Epidemiology of Anticoagulation in Atrial Fibrillation

我们建议继续对来自北方加州Kaiser医疗护理项目（“Kaiser”）的超过13，559例房颤（AF）患者的独特信息队列进行研究。 我们的总体目标仍然是通过改善抗凝治疗患者的选择和改善抗凝治疗管理来优化AF卒中的预防。 房颤是最常见的严重心律失常。 其发生率随着年龄的增长而显著增加，在80岁以上的人群中，患病率接近10%。AF也是中风的一个重要风险因素，使这种风险增加5倍。随机对照试验（RCT）已经证实抗凝治疗在很大程度上消除了房颤引起的卒中风险。尽管如此，华法林仍然是一种负担沉重且有风险的治疗方法。华法林治疗在现实条件下是否有益还存在相当大的不确定性。 指南要求长期抗凝，并在老年人中使用抗凝剂。 然而，随机对照试验相对较短，平均随访时间仅为18个月，研究的患者年龄大于或等于80岁。 在2.7年的当前资助期间，我们已经建立了方法来组装一个非常大的AF队列，表征基线特征和华法林状态，并跟踪血栓栓塞和出血事件。这是通过全面的自动化临床和行政凯撒数据库，辅以病历审查有效地完成的。 我们的房颤队列的持续随访将提供抗凝治疗的长期影响和抗凝治疗对高龄房颤患者的影响的独特评估。此外，我们将能够解决其他重要争议，包括年龄≥ 65岁且无其他卒中风险因素的患者是否需要抗凝治疗，以及老年房颤患者的最佳抗凝强度。 此外，我们还将讨论这一新发现，即雌激素替代疗法显著增加了AF女性患者卒中的风险。总之，对我们队列的持续研究将有效地为许多老年AF美国人优化卒中预防策略提供强有力的见解。

We propose to continue our studies of a uniquely informative cohort of greater than 13,559 patients with atrial fibrillation (AF) from Kaiser Medical Care Program of Northern California ("Kaiser"). Our overall goal remains to optimize prevention of stroke in AF by improving selection of patients treated with anticoagulants, and by improving the management of anticoagulation. AF is the most common significant cardiac rhythm disorder. Its frequency increases strikingly with age, reaching a prevalence of nearly 10 percent in those over age 80. AF is also a powerful risk factor for stroke, raising this risk 5-fold. Randomized trials (RCTs) have established that anticoagulation largely removes the stroke risk posed by AF. Nonetheless, warfarin remains a burdensome and risky therapy. There is considerable uncertainty whether warfarin therapy will prove beneficial under real-world conditions. Guidelines call for long-term anticoagulation, and for use of anticoagulants in the elderly. Yet, the RCTs were relatively brief, with a mean follow-up of only 18 months, and few patients greater than or equal to 80 years old were studied. During the 2.7 years of current funding we have established methods to assemble a very large AF cohort, characterize baseline features and warfarin status, and follow for thromboembolic and hemorrhagic events. This has been accomplished efficiently via comprehensive automated clinical and administrative Kaiser databases supplemented by medical chart review. Continued follow-up of our AF cohort will provide unique assessments of both the long-term impact of anticoagulation and the impact of anticoagulation among the oldest patients with AF. Further, we will be able to address other important controversies including the need for anticoagulation in patients greater than or equal to 65 years old without other risk factors for stroke, and the optimal intensity of anticoagulation in older AF patients. In addition, we will address the provocative new finding that estrogen replacement therapy substantially raises the risk of stroke among women with AF. In all, continued study of our cohort will efficiently provide powerful insights into optimizing stroke prevention strategies for the many older Americans with AF.