Center for Health Care Evaluation, VA Palo Alto Health Care System, Palo Alto, CA 94025, USA.
Am J Manag Care. 2011 Sep;17(9):617-24.
To determine whether atrial fibrillation (AF) patients with mental health conditions (MHCs) were less likely than AF patients without MHCs to be prescribed warfarin and, if receiving warfarin, to maintain an International Normalized Ratio (INR) within the therapeutic range.
Detailed chart review of AF patients using a Veterans Health Administration (VHA) facility in 2003.
For a random sample of 296 AF patients, records identified clinician-diagnosed MHCs (independent variable) and AF-related care in 2003 (dependent variables), receipt of warfarin, INR values below/above key thresholds, and time spent within the therapeutic range (2.0-3.0) or highly out of range. Differences between the MHC and comparison groups were examined using X2 tests and logistic regression controlling for age and comorbidity.
Among warfarin-eligible AF patients (n = 246), 48.5% of those with MHCs versus 28.9% of those without MHCs were not treated with warfarin (P = .004). Among those receiving warfarin and monitored in VHA, highly supratherapeutic INRs were more common in the MHC group; for example, 27.3% versus 1.6% had any INR >5.0 (P <.001). Differences persisted after adjusting for age and comorbidity.
MHC patients with AF were less likely than those without MHC to have adequate management of their AF care. Interventions directed at AF patients with MHC may help to optimize their outcomes.
确定是否伴有心理健康状况（MHC）的房颤（AF）患者比不伴有 MHC 的 AF 患者更不可能被开华法林，如果接受华法林治疗，是否能将国际标准化比值（INR）维持在治疗范围内。
2003 年对使用退伍军人健康管理局（VHA）设施的 AF 患者进行详细的图表回顾。
对于 296 名 AF 患者的随机样本，记录确定了临床诊断的 MHC（自变量）和 2003 年与 AF 相关的护理（因变量）、华法林的使用、INR 值低于/高于关键阈值以及在治疗范围内（2.0-3.0）或高度失准范围内花费的时间。使用 X2 检验和逻辑回归控制年龄和合并症来检查 MHC 和对照组之间的差异。
在华法林适用的 AF 患者（n = 246）中，48.5%的 MHC 患者与 28.9%的无 MHC 患者未接受华法林治疗（P =.004）。在接受华法林监测的 VHA 患者中，MHC 组的超高治疗 INR 更为常见；例如，任何 INR >5.0 的患者比例为 27.3%，而 1.6%（P <.001）。调整年龄和合并症后差异仍然存在。
伴有 AF 的 MHC 患者比不伴有 MHC 的患者更不可能得到其 AF 护理的充分管理。针对 MHC 伴有 AF 的患者的干预措施可能有助于改善他们的结局。
