Wiemer Marcus, Kottmann T, Starrach M, Horstkotte D, Nölker G
Kardiologische Klinik, Herz- und Diabeteszentrum Nordrhein Westfalen, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Deutschland,
Herzschrittmacherther Elektrophysiol. 2015 Jun;26(2):141-7. doi: 10.1007/s00399-015-0363-9. Epub 2015 Mar 26.
In Germany, about 1 million people are affected by atrial fibrillation (AF). Morbidity and mortality are high especially due to the risk of thromboembolic events. A valid risk stratification by the CHADS2 criteria is critical regarding the indication for anticoagulation and thus to improve prognosis. To what extent these criteria and guidelines are known and have been implemented among cardiologists and general practitioners in Germany has not been evaluated so far.
A total of 558 cardiologists (46.8 %) and general practitioners (52.5 %) were surveyed during the annual meeting of the German Society of Cardiology or in writing in a representative sample of German general practitioners.
Compared to 51.8 % of general practitioners, 87.6 % of cardiologists (p < 0.001) claimed to know the CHADS2 criteria. In the total cohort, CHADS2 criteria were correctly identified as risk factors by 55.6-86.9 %. Cardiologists had significantly better knowledge of these criteria (63.6-91.2 % vs. 55.6-86.9 %, p < 0.001). A previous history of cerebral stroke was known to be a risk factor in almost all physicians in contrast to heart failure (47.3 % of cardiologists vs. 36.0 % of general practitioners, p < 0.001). Physicians who had attended a training course on anticoagulation and atrial fibrillation (n = 380) in the 2 years prior to the survey performed significantly better (p = 0.007) than those without training (n = 173).
While the majority of cardiologists knew the CHADS2 criteria and the related guidelines, these criteria were less known in the primary care sector. Nevertheless, even cardiologists do not always apply the guidelines for anticoagulation in AF correctly. Participants of training courses had a significantly better knowledge of these guidelines.
在德国，约有100万人受心房颤动（AF）影响。发病率和死亡率很高，尤其是由于存在血栓栓塞事件的风险。通过CHADS2标准进行有效的风险分层对于抗凝治疗的指征至关重要，从而改善预后。到目前为止，尚未评估这些标准和指南在德国心脏病专家和全科医生中的知晓程度以及实施情况。
在德国心脏病学会年会上或通过对德国全科医生的代表性样本进行书面调查，共调查了558名心脏病专家（46.8%）和全科医生（52.5%）。
与51.8%的全科医生相比，87.6%的心脏病专家（p<0.001）声称知晓CHADS2标准。在整个队列中，55.6%-86.9%的人正确地将CHADS2标准识别为风险因素。心脏病专家对这些标准的了解明显更好（63.6%-91.2%对55.6%-86.9%，p<0.001）。与心力衰竭相比，几乎所有医生都知道既往有脑卒中病史是一个风险因素（47.3%的心脏病专家对36.0%的全科医生，p<0.001）。在调查前2年内参加过抗凝和心房颤动培训课程的医生（n=380）的表现明显优于未参加培训的医生（n=173）（p=0.007）。
虽然大多数心脏病专家知晓CHADS2标准及相关指南，但这些标准在基层医疗领域的知晓度较低。然而，即使是心脏病专家也并非总是正确应用心房颤动的抗凝指南。参加培训课程的人员对这些指南的了解明显更好。
