Center for Family and Community Medicine, Karolinska Institutet, Stockholm, Sweden.
Eur J Clin Pharmacol. 2013 Feb;69(2):245-53. doi: 10.1007/s00228-012-1322-6. Epub 2012 Jun 10.
Little is known about prescription trends in atrial fibrillation (AF) in primary health care in Sweden.
The aim was to study time trends in pharmacotherapy, in men and women with AF. We also aimed at studying doctors' adherence to CHADS2 for prescribing warfarin. CHADS2 assesses stroke risk by presence of known risk factors, i.e., congestive heart failure, hypertension, age >75 years, diabetes, previous stroke and transient ischemic attack.
Data were obtained from primary health care records that contained individual clinical data. In total, 371,036 patients were included in the sample from 2002, and 424,329 patients were included in the sample from 2007. The study population consisted of individuals aged 45+ years who were diagnosed with AF in 2002 (1,330 men and 1,096 women) and 2007 (2,748 men and 2,234 women). The pharmacotherapies prescribed in 2002 and 2007 were analyzed separately in men and women. Logistic regression was used to calculate the association between the CHADS2 score and prescribed warfarin treatment.
Selective beta-blockers, anti-coagulant therapy and lipid-lowering drugs were prescribed more frequently in 2007 than in 2002. In 2007, antithrombotic and RAS-blocking agents were prescribed more frequently to men, whereas beta-1 selective beta-blockers were prescribed more frequently to women. There was no consistent association between the CHADS2 score and prescribed warfarin treatment.
Pharmacotherapy of AF has improved over time, though CHADS2 guidelines need to be implemented systematically in primary health care in Sweden to decrease the risk of stroke and improve quality of life in patients with AF.
在瑞典的初级卫生保健中，关于心房颤动（AF）的处方趋势知之甚少。
研究 AF 患者中药物治疗的时间趋势，包括男性和女性。我们还旨在研究医生根据 CHADS2 开华法林的情况。CHADS2 通过存在已知的危险因素（充血性心力衰竭、高血压、年龄>75 岁、糖尿病、中风和短暂性脑缺血发作）评估中风风险。
数据来自初级卫生保健记录，其中包含个人临床数据。总共纳入了 371036 名 2002 年样本中的患者和 424329 名 2007 年样本中的患者。研究人群包括 2002 年（1330 名男性和 1096 名女性）和 2007 年（2748 名男性和 2234 名女性）诊断为 AF 的 45 岁以上个体。分别分析了 2002 年和 2007 年男性和女性中开具的药物治疗。使用逻辑回归计算 CHADS2 评分与开华法林治疗之间的关联。
选择性β受体阻滞剂、抗凝治疗和降脂药物在 2007 年比 2002 年更常被开处。2007 年，抗血栓和 RAS 阻滞剂更常被男性开处，而β1 选择性β受体阻滞剂更常被女性开处。CHADS2 评分与开华法林治疗之间没有一致的关联。
AF 的药物治疗随着时间的推移而改善，但 CHADS2 指南需要在瑞典的初级卫生保健中系统实施，以降低中风风险并改善 AF 患者的生活质量。
