Department of Cardiology, Odense University Hospital, Odense, Denmark.
Clin Cardiol. 2013 Jul;36(7):427-32. doi: 10.1002/clc.22133. Epub 2013 May 13.
The aim of this prospective survey was to describe the demographics, stroke risk profile, and the guideline adherence of antithrombotic treatment in a Danish primary care population of patients with nonvalvular atrial fibrillation (AF).
We hypothesized that a significant proportion of patients with nonvalvular AF do not receive guideline-adherent antithrombotic treatment in primary care.
We performed a cross-sectional survey of antithrombotic treatment using data of AF patients from general practices.
Sixty-four general practitioners enrolled 1743 patients with a mean age of 74.8 ± 11.2 years. The mean CHADS2 and CHA2 DS2 -VASc scores were 1.9 ± 1.3 and 3.5 ± 1.8, respectively. Of the patients, 12.4% and 4.04%, respectively, were at truly low risk, with a CHADS2 and CHA2 DS2 -VASc score 0 (P < 0.001). A score of 1 was seen in 28.0% vs 9.0% (P < 0.001) of the patients. Of all patients, 66.3% were treated with oral anticoagulants, 18.7% with antiplatelet drugs only, and 15% received no antithrombotic therapy. Based on the CHADS2 score, 75.7% of the patients were treated in adherence with the guidelines, 16% were undertreated, and 8.4% overtreated. The corresponding numbers for the CHA2 DS2 -VASc score were 75.4%, 22.7%, and 1.8%, respectively. The differences in guideline adherence applying the 2 scores were significant (P < 0.001). Of patients receiving no antithrombotic therapy, 64.1% were treated in adherence to the guidelines according to the CHADS2 score. Applying the CHA2 DS2 -VASc score, this proportion was only 53.4%. Antiplatelet drug treatment was in adherence to the guidelines (CHADS2 and CHA2 DS2 -VASc score of 1) in only 31% and 12% of the patients, respectively.
Antithrombotic treatment of AF patients is in general well performed in primary care in Denmark. Further improvements may be achieved by thorough stroke risk stratification on the basis of current evidence-based guidelines.
本前瞻性研究旨在描述丹麦初级保健人群中非瓣膜性心房颤动（AF）患者的人口统计学、卒中风险特征以及抗栓治疗的指南依从性。
我们假设相当一部分非瓣膜性 AF 患者在初级保健中未接受指南推荐的抗栓治疗。
我们使用一般实践中 AF 患者的数据进行了抗栓治疗的横断面调查。
64 名全科医生纳入了 1743 名平均年龄为 74.8±11.2 岁的患者。平均 CHADS2 和 CHA2 DS2 -VASc 评分分别为 1.9±1.3 和 3.5±1.8。分别有 12.4%和 4.04%的患者真正低危，CHADS2 和 CHA2 DS2 -VASc 评分为 0（P<0.001）。28.0%的患者评分 1 分，9.0%（P<0.001）。所有患者中，66.3%接受口服抗凝剂治疗，18.7%接受抗血小板药物治疗，15%未接受抗栓治疗。根据 CHADS2 评分，75.7%的患者接受了符合指南的治疗，16%的患者治疗不足，8.4%的患者治疗过度。对于 CHA2 DS2 -VASc 评分，相应的数字分别为 75.4%、22.7%和 1.8%。应用两种评分的指南依从性差异具有统计学意义（P<0.001）。未接受抗栓治疗的患者中，根据 CHADS2 评分，64.1%的患者治疗符合指南。根据 CHA2 DS2 -VASc 评分，这一比例仅为 53.4%。抗血小板药物治疗符合指南（CHADS2 和 CHA2 DS2 -VASc 评分为 1）的患者分别仅为 31%和 12%。
丹麦初级保健中非瓣膜性心房颤动患者的抗栓治疗总体上执行良好。进一步的改进可以通过基于当前循证指南的彻底卒中风险分层来实现。
