Boriani Giuseppe, Santini Massimo, Lunati Maurizio, Gasparini Maurizio, Proclemer Alessandro, Landolina Maurizio, Padeletti Luigi, Botto Giovanni Luca, Capucci Alessandro, Bianchi Stefano, Biffi Mauro, Ricci Renato Pietro, Vimercati Marco, Grammatico Andrea, Lip Gregory Y H
Institute of Cardiology, University of Bologna and Azienda Ospedaliera S Orsola-Malpighi, Via Massarenti 9, Bologna, Italy.
Circ Cardiovasc Qual Outcomes. 2012 Mar 1;5(2):182-8. doi: 10.1161/CIRCOUTCOMES.111.964205. Epub 2012 Feb 28.
Atrial fibrillation (AF) is a well-established risk factor for stroke and thromboembolism and is a frequent comorbid arrhythmia in patients with implantable cardioverter-defibrillators (ICDs). The Anticoagulation Use Evaluation and Life Threatening Events Sentinels (ANGELS) of AF project was a medical care program aimed at supporting adherence to oral anticoagulation (OAC) guidelines for thromboprophylaxis through the use of ICD AF diagnostics.
Fifty Italian cardiology clinics followed 3438 patients with ICDs. In a subgroup of 15 centers (the ANGELS of AF centers), cardiologists attending to follow-up visits were supplied with specific reports describing stroke risk factors and risk scores (American College of Chest Physicians and CHADS(2) [congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke or transient ischemic attack]), AF occurrence and duration, and current antithrombotic therapy for patients with AF, especially those with a CHADS(2) score >0 and not on OAC therapy. The remaining centers represented a control group of patients as a comparison of OAC use. In the ANGELS of AF centers, 709 (36%) patients had AF described either in their clinical history (n=426 [22%]) or as new-onset AF (n=257 [14%]). Among 683 (96%) patients with CHADS2 score >0, 209 (30.6%) were not taking an OAC. Appropriate OAC therapy was prescribed in 10% (22/209) of patients after evaluation of ANGELS of AF reports. The percentage of patients on OAC therapy, as indicated by guidelines, increased during follow-up from 46.1% at baseline, to 69.4% at the stroke risk evaluation phase, to up to 72.6% at the end of the observation period. In control centers, corresponding figures were 46.9% at baseline and 56.8% at the end of the observation period (P<0.001 versus ANGELS of AF group).
The ANGELS of AF project demonstrates the possibility to improve OAC use in accordance with available guidelines for stroke risk reduction in AF by supplying attending physicians with reports about patients risk factors and AF information from continuous ICD monitoring.
心房颤动（AF）是公认的中风和血栓栓塞的危险因素，并且是植入式心脏复律除颤器（ICD）患者中常见的合并心律失常。房颤抗凝使用评估与危及生命事件监测（ANGELS）项目是一项医疗保健计划，旨在通过使用ICD房颤诊断来支持遵循口服抗凝药（OAC）预防血栓形成的指南。
五十家意大利心脏病诊所对3438例ICD患者进行了随访。在15个中心的亚组（房颤ANGELS中心）中，随访门诊的心脏病专家收到了特定报告，这些报告描述了中风危险因素和风险评分（美国胸科医师学会和CHADS(2) [充血性心力衰竭、高血压、年龄≥75岁、糖尿病以及既往中风或短暂性脑缺血发作]）、房颤的发生和持续时间，以及房颤患者，尤其是CHADS(2)评分>0且未接受OAC治疗患者的当前抗栓治疗情况。其余中心代表患者对照组，用于比较OAC的使用情况。在房颤ANGELS中心中，709例（36%）患者的临床病史中描述有房颤（n = 426例[22%]）或新发房颤（n = 257例[14%]）。在683例（96%）CHADS2评分>0的患者中，209例（30.6%）未服用OAC。在评估房颤ANGELS报告后，10%（22/209）的患者接受了适当的OAC治疗。根据指南，接受OAC治疗的患者百分比在随访期间从基线时的46.1%增加到中风风险评估阶段的69.4%，在观察期结束时高达72.6%。在对照中心，相应的数字在基线时为46.9%，在观察期结束时为56.8%（与房颤ANGELS组相比，P<0.001）。
房颤ANGELS项目表明，通过向主治医生提供来自持续ICD监测的患者危险因素和房颤信息报告，有可能按照现有指南提高OAC的使用，以降低房颤患者中风风险。
