Prescribing of anticoagulation for atrial fibrillation in primary care.
Prescribing of anticoagulation for atrial fibrillation in primary care.
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DOI：
10.1007/s11239-022-02655-z
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发表时间：
2022-11
影响因子：
4
通讯作者：
Rothberg, Michael B.
中科院分区：
文献类型：
--
作者：
Martinez, Kathryn A.;Eckman, Mark H.;Pappas, Matthew A.;Rothberg, Michael B.
关键词：
心房颤动（AF）在初级保健患者中很常见。许多患者本可以从抗凝治疗中获益，但却没有接受。本研究的目的是描述抗凝处方在初级保健医生。我们在克利夫兰诊所卫生系统进行了一项观察性研究，研究对象是2015年至2018年间AF患者和≥1次初级保健预约的患者及其医生。我们使用两种混合效应logistic回归模型，根据患者社会人口因素、跌倒或痴呆史、CHA2DS2-VASc和HAS-BLED评分进行调整，估计了符合条件的患者接受抗凝治疗与不接受抗凝治疗、DOAC与华法林治疗的几率差异。我们根据调整后的处方率将医生分为处方等级，并将其作为模型中的预测因子。在5253名患者中，47%接受了抗凝治疗。其中，56%的人收到了DOAC。CHA2DS2-VASc和HAS-BLED评分与抗凝处方无关。黑人与接受抗凝治疗总体呈负相关（aOR:0.71; 95%CI: 0.56-0.89），与DOAC处方呈负相关（aOR:0.65; 95%CI: 0.45-0.93）。在195名医生中，抗凝处方率从27%到57%，DOAC率从34%到69%。医生开的处方与患者接受抗凝治疗的总体几率相关（aOR:1.51; 95%CI: 1.13-2.01），但与DOAC处方无关。在开抗凝处方时，医生似乎不会考虑中风或出血的风险，但患者的种族是一个重要的决定因素。看抗凝处方率高的医生与接受抗凝处方的患者密切相关，这表明缺乏个体化。
Atrial fibrillation (AF) is common in primary care patients. Many patients who could benefit from anticoagulation do not receive it. The objective of this study was to describe anticoagulation prescribing among primary care physicians. We conducted an observational study in the Cleveland Clinic Health System among patients with AF and ≥1 primary care appointment between 2015 and 2018 and their physicians. We estimated differences in the odds of an eligible patient receiving anticoagulation versus not and a DOAC versus warfarin using two mixed effects logistic regression models, adjusted for patient sociodemographic factors, history of falls or dementia, and CHA2DS2-VASc and HAS-BLED scores. We categorized physicians into prescribing tertiles, based on their adjusted prescribing rate, which we included as predictors in the models. Among 5,253 patients, 47% received anticoagulation. Of those, 56% received a DOAC. CHA2DS2-VASc and HAS-BLED scores were not associated with anticoagulation prescription. Black race was negatively associated with receiving anticoagulation overall (aOR:0.71; 95%CI:0.56–0.89) and with prescription for a DOAC (aOR:0.65; 95%CI:0.45–0.93). Among 195 physicians, the anticoagulation prescribing rate ranged from 27% to 57% and DOAC rates ranged from 34% to 69%. Physician prescribing tertile was associated with odds of a patient receiving anticoagulation overall (aOR:1.51; 95%CI: 1.13–2.01 for the highest versus lowest tertile), but not DOAC prescriptions. When prescribing anticoagulation, physicians appear not to consider risk of stroke or bleeding but patient race is an important determinant. Seeing a physician with a high anticoagulation prescribing rate was strongly associated with a patient receiving it, suggesting a lack of individualization.
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影响因子：
5.4
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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
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Al-Khatib SM
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通讯作者：
Kues J
影响因子：
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作者：
Glazer, Nicole L.;Dublin, Sascha;Heckbert, Susan R.
通讯作者：
Heckbert, Susan R.
影响因子：
5.7
作者：
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通讯作者：
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