Medical Clinic III, University Schleswig-Holstein, Campus Kiel, Germany.
Curr Med Res Opin. 2011 May;27(5):995-1003. doi: 10.1185/03007995.2011.563286. Epub 2011 Mar 11.
The aim of the study was to collect comprehensive data on atrial fibrillation (AF) in ambulatory and hospital-based management in Germany.
Consecutive patients with ECG-confirmed AF in the previous 12 months were documented in a non-interventional study in 638 physician offices (78.0%) or hospitals (12.7%).
Of the 3354 patients (mean age 68.9 ± 10.1 years; CHADS(2) score 1.9 ± 1.3), a total of 1136 (33.9%) had paroxysmal, 899 (26.8%) persistent, 1295 (38.6%) permanent and 24 (0.7%) unspecified AF. In the 12 months prior to documentation, pharmacological conversion was attempted in 18.2%, electric cardioversion in 17.5%, the combination of both in 31.2%, and catheter ablation of AF in 5.5%. Only 41.4% of patients met the definition of stable disease (having neither AF related intervention nor change in antiarrhythmic therapy in the previous 12 months). As treatment strategy, physicians stated rate control in 64%, rhythm control in 8%, and both in 19% (not reported: 8%). Patients received antiarrhythmic drugs of class IA in 1.3%, IC in 13.8%, II in 78.1%, III in 17.9%, IV in 9.7% and digitalis in 26.7%. Drugs for thromboembolic prevention (oral anticoagulants and/or antithrombotics) were administered in 81.5%. Hospitalisations for AF or associated diseases in the previous 12 months were reported in 34.2%. Possible limitations include the open, observational design, selection of physicians with particular interest in the field and selection of patients (i.e. underrepresentation of critically ill individuals).
While treatment rates with regards to the prevention of thromboembolic events were among the highest reported to date, the low proportion of stable patients and in particular, the high hospitalisation rate hint at difficulties in the management of patients with AF in clinical practice.
本研究旨在收集德国门诊和住院环境下房颤（AF）管理的综合数据。
在一项非干预性研究中，连续记录了过去 12 个月内心电图确诊为房颤的患者，共纳入 638 家医生办公室（78.0%）或医院（12.7%）。
在 3354 例患者中（平均年龄 68.9±10.1 岁；CHADS2 评分 1.9±1.3），阵发性房颤 1136 例（33.9%），持续性房颤 899 例（26.8%），永久性房颤 1295 例（38.6%），未明确分类房颤 24 例（0.7%）。在记录前的 12 个月内，尝试药物转复 18.2%，电复律 17.5%，两者联合应用 31.2%，导管消融房颤 5.5%。仅有 41.4%的患者符合疾病稳定的定义（在过去 12 个月内既没有房颤相关治疗，也没有抗心律失常药物治疗的改变）。作为治疗策略，医生指出，64%的患者采用了控制心室率，8%的患者采用了节律控制，19%的患者采用了两者联合（未报告：8%）。患者接受了 I 类抗心律失常药物 1.3%，IC 类 13.8%，II 类 78.1%，III 类 17.9%，IV 类 9.7%和地高辛 26.7%。接受血栓栓塞预防（口服抗凝药和/或抗血小板药物）的患者为 81.5%。在过去 12 个月内，因房颤或相关疾病住院的患者为 34.2%。可能的局限性包括开放性、观察性设计、选择对该领域有特殊兴趣的医生以及选择患者（即重症患者代表性不足）。
尽管在预防血栓栓塞事件方面的治疗率是迄今为止报告的最高水平之一，但稳定患者的比例较低，尤其是较高的住院率，表明在临床实践中管理房颤患者存在困难。
