不同层级医疗机构心房颤动患者卒中后抗凝治疗状况分析  

Situation of long-term use of oral anticoagulation among atrial fibrillation patients with stroke in different level hospital

作　　者：井然[1] 郭雪原[1] 夏时俊 常三帅 李景业[1] 卢尚欣 杜昕[1] 董建增[1] 马长生[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科北京市心肺血管疾病研究所,100029

出　　处：《中华医学杂志》2016年第26期2049-2053,共5页National Medical Journal of China

基　　金：科技部国际合作项目（2013DFB30310）

摘　　要：目的通过对北京地区心房颤动（简称房颤）患者的多中心前瞻性研究，了解房颤患者缺血性脑卒中后长期口服抗凝药治疗现状。方法本研究纳入中国房颤注册研究（CAFR）自2003年10月至2014年5月注册登记的非瓣膜性房颤患者，筛选出380例在随访过程中发生缺血性脑卒中的患者，根据就诊医院等级进行分组，统计和分析房颤患者卒中后口服抗凝药使用情况及影响因素。结果房颤患者卒中后12个月内整体口服抗凝药使用率为27.71%，脑卒中后6个月及12个月时口服抗凝药使用率分别为22.11%，15.26%。本研究中298例患者（78.42%）就诊于三级医院，82例患者（21.58%）就诊于非三级医院，其中就诊于三级医院患者口服抗凝药使用情况（32.66%）优于非三级医院（7.32%）。多因素分析显示既往有心衰病史与口服抗凝药使用率相关（OR 1.785, 95% CI 1.026～3.106，P＝0.040）。结论此次研究数据提示我国北京地区房颤患者卒中后口服抗凝药情况较前好转，但仍偏低。三级医院用药情况优于非三级医院，既往心衰病史可影响该类患者的口服抗凝药使用。Objective To investigate the current situation, time trends and factors associated with long-term use of oral anticoagulation （OAC） among atrial fibrillation （AF） patients with ischemic stroke. Methods We used the dataset from the CAFR （Chinese Atrial Fibrillation Registry ）, a prospective, multicenter, hospital-based registry study involving 20 tertiary and 12 nontertiary hospitals in Beijing. In brief, 380 consecutive AF patients with following ischemic stroke were enrolled from 2003 to 2014. Patients with valvular AF, radiofrequency catheter ablation history or contraindications of OAC were excluded. We divided the patients into two groups according to hospital level, and investigated the rate of OAC use and its change over time in patients who had indication, the factors including patient characteristics and hospital level associated with OAC use were also analyzed. Results Overall oral anticoagulation use rate was 27.71%, which dropped to 22. 11% and 15.26% at 6 months and 12 months, respectively. A total of 298 participates were enrolled from tertiary hospitals （78.42%）, and 82 were enrolled from nontertiary hospitals. The status of OAC use in tertiary hospitals was better than nontertiary hospitals （32.66% vs 7.32% , P 〈 0. 001 ） . Muhivariable analysis showed better oral anticoagulation use was independently associated with higher-level hospitals （ odds ratio 1. 785,95% confidence interval 1. 026 -3. 106, P = 0. 040）, and history of heart failure （ odds ratio 2. 247, 95% confidence interval 1. 235 -4. 090, P = 0. 008）. Conclusions These data indicates oral anticoagulation use has improved in atrial fibrillation patients with stroke in Beijing. The use of anticoagulation among the patients from tertiary hospitals is significantly better than those from nontertiary hospitals, and the history of heart failure may have effect on the use of oral anticoagulation.

关 键 词：心房颤动 卒中 口服抗凝药 

分 类 号：R541.75[医药卫生—心血管疾病]