房颤患者的处方率、口服抗凝剂剂量、临床结果和非抗凝相关因素的时间趋势

IF 4.8 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Jo-Nan Liao, Yi-Hsin Chan, Ling Kuo, Chuan-Tsai Tsai, Chih-Min Liu, Tzeng-Ji Chen, Gregory Y H Lip, Shih-Ann Chen, Tze-Fan Chao
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引用次数: 0

摘要

目的:分析房颤(AF)患者口服抗凝剂(OAC)处方、直接口服抗凝剂(DOAC)剂量、临床结局及非抗凝相关因素的时间变化趋势。患者和方法:2011年1月1日至2020年12月31日,共发现249,107例新诊断的房颤患者,分析其缺血性卒中、颅内出血(ICH)和全因死亡率的1年风险。结果:OAC处方从2011年的22.1%增加到2020年的57.7%,DOAC占OAC总处方的91.0%。与2011年诊断为AF的患者相比,2012 - 2020年缺血性卒中的风险和2014 - 2020年的死亡率有更大的下降趋势,而脑出血的风险没有明显变化。对于DOAC使用者来说,较高剂量的使用从2012年的11.04%增加到2019-2020年的44.29%,与2012-2014年相比,2015-2017年和2018-2020年缺血性卒中的风险较低。抑制OAC使用的决定因素包括一些“患者相关因素”和“非患者”因素(房颤在诊所由心脏病专家/神经科医生/内科医生以外的医生和城市以外的公民诊断)。结论:OAC处方呈增加趋势,与缺血性脑卒中风险和死亡率降低具有暂时性相关性。在DOACs使用者中,缺血性卒中的风险逐渐下降,部分原因是高剂量DOACs处方的增加。患者和非患者因素均与非抗凝相关。需要进一步努力增加OAC处方。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Temporal trends of prescription rates, oral anticoagulants dose, clinical outcomes, and factors associated with non-anticoagulation in patients with incident atrial fibrillation.

Aims: To analyse the temporal trends of oral anticoagulant (OAC) prescription, direct oral anticoagulant (DOAC) dose, clinical outcomes, and factors associated with non-anticoagulation in patients with incident atrial fibrillation (AF).

Methods and results: During 1 January 2011-31 December 2020, a total of 249 107 patients with newly diagnosed AF were identified, and the 1-year risks of ischaemic stroke, intracranial haemorrhage (ICH), and all-cause mortality were analysed. OAC prescription increased from 22.1% in 2011 to 57.7% in 2020 with DOAC accounting for 91.0% of overall OAC prescriptions. Compared to patients with incident AF diagnosed in 2011, there were increasing trends for a greater decrease in the risks of ischaemic stroke during 2012-2020 and mortality during 2014-2020, while the risk of ICH did not change significantly. For DOAC users, higher dose use increased from 11.04% in 2012 to 44.29% in 2019-2020 temporally associated with a lower risk of ischaemic stroke in the years 2015-2017 and 2018-2020 compared to 2012-2014. Determining factors refraining from OAC use included some 'patient-related factors' and 'non-patient' factors (AF diagnosed at clinics by physicians other than cardiologist/neurologist/internal medicine and citizens outside municipalities).

Conclusion: There was an increasing trend of OAC prescription, temporally associated with a decreased risk of ischaemic stroke and mortality. Among DOACs users, the risk of ischaemic stroke declined gradually, partly explained by the increasing prescriptions of higher dose DOACs. Both patient and non-patient factors were associated with non-anticoagulation. Further efforts are required to increase OAC prescription.

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来源期刊
CiteScore
9.40
自引率
3.80%
发文量
76
期刊介绍: European Heart Journal - Quality of Care & Clinical Outcomes is an English language, peer-reviewed journal dedicated to publishing cardiovascular outcomes research. It serves as an official journal of the European Society of Cardiology and maintains a close alliance with the European Heart Health Institute. The journal disseminates original research and topical reviews contributed by health scientists globally, with a focus on the quality of care and its impact on cardiovascular outcomes at the hospital, national, and international levels. It provides a platform for presenting the most outstanding cardiovascular outcomes research to influence cardiovascular public health policy on a global scale. Additionally, the journal aims to motivate young investigators and foster the growth of the outcomes research community.
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