DOACs increases the proportion of patients for whom oral anticoagulation therapy is recommended in a real-world cohort of AF patients and increased projected QALYs by more than 1,500 when all patients are receiving thromboprophylaxis as recommended by the AFDST compared with current treatment.
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DOI：
10.1161/circoutcomes.114.001163
发表时间：
2014-09-01
影响因子：
6.9
作者：
Eckman, Mark H.;Wise, Ruth E.;Costea, Alexandru
通讯作者：
Costea, Alexandru
影响因子：
39.2
作者：
HYLEK, EM;SINGER, DE
通讯作者：
SINGER, DE
影响因子：
4.8
作者：
Eckman, Mark H.;Lip, Gregory Y. H.;Kues, John
通讯作者：
Kues, John
影响因子：
8.3
作者：
Lip, Gregory Y. H.;Frison, Lars;Lane, Deirdre A.
通讯作者：
Lane, Deirdre A.
影响因子：
--
作者：
Gage, BF;Cardinalli, AB;Owens, DK
通讯作者：
Owens, DK