Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Diego.
Division of Cardiology, Department of Medicine, Veterans Affairs Eastern Colorado Health Care System, Denver3Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Denver4Division of Cardiology, Department of Medicine.
JAMA Cardiol. 2016 Apr 1;1(1):55-62. doi: 10.1001/jamacardio.2015.0374.
Patients with atrial fibrillation (AF) are at a proportionally higher risk of stroke based on accumulation of well-defined risk factors.
To examine the extent to which prescription of an oral anticoagulant (OAC) in US cardiology practices increases as the number of stroke risk factors increases.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional registry study of outpatients with AF enrolled in the American College of Cardiology National Cardiovascular Data Registry's PINNACLE (Practice Innovation and Clinical Excellence) Registry between January 1, 2008, and December 30, 2012. As a measure of stroke risk, we calculated the CHADS2 score and the CHA2DS2-VASc score for all patients. Using multinomial logistic regression models adjusted for patient, physician, and practice characteristics, we examined the association between increased stroke risk score and prescription of an OAC.
The primary outcome was prescription of an OAC with warfarin sodium or a non-vitamin K antagonist OAC.
The study cohort comprised 429 417 outpatients with AF. Their mean (SD) age was 71.3 (12.9) years, and 55.8% were male. Prescribed treatment consisted of an OAC (192 600 [44.9%]), aspirin only (111 134 [25.9%]), aspirin plus a thienopyridine (23 454 [5.5%]), or no antithrombotic therapy (102 229 [23.8%]). Each 1-point increase in risk score was associated with increased odds of OAC prescription compared with aspirin-only prescription using the CHADS2 score (adjusted odds ratio, 1.158; 95% CI, 1.144-1.172; P < .001) and the CHA2DS2-VASc score (adjusted odds ratio, 1.163; 95% CI, 1.157-1.169; P < .001). Overall, OAC prescription prevalence did not exceed 50% even in higher-risk patients with a CHADS2 score exceeding 3 or a CHA2DS2-VASc score exceeding 4.
In a large quality improvement registry of outpatients with AF, prescription of OAC therapy increased with a higher CHADS2 score and CHA2DS2-VASc score. However, a plateau of OAC prescription was observed, with less than half of high-risk patients receiving an OAC prescription.
基于明确的风险因素积累，患有心房颤动 (AF) 的患者中风的风险比例更高。
研究美国心脏病学会实践创新和临床卓越 (PINNACLE) 注册中心的美国心血管数据登记处 (American College of Cardiology National Cardiovascular Data Registry) 中 2008 年 1 月 1 日至 2012 年 12 月 30 日登记的 AF 门诊患者中，随着中风危险因素数量的增加，口服抗凝剂 (OAC) 的处方数量增加的程度。
设计、设置和参与者：这是一项横断面注册研究，纳入了美国心脏病学会实践创新和临床卓越 (PINNACLE) 注册中心的门诊心房颤动 (AF) 患者。作为中风风险的衡量标准，我们为所有患者计算了 CHADS2 评分和 CHA2DS2-VASc 评分。使用调整了患者、医生和实践特征的多项逻辑回归模型，我们研究了中风风险评分增加与 OAC 处方之间的关联。
主要结局是华法林钠或非维生素 K 拮抗剂 OAC 的 OAC 处方。
研究队列包括 429417 名 AF 门诊患者。他们的平均（SD）年龄为 71.3（12.9）岁，55.8%为男性。处方治疗包括 OAC（192600[44.9%]）、阿司匹林（111134[25.9%]）、阿司匹林加噻吩吡啶（23454[5.5%]）或无抗血栓治疗（102229[23.8%]）。与阿司匹林单药治疗相比，CHADS2 评分（调整后的优势比，1.158；95%置信区间，1.144-1.172；P < .001）和 CHA2DS2-VASc 评分（调整后的优势比，1.163；95%置信区间，1.157-1.169；P < .001）每增加 1 分，OAC 处方的可能性就会增加。然而，观察到 OAC 处方的比例出现了平台期，即使在 CHADS2 评分超过 3 或 CHA2DS2-VASc 评分超过 4 的高危患者中，OAC 处方的比例也未超过 50%。
在 AF 门诊患者的大型质量改进登记处中，随着 CHADS2 评分和 CHA2DS2-VASc 评分的升高，OAC 治疗的处方量有所增加。
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