Elezi Shpend, Qerkini Gazmend, Bujupi Liridon, Shabani Driton, Bajraktari Gani
Department of Internal Medicine, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo.
Anadolu Kardiyol Derg. 2010 Feb;10(1):36-40. doi: 10.5152/akd.2010.008.
Atrial fibrillation (AF) is the most important risk factor for ischemic stroke. Anticoagulation therapy can substantially decrease the risk of stroke in patients with AF. The aim of our study was to investigate the patient's comorbidities and management of patients with AF on the discharge.
From 5382 consecutive patients admitted in our institution between January 2005 and March 2008, 525 (mean age 66.4+/- 11.4 years, 53.3% male) had AF upon discharge, who were included in this retrospective study. Patients were divided in two groups according to prescription of anticoagulation therapy at discharge. Continuous data were compared between groups using a two-tailed unpaired Student t test. Discrete variables were compared using Chi-square test or Fisher's exact probability test as appropriate. Logistic regression analysis was used to identify the independent clinical and echocardiographic predictors of prescribing oral anticoagulation therapy.
Associated comorbidities of AF in our patients were: ischemic heart disease (21.4%), hypertensive heart disease (27.44%), valvular heart disease (17.4%), congestive heart failure (47%), chronic obstructive pulmonary disease (6.7%), and diabetes 14.3%). Of 525 patients 76% were discharged on beta-blockers, 67% on angiotensin converting enzyme inhibitors, 23% on digoxin, 16% on calcium antagonists, 67% on diuretics, 72% on aspirin, and 27% on oral anticoagulant (OAC) therapy, 11% were with both antithrombotics. Multivariate analysis showed that the under-prescription of OAC therapy in patients with AF was independently associated with elder age (OR=0.916, 95%CI 0.891-0.942, p<0.001), non-enlarged left atrium (OR=1.148, 95%CI 1.100-1.198, p<0.001) and good left ventricular ejection fraction (OR=0.970, 95%CI 0.948-0.993, p=0.011).
Patients with atrial fibrillation were mainly with ischemic, hypertensive heart disease and congestive heart failure. Our study, suggests underuse of anticoagulation therapy. The independent predictors of under prescription of anticoagulants in patients with atrial fibrillation were elder age, non-enlarged left atrium, and good left ventricular ejection fraction. Medical treatment with other groups of drugs for atrial fibrillation and comorbidities seems to be according to current guidelines.
心房颤动（AF）是缺血性卒中最重要的危险因素。抗凝治疗可大幅降低AF患者的卒中风险。我们研究的目的是调查出院时AF患者的合并症及管理情况。
在2005年1月至2008年3月期间我院连续收治的5382例患者中，525例（平均年龄66.4±11.4岁，男性占53.3%）出院时患有AF，纳入本回顾性研究。根据出院时抗凝治疗的处方将患者分为两组。连续数据采用双尾非配对Student t检验进行组间比较。离散变量根据情况采用卡方检验或Fisher精确概率检验进行比较。采用逻辑回归分析确定开具口服抗凝治疗的独立临床和超声心动图预测因素。
我们患者中AF的相关合并症有：缺血性心脏病（21.4%）、高血压性心脏病（27.44%）、瓣膜性心脏病（17.4%）、充血性心力衰竭（47%）、慢性阻塞性肺疾病（6.7%）和糖尿病（14.3%）。525例患者中，76%出院时使用β受体阻滞剂，67%使用血管紧张素转换酶抑制剂，23%使用地高辛，16%使用钙拮抗剂，67%使用利尿剂，72%使用阿司匹林，27%接受口服抗凝剂（OAC）治疗，11%同时使用两种抗栓药物。多因素分析显示，AF患者OAC治疗处方不足与老年（OR=0.916，95%CI 0.891-0.942，p<0.001）、左心房未增大（OR=1.148，95%CI 1.100-1.198，p<0.001）和左心室射血分数良好（OR=0.970，95%CI 0.948-0.993，p=0.011）独立相关。
心房颤动患者主要合并缺血性、高血压性心脏病和充血性心力衰竭。我们的研究表明抗凝治疗使用不足。心房颤动患者抗凝处方不足的独立预测因素为老年、左心房未增大和左心室射血分数良好。针对心房颤动及其合并症使用其他药物组进行的药物治疗似乎符合现行指南。
