National trends in antiarrhythmic and antithrombotic medication use in atrial fibrillation
National trends in antiarrhythmic and antithrombotic medication use in atrial fibrillation
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DOI：
10.1001/archinte.164.1.55
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发表时间：
2004-01-12
影响因子：
--
通讯作者：
Singer, DE
中科院分区：
文献类型：
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作者：
Fang, MC;Stafford, RS;Singer, DE
背景：心房颤动是最常见的心律失常，并伴有严重的内科并发症。我们研究了1991年至2000年美国房颤药物治疗的趋势。方法：1355例房颤患者的就诊数据来自全国门诊医疗调查，这是一项具有全国代表性的基于办公室的实践评估。我们评估了心室率控制药物的使用趋势（地高辛、β受体阻滞剂和钙通道阻滞剂）、窦性心律维持（IA类、IC类和III类抗血小板药物）和血栓栓塞预防（口服抗凝剂和阿司匹林）。总体心率控制药物使用率从1991-1992年的72%下降到1999-2000年的56%（趋势P = 0.01），原因是地高辛使用率下降（64%至37%，趋势P <0.001）。β受体阻滞剂和钙通道阻滞剂的使用保持不变。尽管总体窦性心律药物使用率随时间推移没有变化，但盐酸阿莫达酮的使用率从0.2%增加到6.4%（趋势P <0.001），而奎尼丁的使用率从5.0%下降到0.0%（趋势P = 0.01）。口服抗凝剂使用增加（28%至41%，趋势P = 0.01），80岁及以上患者增加最多（14%至48%，趋势P <0.001）。尽管如此，在1999- 2000年，仅有46.5%的卒中高危患者使用抗凝剂。结论：地高辛在房颤中的使用随着时间的推移而减少，而β受体阻滞剂或钙通道阻滞剂的使用并没有随之增加。抗碘呋酮取代奎尼丁成为主要的窦性心律药物。尽管口服抗凝剂的使用随着时间的推移而增加，特别是在年龄最大的患者中，但只有不到一半的卒中高危患者接受抗凝治疗。
Background: Atrial fibrillation is the most common cardiac arrhythmia associated with significant medical complications. We examined trends in the medical therapy of atrial fibrillation in the United States from 1991 through 2000.Methods: Data from 1355 visits among patients with atrial fibrillation were obtained from the National Ambulatory Medical Care Survey, a nationally representative assessment of office-based practice. We assessed trends in medication use for ventricular rate control (digoxin, beta-blockers, and calcium channel blockers), sinus rhythm maintenance (class IA, IC, and III antiarrhythmics), and thromboembolism prevention (oral anticoagulants and aspirin).Results: Overall rate control medication use decreased from 72% of visits in 1991-1992 to 56% in 1999-2000 (P = .01 for trend) due to declining digoxin use (64% to 37%, P < .001 for trend). β-Blocker and calcium channel blocker use remained unchanged. Although there was no change in overall sinus rhythm medication use over time, armodarone hydrochloride use increased from 0.2% to 6.4% (P < .001 for trend), while quinidine use decreased from 5.0% to 0.0% (P = .01 for trend). Oral anticoagulant use increased (28% to 41%, P = .01 for trend), with the greatest increase in patients aged 80 years and older (14% to 48%, P < .001 for trend). Despite this, only 46.5% of patients at high risk for stroke were taking anticoagulants in 1999-2000.Conclusions: Digoxin use in atrial fibrillation decreased over time, without concomitant increases in β-blocker or calcium channel blocker use. Antiodarone replaced quinidine as the dominant sinus rhythm medication. Although oral anticoagulant use increased over time, particularly in the oldest patients, fewer than half of the patients at high risk for stroke were anticoagulated.