瑞典初级卫生保健中慢性房颤患者的抗凝治疗——对登记人群发病率和质量的回顾性研究

Anticoagulant treatment of patients with chronic atrial fibrillation in primary health care in Sweden--a retrospective study of incidence and quality in a registered population.

作者信息

Nilsson Gunnar H, Björholt Ingela, Krakau Ingvar

机构信息

Department of Clinical Sciences, Center of Family Medicine, Karolinska Institute, Stockholm, Sweden.

出版信息

Fam Pract. 2004 Dec;21(6):612-6. doi: 10.1093/fampra/cmh606. Epub 2004 Oct 1.

DOI:10.1093/fampra/cmh606

PMID:15465879

Abstract

BACKGROUND

The number of patients receiving anticoagulant treatment is increasing. Chronic atrial fibrillation is the most common treatment diagnosis. The literature indicates a variable level of treatment control. Estimates of time within the therapeutic range have been recommended as a measurement of quality. Electronic patient records are providing clinical data that are useful for audits concerning anticoagulant treatment in real-life practice.

OBJECTIVE

Our aim was to assess warfarin treatment for chronic atrial fibrillation in primary health care with regard to prevalence, incidence and quality.

METHODS

A 2 year retrospective study was carried out of electronic patient records up to April 2002 in primary health care in Stockholm, including 12 primary health care centres with a registered population of 203 407. Main outcome measures were the number of new patients on wafarin treatment for chronic atrial fibrillation, and time within the therapeutic prothrombin range in the first 90 days of treatment using a linear interpolation method.

RESULTS

In total, 827 patients were on warfarin treatment for chronic atrial fibrillation, giving a prevalence of 0.41%. Of these, 144 patients (study group) started treatment with warfarin for chronic atrial fibrillation during the study period, giving a yearly incidence of 0.07%. Their mean age was 73.1 years and 61.1% were men. There were 1721 prothrombin monitoring episodes registered in the first 90 days of treatment, on average once a week per patient. The average proportion of time within the therapeutic range was 54.1% (95% confidence interval (CI) 50.1-58.1), and the proportion of therapeutic tests was 50.2% (95% CI 47.8-52.6).

CONCLUSIONS

During the first, second and third months of warfarin treatment for chronic atrial fibrillation, patients were outside the therapeutic range time nearly half the time. There was a gender difference favouring men regarding initiation of treatment.

摘要

背景

接受抗凝治疗的患者数量正在增加。慢性房颤是最常见的治疗诊断。文献表明治疗控制水平存在差异。推荐将治疗范围内的时间估计作为质量衡量标准。电子病历提供的临床数据有助于对实际临床实践中的抗凝治疗进行审核。

目的

我们的目的是评估初级卫生保健中慢性房颤的华法林治疗的患病率、发病率和质量。

方法

对斯德哥尔摩初级卫生保健机构截至2002年4月的电子病历进行了一项为期2年的回顾性研究，包括12个初级卫生保健中心，登记人口为203407人。主要观察指标是接受华法林治疗慢性房颤的新患者数量，以及使用线性插值法计算治疗前90天内凝血酶原治疗范围内的时间。

结果

共有827例患者接受华法林治疗慢性房颤，患病率为0.41%。其中，144例患者（研究组）在研究期间开始使用华法林治疗慢性房颤，年发病率为0.07%。他们的平均年龄为73.1岁，61.1%为男性。治疗的前90天内共记录了1721次凝血酶原监测事件，平均每位患者每周一次。治疗范围内的平均时间比例为54.1%（95%置信区间（CI）50.1-58.1），治疗性检测的比例为50.2%（95%CI 47.8-52.6）。