Cloutier Justin M, Khoo Clarence, Hiebert Brett, Wassef Anthony, Seifer Colette M
Section of Cardiology, University of Manitoba, Winnipeg, MB, Canada Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, MB, Canada.
Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, MB, Canada.
Ther Adv Cardiovasc Dis. 2018 Apr;12(4):113-122. doi: 10.1177/1753944717749739.
The objectives of this study were to evaluate the effectiveness of a physician notification system for atrial fibrillation (AF) detected on cardiac devices, and to assess predictors of anticoagulation in patients with device-detected AF.
In 2013, a physician notification system for AF detected on a patient's CIED [including pacemakers, implantable cardioverter defibrillators (ICD) or cardiac resynchronization therapy (CRT) devices] was implemented, with a recommendation to consider oral anticoagulation in high-risk patients. We prospectively investigated the effectiveness of this system, and evaluated both patient and physician predictors of anticoagulation, as well as factors influencing physician decision making in prescribing anticoagulation. Both uni- and multivariable analysis as well as descriptive statistics were used in the analysis.
We identified 177 patients with device-detected AF, 126 with a CHADS ⩾2. Only 41% were prescribed anticoagulation at any point within 12 months. On multivariable analysis, stroke risk as predicted by CHADS was not a predictor of anticoagulation. ASA use predicted a lower rate of anticoagulation (OR 0.39, 95% CI 0.16-0.97, p = 0.04); physicians in practice for <20 years were more likely to prescribe anticoagulation (OR 3.39, 95% CI 1.28-8.93, p = 0.01); and physicians who believed both cardiologist and family doctor should be involved in managing anticoagulation were more likely to prescribe anticoagulation (OR 3.28, 95% CI 1.02-10.5, p = 0.05).
Patients on aspirin were less likely to be anticoagulated. Physicians in practice for <20 years and who believed that both the general practitioner and cardiologist should be involved in managing anticoagulants were more likely to prescribe anticoagulation.
本研究的目的是评估心脏设备检测到心房颤动（AF）时医生通知系统的有效性，并评估设备检测到AF患者抗凝治疗的预测因素。
2013年，实施了针对患者心脏植入电子设备（CIED）[包括起搏器、植入式心脏复律除颤器（ICD）或心脏再同步治疗（CRT）设备]检测到AF的医生通知系统，并建议对高危患者考虑口服抗凝治疗。我们前瞻性地研究了该系统的有效性，并评估了患者和医生抗凝治疗的预测因素，以及影响医生开具抗凝治疗决策的因素。分析中使用了单变量和多变量分析以及描述性统计。
我们确定了177例设备检测到AF的患者，其中126例CHADS≥2。在12个月内的任何时间，只有41%的患者接受了抗凝治疗。多变量分析显示，CHADS预测的中风风险不是抗凝治疗的预测因素。使用阿司匹林预测抗凝治疗率较低（OR 0.39，95%CI 0.16 - 0.97，p = 0.04）；执业<20年的医生更有可能开具抗凝治疗（OR 3.39，95%CI 1.28 - 8.93，p = 0.01）；认为心脏病专家和家庭医生都应参与抗凝管理的医生更有可能开具抗凝治疗（OR 3.28，95%CI 1.02 - 10.5，p = 0.05）。
服用阿司匹林的患者接受抗凝治疗的可能性较小。执业<20年且认为全科医生和心脏病专家都应参与抗凝管理的医生更有可能开具抗凝治疗。
