Liard François, Le Heuzey Jean-Yves, Aliot Etienne, Mabo Philippe, Leenhardt Antoine
Médecine générale, 37800 Saint-Épain, France.
Presse Med. 2013 Jul-Aug;42(7-8):e259-70. doi: 10.1016/j.lpm.2012.11.010. Epub 2013 Mar 5.
This French study was set up to collect perceptions of general practitioners (GPs), cardiologists and patients on anticoagulation therapy with vitamin K antagonists (VKA) in the management of thromboembolic risk in atrial fibrillation (AF).
This is a prospective survey conducted in France, between July 1 and August 7 2011, on a sample defined to obtain a sufficient number of patient files of 133 physicians, divided into 65 cardiologists and 68 GPs.
Three hundred and ninety-four patients on VKA and 130 patients not receiving VKA were included in this study. For more than one in three patients, AF was diagnosed incidentally in a medical consultation for another reason. In addition, 15% and 23% of diagnoses of FA were performed after hospitalization for stroke or TIA by cardiologists and GPs, respectively. According to the patient, the doctor contacted first is a GP (52% for the GP vs. 35.5% for the cardiologist), but they state that the diagnosis was made mainly by a cardiologist (63% for the cardiologist vs. 27% for the GP). In 78% of cases, cardiologists are initial prescribers. A CHADS2 score of 0 was found in 23% of patients not receiving VKA and in 11% of patients on VKA. A CHADS2 score superior or equal to 2 is significantly more frequently found in patients with paroxysmal AF. Concerning the monitoring of the patient, GPs ensure mainly monitoring of INR. In terms of compliance, according to doctors, their patients systematically take their treatment in 91% of cases. However, by interviewing patients, 60% of non-compliant patients are considered compliant by their physician.
This study has achieved an overview of anticoagulation treatment in AF, in France. The initiation is mainly ensured by the cardiologist and the monitoring by the GP. Assessments between cardiologists and GPs are relatively similar, however, it appears that anticoagulation treatment is under-prescribed for the patients at risk.
这项法国研究旨在收集全科医生（GP）、心脏病专家和患者对维生素K拮抗剂（VKA）抗凝治疗在房颤（AF）血栓栓塞风险管理中的看法。
这是一项于2011年7月1日至8月7日在法国进行的前瞻性调查，样本选取旨在获得133名医生的足够数量患者档案，这些医生分为65名心脏病专家和68名全科医生。
本研究纳入了394名接受VKA治疗的患者和130名未接受VKA治疗的患者。超过三分之一的患者是在因其他原因进行医疗咨询时偶然被诊断出房颤。此外，心脏病专家和全科医生分别在患者因中风或短暂性脑缺血发作住院后，做出了15%和23%的房颤诊断。据患者称，首先联系的医生是全科医生（全科医生占52%，心脏病专家占35.5%），但他们表示诊断主要由心脏病专家做出（心脏病专家占63%，全科医生占27%）。在78%的病例中，心脏病专家是初始开处方者。未接受VKA治疗的患者中有23%、接受VKA治疗的患者中有11%的CHADS2评分为0。阵发性房颤患者中CHADS2评分大于或等于2的情况明显更常见。关于患者监测，全科医生主要负责监测国际标准化比值（INR）。在依从性方面，据医生称，他们的患者在91%的情况下系统地接受治疗。然而，通过对患者进行访谈发现，60%的不依从患者被其医生认为是依从的。
本研究对法国房颤抗凝治疗进行了概述。起始治疗主要由心脏病专家负责，监测由全科医生负责。心脏病专家和全科医生之间的评估相对相似，然而，对于有风险的患者，抗凝治疗似乎处方不足。
