Scott Phillip A, Pancioli Arthur M, Davis Lisa A, Frederiksen Shirley M, Eckman John
Department of Emergency Medicine, University of Michigan, Ann Arbor 48109, USA.
Stroke. 2002 Nov;33(11):2664-9. doi: 10.1161/01.str.0000035260.70403.88.
The emergency department (ED), as the point of first medical contact for many complaints referable to atrial fibrillation (AF) and a common source of primary care, occupies a unique position to identify AF patients at risk of stroke. This study evaluates that potential by determining the prevalence of AF in an ED population and assessing antithrombotic use in those patients with recurrent AF.
This was a multicenter, retrospective, cross-sectional study of consecutive records of ED patients with AF identified by ECG between January and June 1998. American Heart Association and modified Stroke Prevention in Atrial Fibrillation criteria established high-risk patients and contraindications to anticoagulation, respectively.
We identified 866 records with ECG-proven AF in 78 787 patient visits for an estimated prevalence of 1.10% (95% CI, 1.03 to 1.17). We found that 556 records had a prior history of AF; of these, 221 (40%) used warfarin alone, 155 (28%) had antiplatelet therapy alone, 28 (5%) used both, and 152 (27%) had no antithrombotic therapy identified. Sixty-eight patients (12%; 95% CI, 0.10 to 0.15) were warfarin eligible and without antithrombotic therapy. An additional 64 (12%; 95% CI, 0.09 to 0.14) had antiplatelet therapy alone. In warfarin-eligible patients, no differences were identified between the anticoagulated and nonanticoagulated groups on the basis of age, sex, or race. Of patients on warfarin with a measured international normalized ratio, 61% (95% CI, 0.55 to 0.67) were outside the AHA-recommended range of 2.0 to 3.0.
AF is a common finding in an ED population. Many are warfarin eligible and untreated or undertreated. Methods to increase anticoagulant use in this at-risk population warrant further investigation.
急诊科作为许多房颤相关病症的首个医疗接触点以及初级保健的常见来源，在识别有中风风险的房颤患者方面占据独特地位。本研究通过确定急诊科人群中房颤的患病率并评估复发性房颤患者的抗栓治疗使用情况来评估这一潜力。
这是一项多中心、回顾性、横断面研究，对1998年1月至6月间通过心电图确诊为房颤的急诊科患者的连续记录进行分析。美国心脏协会标准和改良的房颤卒中预防标准分别确定了高危患者和抗凝治疗的禁忌证。
在78787次患者就诊记录中，我们识别出866份经心电图证实为房颤的记录，估计患病率为1.10%（95%可信区间，1.03至1.17）。我们发现556份记录有房颤病史；其中，221份（40%）仅使用华法林，155份（28%）仅接受抗血小板治疗，28份（5%）两者都用，152份（27%）未发现有抗栓治疗。68例患者（12%；95%可信区间，0.10至0.15）符合使用华法林条件但未接受抗栓治疗。另有64例（12%；95%可信区间，0.09至0.14）仅接受抗血小板治疗。在符合使用华法林条件的患者中，抗凝组和未抗凝组在年龄、性别或种族方面未发现差异。在接受华法林治疗且测量了国际标准化比值的患者中，61%（95%可信区间，0.55至0.67）超出了美国心脏协会推荐的2.0至3.0范围。
房颤在急诊科人群中很常见。许多患者符合使用华法林条件但未接受治疗或治疗不足。增加这一高危人群抗凝治疗使用的方法值得进一步研究。
