Ashburner Jeffrey M, Singer Daniel E, Lubitz Steven A, Borowsky Leila H, Atlas Steven J
Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts.
Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts.
Am J Cardiol. 2017 Sep 1;120(5):786-791. doi: 10.1016/j.amjcard.2017.05.055. Epub 2017 Jun 15.
Atrial fibrillation (AF) and the decision to anticoagulate is a common problem faced by primary care physicians. Oral anticoagulation (OAC) is underused, despite its clear benefits with regard to stroke prevention. We examined OAC usage between 2010 and 2015, following the introduction of direct oral anticoagulants (DOACs) and specifically assessed whether more patients were anticoagulated over time. The study cohort included adult patients aged 18 and older with AF cared for in an 18-practice primary care network between 2010 and 2015. AF status was assigned each calendar year using a validated electronic health record algorithm. We examined OAC usage over time in all patients with AF, and in patients at high risk of stroke (CHADS-VASc ≥ 2). The proportion of the population with AF increased over time (2010: 4,920 patients [3.5%], 2015: 6,452 patients [4.0%]). There was no increase in the proportion of patients prescribed any OAC treatment from 2010 (57.0%) to 2015 (57.4%) (p = 0.41). Similarly, in patients at high risk of stroke, the proportion anticoagulated did not increase over time (2010: 61.1%, 2015: 61.7%, p = 0.51). Over the study period, DOAC usage increased from 0.31% of all patients with AF in 2010 to 18.3% in 2015 (p < 0.001). Patients prescribed DOACs were younger, with lower risk of stroke. In conclusion, this study showed an increasing proportion of patients with AF over time in a primary care network. The use of DOACs increased over time; however, the proportion of patients treated with OAC did not increase over time.
心房颤动（AF）以及抗凝治疗的决策是初级保健医生面临的常见问题。尽管口服抗凝药（OAC）在预防中风方面有明显益处，但目前其使用不足。我们研究了2010年至2015年期间直接口服抗凝剂（DOACs）引入后OAC的使用情况，并特别评估了随着时间推移是否有更多患者接受抗凝治疗。研究队列包括2010年至2015年期间在一个拥有18家诊所的初级保健网络中接受治疗的18岁及以上的成年AF患者。每年使用经过验证的电子健康记录算法确定AF状态。我们研究了所有AF患者以及中风高危患者（CHADS-VASc≥2）随时间推移的OAC使用情况。AF患者的比例随时间增加（2010年：4920例患者[3.5%]，2015年：6452例患者[4.0%]）。从2010年（57.0%）到2015年（57.4%），接受任何OAC治疗的患者比例没有增加（p = 0.41）。同样，在中风高危患者中，接受抗凝治疗的比例也没有随时间增加（2010年：61.1%，2015年：61.7%，p = 0.51）。在研究期间，DOAC的使用从2010年所有AF患者的0.31%增加到2015年的18.3%（p < 0.001）。接受DOAC治疗的患者更年轻，中风风险更低。总之，本研究表明，在初级保健网络中，AF患者的比例随时间增加。DOAC的使用随时间增加；然而，接受OAC治疗的患者比例并未随时间增加。
