心房颤动综合管理平台对6923例患者随访及抗凝治疗的影响  

Effect of information management platformon the follow-up and anticoagulant therapy of 6923 patients with atrial fibrillation

作　　者：刘韦卓 周鹏 吴帮卫 熊楠青 谢坤 包丽雯 高秀芳 王玉涛 施海明 罗心平 李剑 Liu Weizhuo;Zhou Peng;Wu Bangwei;Xiong Nanqing;Xie Kun;Bao Liwen;Gao Xiufang;Wang Yutao;Shi Haiming;Luo Xinping;Li Jian(Department of Cardiology,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院心内科,上海200040

出　　处：《中华心律失常学杂志》2020年第3期293-297,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：上海市自然科学基金(17ZR1403700)。

摘　　要：目的:心房颤动(房颤)的综合管理对其预后起决定性作用,复旦大学附属华山医院建立一套计算机辅助下的综合管理平台,以加强房颤的规范治疗及随访。本研究观察该平台对房颤诊疗的干预效果。方法:入选华山医院2015年1月至2019年2月诊断为房颤的患者,进行CHA 2DS 2-VASc评分,对比平台建立前后患者人群的临床特征、药物使用、临床事件及随访等信息。 结果:研究纳入平台建立之前3 538例(A组,就诊次数8 343)患者,平均年龄74.31岁,就诊女性占48.1%(4 011/8 343);平台建立之后患者3 385例(B组,就诊次数13 294),平均年龄73.86岁,就给女性占48.7%(6 472/13 294)。①A组人均年随访次数2.35次/人年,B组3.93次/人年( P<0.001);门诊患者占比分别为75.4%和86.1%,住院患者占比12.5%和6.1%,急诊留观占比12.1%和7.8%。②A组CHA 2DS 2-VASc评分中位数为3,B组评分中位数为2。③相关合并疾病排名前3:高血压(A组32.8%,B组21.7%, P<0.001)、冠心病(A组13.4%,B组8.2%, P<0.001)、糖尿病(A组12.5%,B组11.3%, P<0.001)。④两组人群使用抗凝药物比例分别为22.6%(1 885/8 343)和67.0%(8 913/13 294),抗血小板治疗比例19.7%(1 645/8 343)和5.6%(738/13 294)。 结论:综合管理平台干预后,房颤患者随访依从性增高,低分值人群(CHA 2DS 2-VASc评分≤2)失访率大大下降。综合管理平台的建立使诊疗更加循证、规范,为患者后续长期自我健康管理提供了多维度的支持,最终使房颤患者获益。Objective The comprehensive management of atrial fibrillation(AF)plays a critical role in its prognosis.This research was to observe the intervention effect of a computer-aided comprehensive management platform for AF patients,which was established to help strengthen the early diagnosis,standardized treatment,and long-term follow-up of patients with AF in Huashan Hospital,Fudan University.Methods We compared and analyzed the clinical characteristics of patients diagnosed as AF from January 2015 to February 2019 in Huashan Hospital Fudan University,who were classified into pre-platform(group A)and post-platform(group B)group including demography variates,comorbidities,CHA2DS2-VASc score,treatments and so on.Results①There were 3538 patients(numbers of visits:8343)in group A and 3385 patients(numbers of visits:13294)in group B with an average age of 74.31 and 73.86 years,respectively.②A raise in the number of annual physician office visits were shown with increased proportion of outpatient visits(A:75.4%,B:86.1%),decreased proportion of inpatients(A:12.5%,B:6.1%)and emergency visits(A:12.1%,B:7.8%).③The median CHA2DS2-VASc score of group A was 3,and 2 of group B.Top three comorbidities were hypertension(A:32.8%,B:21.7%,P<0.001),coronary heart disease(A:13.4%,B:8.2%,P<0.001),diabetes mellitus(A:12.5%,B:11.3%,P<0.001)in both groups.④The use of anticoagulant was 22.6%(1885/8343)in group A and 67.0%(8913/13294)in group B and antiplatelet agents used in the two groups were 19.7%(1645/8343)and 5.6%(738/13294).Conclusion The medical compliance of patients with AF was significantly increased with the help of computer-assisted platform,especially demonstrated by the decrease on the loss of follow-up among the"low score"(CHA2DS2-VASc score≤2)population.The comprehensive management platform provides a multi-dimensional support for thelong-term follow-up and self-health management of AF patients.

关 键 词：心房颤动 综合管理平台 随访 CHA2DS2-VASc评分 抗凝率 

分 类 号：R541.75[医药卫生—心血管疾病]