Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, 67 Thomas St, Broadway, Ultimo, 2007, NSW, Australia.
Western Sydney Nursing and Midwifery Research Centre, Western Sydney Local Health District and Western Sydney University, Blacktown Clinical and Research School, Blacktown Hospital, Marcel Crescent, Blacktown, NSW, 2148, Australia.
Curr Cardiol Rep. 2018 Mar 24;20(5):32. doi: 10.1007/s11886-018-0975-x.
The objectives of this review were to (1) discuss how multimorbidity and polypharmacy contributes to the complexity of management among individuals with AF and (2) identify any interventions to manage polypharmacy in relation to AF.
Based on the four landmark clinical trials of novel anticoagulants, the most common comorbidities with AF are hypertension, heart failure, diabetes, stroke and myocardial infarction. Polypharmacy was also found prevalent in 76.5% of patients with AF, with a median of six drugs per patient. Despite the consequences of polypharmacy in AF, there is very little evidence-based intervention designed to manage it. Hence, there is a need for further research to examine interventions to manage polypharmacy in relation to AF. Atrial fibrillation (AF) is the most common type of cardiac arrhythmia requiring treatment in adults. Due to the structural and/or electrophysiological abnormalities that occur in AF, patients are managed through the use of prophylactic anticoagulant and rate and/or rhythm control medications. However, these medications are considered high risk and can increase the chances of medication misadventure. Additionally, AF rarely occurs in isolation and is known to coexist with multiple other medical comorbidities, i.e. multimorbidity. This also increases the number of medications, i.e. polypharmacy and pill burden which results in treatment non-compliance to prescribed therapy.
本次综述的目的在于：(1) 讨论共病和多种药物治疗如何增加房颤患者管理的复杂性；(2) 确定与房颤相关的任何药物管理干预措施。
基于四项新型抗凝剂的标志性临床试验，房颤最常见的共病是高血压、心力衰竭、糖尿病、中风和心肌梗死。还发现，76.5%的房颤患者存在多种药物治疗，中位数为每位患者 6 种药物。尽管房颤患者的多种药物治疗存在后果，但几乎没有针对其进行管理的循证干预措施。因此，需要进一步研究，以检查与房颤相关的药物管理干预措施。房颤是成年人需要治疗的最常见类型的心律失常。由于在房颤中发生的结构和/或电生理异常，患者通过使用预防性抗凝和控制心率和/或节律的药物进行管理。然而，这些药物被认为风险较高，并且可能增加药物误用的几率。此外，房颤很少单独发生，已知与多种其他合并症共存，即共病。这也增加了药物的数量，即多种药物治疗和药物负担，导致治疗不遵守规定的治疗方案。
