与心房颤动高危患者治疗不足相比，遵循指南的抗栓治疗与改善的结局相关。欧洲心房颤动调查。

Guideline-adherent antithrombotic treatment is associated with improved outcomes compared with undertreatment in high-risk patients with atrial fibrillation. The Euro Heart Survey on Atrial Fibrillation.

作者信息

Nieuwlaat Robby, Olsson S Bertil, Lip Gregory Y H, Camm A John, Breithardt Günter, Capucci Alessandro, Meeder Joan G, Prins Martin H, Lévy Samuel, Crijns Harry J G M

机构信息

Department of Cardiology, University Hospital Maastricht, Maastricht, The Netherlands.

出版信息

Am Heart J. 2007 Jun;153(6):1006-12. doi: 10.1016/j.ahj.2007.03.008.

DOI:10.1016/j.ahj.2007.03.008

PMID:17540203

Abstract

BACKGROUND

The Euro Heart Survey showed that antithrombotic treatment in patients with atrial fibrillation (AF) was moderately tailored to the 2001 American College of Cardiology, American Heart Association, and European Society of Cardiology (ACC/AHA/ESC) guidelines for the management of AF. What consequences does guideline-deviant antithrombotic treatment have in daily practice?

METHODS

In the Euro Heart Survey on AF (2003-2004), an observational study on AF care in European cardiology practices, information was available on baseline stroke risk profile and antithrombotic drug treatment and on cardiovascular events during 1-year follow-up. Antithrombotic guideline adherence is assessed according to the 2001 ACC/AHA/ESC guidelines. Multivariable logistic regression was performed to assess the association of guideline deviance with adverse outcome.

RESULTS

The effect of antithrombotic guideline deviance was analyzed exclusively in 3634 high-risk patients with AF because these composed the majority (89%) and because few cardiovascular events occurred in low-risk patients. Among high-risk patients, antithrombotic treatment was in agreement with the guidelines in 61% of patients, whereas 28% were undertreated and 11% overtreated. Compared to guideline adherence, undertreatment was associated with a higher chance of thromboembolism (odds ratio [OR], 1.97; 95% CI, 1.29-3.01; P = .004) and the combined end point of cardiovascular death, thromboembolism, or major bleeding (OR, 1.54; 95% CI, 1.14-2.10; P = .024). This increased risk was nonsignificant for the end point of stroke alone (OR, 1.42; 95% CI, 0.82-2.46; P = .170). Overtreatment was nonsignificantly associated with a higher risk for major bleeding (OR, 1.52; 95% CI, 0.76-3.02; P = .405).

CONCLUSIONS

Antithrombotic undertreatment of high-risk patients with AF was associated with a worse cardiovascular prognosis during 1 year, whereas overtreatment was not associated with a higher chance for major bleeding.

摘要

背景

欧洲心脏调查显示，心房颤动（AF）患者的抗栓治疗仅适度符合2001年美国心脏病学会、美国心脏协会和欧洲心脏病学会（ACC/AHA/ESC）发布的AF管理指南。在日常实践中，不符合指南的抗栓治疗会产生什么后果？

方法

在欧洲心脏AF调查（2003 - 2004年）中，一项关于欧洲心脏病学实践中AF护理的观察性研究，可获取基线卒中风险概况、抗栓药物治疗以及1年随访期间心血管事件的信息。根据2001年ACC/AHA/ESC指南评估抗栓指南依从性。进行多变量逻辑回归以评估指南偏差与不良结局之间的关联。

结果

仅在3634例高危AF患者中分析了抗栓指南偏差的影响，因为这些患者占大多数（89%），且低危患者发生的心血管事件较少。在高危患者中，61%的患者抗栓治疗符合指南，而28%的患者治疗不足，11%的患者治疗过度。与遵循指南相比，治疗不足与血栓栓塞风险增加相关（比值比[OR]，1.97；95%置信区间[CI]，1.29 - 3.01；P = 0.004），以及与心血管死亡、血栓栓塞或大出血的复合终点相关（OR，1.54；95% CI，1.14 - 2.10；P = 0.024）。仅卒中终点的这种风险增加无统计学意义（OR，1.42；95% CI，0.82 - 2.46；P = 0.170）。治疗过度与大出血风险增加无显著关联（OR，1.52；95% CI，0.76 - 3.02；P = 0.405）。