Impact of Achieving Blood Pressure Targets and High Time in Therapeutic Range on Clinical Outcomes in Patients With Atrial Fibrillation Adherent to the Atrial Fibrillation Better Care Pathway: A Report From the COOL-AF Registry.
Impact of Achieving Blood Pressure Targets and High Time in Therapeutic Range on Clinical Outcomes in Patients With Atrial Fibrillation Adherent to the Atrial Fibrillation Better Care Pathway: A Report From the COOL-AF Registry.
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DOI：
10.1161/jaha.122.028463
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发表时间：
2023-02-07
影响因子：
5.4
通讯作者：
Lip, Gregory Y. H.
中科院分区：
文献类型：
--
作者：
Krittayaphong, Rungroj;Winijkul, Arjbordin;Methavigul, Komsing;Lip, Gregory Y. H.
我们的目的是确定整合心房颤动更好的护理途径依从性与收缩压（SBP）目标的实现和治疗范围时间（TTR）的良好控制对心房颤动患者临床结局的影响。我们前瞻性地招募了来自泰国27家医院的非瓣膜性心房颤动患者。记录所有临床结果。主要结局为全因死亡或缺血性卒中/全身性栓塞（SSE），次要结局为全因死亡、SSE、大出血、颅内出血和心力衰竭。收缩压在120 ~ 140毫米汞柱被认为是良好的血压控制。目标TTR为TTR≥65%。共纳入3405例患者，平均年龄67.8岁，女性41.8%。42.7%的患者完全符合ABC通路。在血压控制方面，41.9%的患者收缩压在目标范围内，而35.9%的华法林患者TTR在目标范围内。全因死亡/SSE、全因死亡、SSE、大出血、颅内出血和心力衰竭的发生率分别为5.29、4.21、1.51、2.25、0.78和2.84 / 100人年。与不依从性相比，房颤更好护理途径依从性对全因死亡/SSE、全因死亡和心力衰竭的校正危险比和95% CI分别为0.76（0.62-0.94）、0.79（0.62-0.99）和0.69（0.51-0.94）。房颤患者更好的护理依从性和收缩压在目标内有更好的结果或TTR在目标内有更好的结果。COOL - AF（泰国非瓣膜性房颤患者抗血栓使用和最佳国际标准化比率水平队列研究）是一项针对房颤患者的多中心全国前瞻性队列研究，在目标收缩压和TTR≥65%的情况下，房颤更好的治疗途径依从性在减少房颤患者的不良临床结局方面增加了价值。
We aimed to determine the effect of integrating Atrial Fibrillation Better Care pathway compliance in relation to achievement of systolic blood pressure (SBP) targets and good control of time in therapeutic range (TTR) on clinical outcomes in patients with atrial fibrillation. We prospectively enrolled patients with nonvalvular atrial fibrillation from 27 hospitals in Thailand. All clinical outcomes were recorded. Main outcomes were the composite of all‐cause death or ischemic stroke/systemic embolism (SSE), as well as secondary outcomes of all‐cause death, SSE, major bleeding, intracranial hemorrhage, and heart failure. An SBP of 120 to 140 mm Hg was considered good blood pressure control. Target TTR was a TTR ≥65%. A total of 3405 patients were studied (mean age 67.8 years, 41.8% female). Full ABC pathway compliance was evident in 42.7%. For blood pressure control, 41.9% had SBP within target, whereas 35.9% of those on warfarin had TTR within target. The incidence rates of all‐cause death/SSE, all‐cause death, SSE, major bleeding, intracranial hemorrhage, and heart failure were 5.29, 4.21, 1.51, 2.25, 0.78, and 2.84 per 100 person‐years respectively. Adjusted hazard ratios and 95% CI of Atrial Fibrillation Better Care pathway compliance for all‐cause death/SSE, all‐cause death, and heart failure were 0.76 (0.62–0.94), 0.79 (0.62–0.99), and 0.69 (0.51–0.94), respectively, compared with noncompliance. Patients with Atrial Fibrillation Better Care compliance and SBP within target had a better outcome or TTR within target had better outcomes. In COOL‐AF (Cohort of Antithrombotic Use and Optimal International Normalized Ratio Level in Patients With Non‐Valvular Atrial Fibrillation in Thailand), a multicenter nationwide prospective cohort of patients with atrial fibrillation, achieving SBP within target and TTR ≥ 65% has added value to Atrial Fibrillation Better Care pathway compliance in the reduction of adverse clinical outcomes in patients with atrial fibrillation.
影响因子：
4.8
作者：
Xia Z;Dang W;Jiang Y;Liu S;Yue L;Jia F;Sun Q;Shi L;Sun J;Li J;Chen H
通讯作者：
Chen H