美国心房纤颤的抗凝治疗趋势－来自全国非卧床病人医疗护理调查数据库的分析

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Title: Trends in Anticoagulation for Atrial Fibrillation in the U.S.
An Analysis of the National Ambulatory Medical Care Survey Database
美国心房纤颤的抗凝治疗趋势－来自全国非卧床病人医疗护理调查数据库的分析
The First three authors: Shane B. Rowan, Desiree N. Bailey, Caroline E. Bublitz
Corresponding author and Address: Robert J. Anderson, Denver and Aurora, Colorado

Abstract:

Objectives The purpose of this study was to track trends in the use of anticoagulation for atrial fibrillation (AF) over the past decade and identify predictors of use.
目的：该研究目的是寻找近十年来房颤抗凝治疗的趋势并识别使用的预测因素
Background Atrial fibrillation is common and associated with significant morbidity. Previous studies suggest underuse of anticoagulant therapy in patients with AF.
背景：房颤是一种较普遍和发病率较高的疾病。既往研究发现房颤抗凝治疗不足。
Methods The National Ambulatory Medical Care Survey database was queried for all patient visits with a diagnosis of AF between 1994 and 2003. Other diagnoses, other medications, and demographic, visit, geographic, and were compared with the prescription of anticoagulation in predefined age and risk groups.
方法：通过全国非卧床病人医疗护理调查数据库查询1994－2003年间的诊断为房颤的病人。在事先定义的年龄和危险因素组，对房颤外其他诊断、其他治疗、人口统计学、地理因素、资料提供者细节和抗凝治疗进行比较。
Results The prevalence of the diagnosis of AF and anticoagulation for AF has increased over the last decade. Increased age and use of rate control agents is associated with the use of anticoagulation. There is a trend toward less anticoagulation when a rhythm control agent is used instead of a rate control agent. Anticoagulation might be overused in a group of low-risk patients.
结果：过去十年里，房颤的诊断和抗凝治疗呈增长趋势。年龄的增加和控制心率药物的使用和抗凝治疗与否有关。在使用控制节律治疗而非控制心率治疗中，抗凝治疗趋于减少。
Conclusions From 1995 through 2002, an increase has occurred in anticoagulation for AF, especially in those at highest risk for thromboembolic phenomena. A substantial number of patients at risk for thromboembolic events are not anticoagulated, and further studies are needed to determine how many of these patients are candidates for anticoagulation. Anticoagulation use has increased in nontargeted, low-risk groups in whom antiplatelet agents are appropriate. Use of a rhythm control agent might be associated with less use of anticoagulation.
结论：1995－2002年，房颤的抗凝治疗呈增加趋势，尤其在那些具有极高栓塞危险的病人。实际上，一部分有栓塞危险的病人并未接受抗凝治疗，并且需要有进一步的研究来发现究竟有多少上述的病人应该接受抗凝治疗。在那些接受抗血小板治疗更加合适的低危险组病人中，抗凝治疗的使用也呈增加趋势。使用控制节律药物或许跟抗凝治疗减少有关。
J Am Coll Cardiol 2007;49:1561–5.