房颤患者中风风险与口服抗凝剂使用：一项横断面调查。
Risk of stroke and oral anticoagulant use in atrial fibrillation: a cross-sectional survey.
机构信息
Department of Primary Care Health Sciences, Oxford University, Oxford, UK.
出版信息
Br J Gen Pract. 2012 Oct;62(603):e710-7. doi: 10.3399/bjgp12X656856.
BACKGROUND
Oral anticoagulants substantially reduce the risk of stroke in atrial fibrillation but are underutilised in current practice.
AIM
To measure the distribution of stroke risk in patients with atrial fibrillation (using the CHADS(2) and CHA(2)DS(2)-VASc scores) and changes in oral anticoagulant use during 2007-2010.
DESIGN AND SETTING
Longitudinal series of cross-sectional survey in 583 UK practices linked to the QResearch(®) database providing 99 351 anonymised electronic records from people with atrial fibrillation.
METHOD
The proportion of patients in each CHADS(2) and CHA(2)DS(2)-VASc risk band in 2010 was calculated; for each of the years 2007-2010, the proportions with risk scores ≥2 that were using anticoagulants or antiplatelet agents were estimated. The proportions identified at high risk were re-estimated using alternative definitions of hypertension based on coded data. Finally, the prevalence of comorbid conditions in treated and untreated high-risk (CHADS(2) ≥2) groups was derived.
RESULTS
The proportion at high risk of stroke in 2010 was 56.9% according to the CHADS(2) ≥2 threshold, and 84.5% according to CHA(2)DS(2)-VASc ≥2 threshold. The proportions of these groups receiving anticoagulants were 53.0% and 50.7% respectively and increased during 2007-2010. The means of identifying the population of individuals with hypertension significantly influenced the estimated proportion at high risk. Comorbid conditions associated with avoidance of anticoagulants included history of falls, use of nonsteroidal anti-inflammatory drugs, and dementia.
CONCLUSION
Oral anticoagulant use in atrial fibrillation has increased in UK practice since 2007, but remains suboptimal. Improved coding of hypertension is required to support systematic identification of individuals at high risk of stroke and could be assisted by practice-based software.
背景
口服抗凝剂可显著降低心房颤动患者发生中风的风险，但目前在临床实践中的应用不足。
目的
测量心房颤动患者的中风风险分布（使用 CHADS₂ 和 CHA₂DS₂-VASc 评分），并在 2007 年至 2010 年期间观察口服抗凝剂的使用变化。
设计和设置
对来自英国 583 家实践的 99351 份匿名电子记录进行的 QResearch®数据库的纵向系列横断面调查，这些记录与 583 家实践相链接。
方法
计算了 2010 年每个 CHADS₂ 和 CHA₂DS₂-VASc 风险带的患者比例；估计了每个 2007 年至 2010 年，风险评分≥2 的患者使用抗凝剂或抗血小板药物的比例。使用基于编码数据的替代高血压定义，重新估算了高风险患者的比例。最后，根据 CHADS₂≥2 的定义，得出了治疗和未治疗高危（CHADS₂≥2）人群中合并症的患病率。
结果
根据 CHADS₂≥2 阈值，2010 年中风高危患者的比例为 56.9%，根据 CHA₂DS₂-VASc≥2 阈值为 84.5%。这些人群中接受抗凝治疗的比例分别为 53.0%和 50.7%，并在 2007 年至 2010 年期间有所增加。用于识别高血压人群的方法显著影响了高危人群的估计比例。与避免使用抗凝剂相关的合并症包括跌倒史、非甾体抗炎药的使用和痴呆。
结论
自 2007 年以来，英国临床实践中口服抗凝剂的使用有所增加，但仍不理想。需要改善高血压的编码，以支持对中风高危人群的系统识别，并可通过基于实践的软件进行辅助。
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