Chen Shih-Yin, Vanderpoel Julie, Mody Samir, Nelson Winnie W, Schein Jeffrey, Rao Preethi, Boulanger Luke
United BioSource Corporation, Lexington, MA, USA.
Am J Geriatr Pharmacother. 2012 Oct;10(5):273-83. doi: 10.1016/j.amjopharm.2012.08.003. Epub 2012 Sep 12.
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and disproportionately affects the elderly.
This study describes patient characteristics and caregiver assistance among Medicare beneficiaries with AF and examines factors associated with receiving anticoagulant treatment.
Patients with AF and age/gender-matched controls were identified from Medicare Current Beneficiary Survey data from 2001 to 2006. A logistic regression model was used to assess factors associated with receiving anticoagulants in a subgroup of patients with AF whose treatment pattern was established for 2 consecutive years. Sample weights were applied to obtain nationally representative estimates.
A total of 2990 patients with AF and 5980 control patients were included in the burden of disease analysis, and 1481 patients with AF were included in the anticoagulant predictor analysis. Patients with AF had a higher level of comorbidity (Charlson Comorbidity Index: 3.3 vs 1.5; P < 0.05), worse self-perceived health status (P < 0.001), and greater level of disability (P < 0.001) than their matched counterparts. A greater proportion of patients with AF required caregiver assistance (62.8% vs 51.5%; P < 0.001). Logistic regression found that higher Charlson Comorbidity Index scores, difficulty in obtaining necessary health care, older age, being widowed, a history of psychiatric disorders, and being underweight decreased the likelihood of receiving anticoagulant therapy.
In a Medicare population, a greater need for caregiver assistance was observed in patients with AF. Subgroups characterized by frailty or inability for self-care were identified as being less likely to receive anticoagulant therapy. The need for caregiver assistance among patients with AF, as well as the patient subgroups identified as less likely to receive anticoagulant therapy, should be considered when making treatment decisions.
心房颤动（AF）是最常见的持续性心律失常，对老年人的影响尤为严重。
本研究描述了医疗保险受益人心房颤动患者的特征及照顾者的协助情况，并探讨了与接受抗凝治疗相关的因素。
从2001年至2006年医疗保险当前受益人调查数据中识别出心房颤动患者及年龄/性别匹配的对照者。采用逻辑回归模型评估在连续两年确定治疗模式的心房颤动患者亚组中与接受抗凝剂相关的因素。应用样本权重以获得具有全国代表性的估计值。
共有2990例心房颤动患者和5980例对照患者纳入疾病负担分析，1481例心房颤动患者纳入抗凝剂预测分析。与匹配的对照者相比，心房颤动患者的合并症水平更高（Charlson合并症指数：3.3对1.5；P<0.05），自我感知健康状况更差（P<0.001），残疾程度更高（P<0.001）。心房颤动患者中需要照顾者协助的比例更高（62.8%对51.5%；P<0.001）。逻辑回归发现，较高的Charlson合并症指数评分、获得必要医疗保健困难、年龄较大、丧偶、有精神疾病病史以及体重过轻会降低接受抗凝治疗的可能性。
在医疗保险人群中，观察到心房颤动患者对照顾者协助的需求更大。以虚弱或无法自我照顾为特征的亚组被确定为接受抗凝治疗的可能性较小。在做出治疗决策时，应考虑心房颤动患者对照顾者协助的需求以及被确定为接受抗凝治疗可能性较小的患者亚组。
