Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom; IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
Int J Cardiol. 2018 Nov 15;271:68-74. doi: 10.1016/j.ijcard.2018.05.034. Epub 2018 Jul 9.
Contemporary European data regarding patients with atrial fibrillation (AF) allow us to assess the use of oral anticoagulants (OACs) and long-term outcomes.
Patients with AF presenting to cardiologists in 9 European Society of Cardiology participating countries were enrolled and followed-up for 3-years.
Among the 2119 patients (40.4% female; mean age 69 ± 11 years) the prevalent types of AF at baseline were first-detected (30.5%) and paroxysmal AF (27.0%). The composite of stroke/TIA/peripheral embolism/all-cause death at 3-years occurred in 18.2%, with first detected AF and permanent AF reporting the highest event rates (22.5% and 27.3%, respectively; p < 0.0001). Age, diabetes mellitus, heart failure, restrictive cardiomyopathy, chronic kidney disease and no physical activity were significant predictors of all-cause death. Paroxysmal and persistent AF patients were more likely to be hospitalised than other types of AF (34.1% and 37.9%, p < 0.0001). At follow-up, OAC drugs were used in 80.1% of patients, with non-vitamin K antagonists (NOACs) accounting for 24.3% of patients. OAC treatment at follow-up visits changed throughout time, with a shift from VKA to NOACs reported in 5.4% of the cases, while the reverse shift (from NOACs to VKA) occurred in 8.6%. Discontinuation of OAC was recorded in while in 9.5% of visits.
Patients outcomes at 3-years follow-up differ according to type of AF at baseline, with worse outcomes in patients presenting with first-detected or permanent AF. Changes in the type of OAC use with shifts from NOACs to VKA and vice-versa are not uncommon, as were interruptions of OAC.
当代欧洲有关心房颤动（AF）患者的数据使我们能够评估口服抗凝剂（OAC）的使用情况和长期结果。
在 9 个欧洲心脏病学会参与国家的心脏病专家处就诊的 AF 患者入选并随访 3 年。
在 2119 例患者（40.4%为女性；平均年龄 69±11 岁）中，基线时常见的 AF 类型为首次发现（30.5%）和阵发性 AF（27.0%）。3 年时，卒中/TIA/外周栓塞/全因死亡的复合终点发生率为 18.2%，其中首次发现 AF 和永久性 AF 的事件发生率最高（分别为 22.5%和 27.3%，p<0.0001）。年龄、糖尿病、心力衰竭、限制型心肌病、慢性肾脏病和无体力活动是全因死亡的显著预测因素。阵发性和持续性 AF 患者住院的可能性高于其他类型的 AF（34.1%和 37.9%，p<0.0001）。随访时，80.1%的患者使用了 OAC 药物，其中非维生素 K 拮抗剂（NOAC）占 24.3%。随着时间的推移，OAC 治疗方案在随访中发生了变化，5.4%的病例从 VKA 转为 NOAC，而 8.6%的病例则从 NOAC 转为 VKA。在 9.5%的就诊中记录了 OAC 的停药。
根据基线时 AF 的类型，患者在 3 年随访时的结局不同，首次发现或永久性 AF 的患者结局更差。NOAC 转为 VKA 和反之的 OAC 类型的改变并不少见，OAC 的中断也很常见。
