共病及衰弱对高龄心房颤动患者抗凝治疗依从性的影响  

Observational Study on the Impact of Comorbidities and Frailty on Anticoagulation Therapy Compliance in Elderly Patients With Atrial Fibrillation

作　　者：王征[1] 闫盈盈[2] 武东[1] 张帆[1] WANG Zheng;YAN Yingying;WU Dong;ZHANG Fan(Geriatric Department,Peking University Third Hospital,Beijing 100191,China;Pharmacy Department,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院老年内科,北京100191 [2]北京大学第三医院药剂科,北京100191

出　　处：《中国循环杂志》2024年第9期853-858,共6页Chinese Circulation Journal

摘　　要：目的:观察共病及衰弱对高龄(≥75岁)心房颤动(房颤)患者抗凝治疗依从性的影响。方法:回顾性选取2016年10月至2019年10月期间于北京大学第三医院老年内科住院的≥75岁非瓣膜性房颤患者528例,其中接受抗凝治疗患者443例(83.9%)。443例患者的平均年龄为(84.72±5.39)岁。443例老年房颤患者均接受栓塞风险(CHA_(2)DS_(2)-VASc评分)和出血风险(HAS-BLED、ATRIA评分)评估,并应用衰弱指数量表和年龄校正Charlson共病指数(ACCI)对患者进行评估。衰弱指数≥3分为衰弱,衰弱指数1~2分为衰弱前期;ACCI≥5分为多重共病(高共病负荷)。对出院后接受抗凝治疗的患者进行1年门诊随访,以出院后患者是否停药进行分组比较,观察患者用药依从性并分析其原因。结果:443例老年房颤患者均接受栓塞风险和出血风险评估,CHA_(2)DS_(2)-VASc评分为(5.61±1.57)分,HAS-BLED评分为(3.08±0.89)分,ATRIA评分为(4.13±1.90)分。衰弱指数量表评估显示,所有患者均处于衰弱期或衰弱前期,ACCI平均值为(5.73±1.51)分。随访1年后停用抗凝治疗的患者为96例(21.67%),衰弱(OR=1.114,95%CI:1.041~1.205,P=0.003)、高共病负荷(OR=3.201,95%CI:2.126~4.509,P=0.001)及ATRIA评分定义的高出血风险(ATRIA评分≥5分,OR=1.457,95%CI:1.212~2.075,P=0.024)是用药依从性的影响因素。如果仅观察非死亡所致停药原因,HAS-BLED评分定义的高出血风险(HAS-BLED评分≥3分,OR=1.098,95%CI:1.035~1.116,P=0.014)和应用华法林(OR=1.015,95%CI:1.001~1.030,P=0.040)也是用药依从性的影响因素。结论:高龄(≥75岁)房颤患者出院后抗凝治疗的依从性受衰弱、高共病负荷和ATRIA评分定义的高出血风险评分的影响较为明显。若除外死亡事件,HAS-BLED评分定义的高出血风险和应用华法林也是患者停止抗凝治疗的影响因素。Objectives:This study was designed to observe the impact of frailty status and multiple comorbidities on anticoagulation therapy adherence in elderly patients(≥75 years old) with atrial fibrillation.Methods:This retrospective study enrolled 528 patients(≥75 years old) with atrial fibrillation who were admitted to the geriatric department of Peking University Third Hospital from October 2016 to October 2019.A total of 443(83.9%) elderly patients receiving anticoagulation therapy were included,with an average age of(84.72 ± 5.39) years.Thromboembolic and bleeding risk were evaluated by CHA_2DS_2-VASc and HAS-BLED,ATRIA bleeding score,while the frailty index(FI) and the age-adjusted Charlson comorbidity index(ACCI) were evaluated.Those with FI ≥ 3 and FI between 1~2 were categorized into the frailty group and pre-frailty group.Patients with ACCI ≥ 5 were defined as elderly multiple comorbidity group(high comorbidity burden).Patients who received anticoagulation therapy after discharge were followed up for one year in the outpatient clinic to observe their medication adherence and to find the related reasons.Results:Thromboembolic risk and bleeding scoring were performed in 443 elderly patients,with CHA_2DS_2-VASc and HAS-BLED scores of 5.61 ± 1.57 and 3.08 ± 0.89,respectively,and ATRIA score was 4.13 ± 1.90.The FI assessment showed that all enrolled patients were in a state of frailty or pre-frailty.The average ACCI was 5.73 ± 1.51.At one year of follow-up,96(21.67%) patients discontinued anticoagulation therapy.Frailty,high comorbidity burden,and high bleeding risk according to ATRIA(ATRIA ≥ 5) were factors affecting medication adherence,with OR values of 1.114(95%CI:1.041-1.205,P=0.003),3.201(95%CI:2.126-4.509,P=0.001),and 1.457(95%CI:1.212-2.075,P=0.024),respectively.Considering non-death endpoint,both the HAS-BLED score(HAS-BLED≥3 分,OR=1.098,95%CI:1.035-1.116,P=0.014) and warfarin(OR=1.015,95%CI:1.001-1.030,P=0.040) were influential factors of medication compliance.Conclusions:The adherence to

关 键 词：非瓣膜性心房颤动 抗凝治疗 衰弱 共病指数 用药依从性 

分 类 号：R54[医药卫生—心血管疾病]