Health Search, Italian College of General Practitioners, Florence, Italy.
Thromb Haemost. 2010 May;103(5):968-75. doi: 10.1160/TH09-08-0525. Epub 2010 Mar 9.
The aims of this study were to investigate trends in the incidence of diagnosed atrial fibrillation (AF), and to identify factors associated with the prescription of antithrombotics (ATs) and to identify the persistence of patients with oral anticoagulant (OAC) treatment in primary care. Data were obtained from 400 Italian primary care physicians providing information to the Health Search/Thales Database from 2001 to 2004. The age-standardised incidence of AF was: 3.9-3.0 cases, and 3.6-3.0 cases per 1,000 person-years in males and females, respectively. During the study period, 2,016 (37.2%) patients had no prescription, 1,663 (30.7%) were prescribed an antiplatelet (AP) agent, 1,440 (26.6%) were prescribed an OAC and 301 (5.5%) had both prescriptions. The date of diagnosis (p = 0.0001) affected the likelihood of receiving an OAC. AP, but not OAC, use significantly increased with a worsening stroke risk profile using the CHADS2 risk score. Older age increased the probability (p < 0.0001) of receiving an AP, but not an OAC. Approximately 42% and 24% of patients persisted with OAC treatment at one and two years, respectively, the remainder interrupted or discontinued their treatment. Underuse and discontinuation of OAC treatment is common in incident AF patients. Risk stratification only partially influences AT management.
本研究旨在探讨诊断为心房颤动 (AF) 的发病率趋势，并确定与抗血栓药物 (ATs) 处方相关的因素，以及确定口服抗凝剂 (OAC) 治疗在初级保健中的持续性。数据来自 400 名向 Health Search/Thales 数据库提供信息的意大利初级保健医生，该数据库于 2001 年至 2004 年期间提供信息。AF 的年龄标准化发病率为：男性和女性分别为每 1000 人年 3.9-3.0 例和 3.6-3.0 例。在研究期间，2016 名（37.2%）患者未开具处方，1663 名（30.7%）开具了抗血小板（AP）药物，1440 名（26.6%）开具了 OAC，301 名（5.5%）同时开具了两种药物。诊断日期（p = 0.0001）影响接受 OAC 的可能性。AP，但不是 OAC 的使用随着 CHADS2 风险评分中风风险状况的恶化而显著增加。年龄越大，接受 AP 的可能性（p < 0.0001）增加，但接受 OAC 的可能性不会增加。大约 42%和 24%的患者分别在一年和两年时持续接受 OAC 治疗，其余患者中断或停止治疗。在新发 AF 患者中，OAC 治疗的使用率低和停药很常见。风险分层仅部分影响 AT 管理。
