Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup 2900, Denmark.
Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen Ø 2100, Denmark.
Eur Heart J. 2017 Mar 21;38(12):899-906. doi: 10.1093/eurheartj/ehw658.
The aim of this study is to examine temporal trends in the use oral anticoagulants (OAC) as stroke prophylaxis in patients with atrial fibrillation (AF) and to examine factors associated with OAC initiation.
From Danish nationwide registries, we identified patients diagnosed with AF at Danish hospitals and outpatient clinics between January 2005 and June 2015. OAC initiation was assessed from prescription fills ±180 days from date of AF diagnosis. We identified a total of 108 410 patients with newly diagnosed AF. Before 2010, 40-50% initiated OAC treatment. From 2010, OAC initiation rates increased (P < 0.0001 for trend) and by June 2015, 66.5% of the incident AF patients were initiated on OAC (74.5% increase since December 2009). Increased OAC prescription was especially seen among females and 'fragile' patients (age > 75 years and high risk of stroke). The increased OAC initiation was accompanied by introduction and increased uptake of the NOACs. By the end of the study, NOACs accounted for 72.5% of all OACs prescribed in newly diagnosed AF patients. OAC initiation was associated with male gender, age 65-74 years, few comorbidities and increased risk of stroke.
Since 2010, more incident AF patients in Denmark were initiated on OAC therapy with predominant NOAC prescription. The increase was pronounced among females, among patients at high risk of stroke, and among older patients.
本研究旨在考察丹麦心房颤动（房颤）患者口服抗凝剂（OAC）预防卒中的使用随时间的变化趋势，并探讨其与 OAC 起始治疗相关的影响因素。
我们从丹麦全国性登记处中，识别出 2005 年 1 月至 2015 年 6 月在丹麦医院和门诊诊断为房颤的患者。OAC 的起始治疗通过处方填写日期±180 天来评估。共纳入了 108410 例新诊断的房颤患者。在 2010 年之前，约 40-50%的患者接受 OAC 治疗。自 2010 年起，OAC 起始治疗率逐渐增加（趋势 P<0.0001），至 2015 年 6 月，66.5%的新发房颤患者开始使用 OAC（自 2009 年 12 月以来增加了 74.5%）。OAC 处方的增加尤其见于女性和“脆弱”患者（年龄>75 岁且卒中风险较高）。OAC 起始治疗的增加伴随着新型口服抗凝剂（NOAC）的引入和使用增加。研究结束时，NOAC 占新诊断房颤患者所有 OAC 处方的 72.5%。OAC 起始治疗与男性、65-74 岁、合并症较少和卒中风险增加相关。
自 2010 年以来，丹麦更多新发房颤患者开始接受 OAC 治疗，其中主要是新型口服抗凝剂处方。这种增加在女性、卒中高危患者和老年患者中更为显著。
