Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Cardiology, Chinese PLA Medical School, Beijing, China.
Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.
Int J Cardiol. 2019 Jan 1;274:158-162. doi: 10.1016/j.ijcard.2018.08.091. Epub 2018 Sep 1.
Differences exist in oral anticoagulation (OAC) use between different populations with atrial fibrillation (AF), which may be associated with varying outcomes.
We aimed to provide patient level comparisons of two cohorts of patients with AF, from the United Kingdom (UK) and Middle East (ME).
The clinical characteristics, prescription of OAC, one-year risk of stroke and mortality were compared between individual patients with AF included into the Darlington AF registry (UK, n = 2258) and the Gulf SAFE (Survey of atrial fibrillation events) registry (ME, n = 1740).
A high percentage of patients from the Darlington registry were candidates for OAC (i.e., CHADS-VASc score ≥2 in males or ≥3 in females; 82.0% in Darlington and 57.1% in Gulf SAFE). OAC use was suboptimal (52.0% in Darlington vs 58.4% in Gulf SAFE). One-year rates of stroke and mortality were high in both populations, especially in those with CHADS-VASc score ≥2 in males and ≥3 in females (Darlington vs. Gulf SAFE: 3.51% vs. 5.63 for stroke; 11.4% vs. 16.8% for mortality). On multivariate analyses, female sex and previous stroke were independently associated with stroke events; while elderly age, female sex, vascular disease and heart failure were independent risk factors for mortality (all p < 0.05). Patients from Gulf SAFE registry had higher risk of stroke (odds ratio, 2.18 [1.47-3.23]) and mortality (odds ratio, 1.67 [1.31-2.14]) compared with those from Darlington registry. The CHADS-VASc score showed good discrimination in predicting one-year risk of stroke (area under curve, 0.71 [0.65-0.76] in non-anticoagulated patients) and mortality (area under curve, 0.70 [0.68-0.72]) in the whole study population, as well as in Darlington or Gulf SAFE registry separately.
Stroke prevention was generally suboptimal in patient cohorts from the two registries, which was associated with high one-year risks of stroke and mortality, particularly so among patients from the Gulf SAFE registry. The higher risks for stroke and mortality in AF patients from the Gulf SAFE registry (compared to a UK cohort) merit further implementation of cardiovascular prevention strategies.
不同人群的心房颤动（AF）患者在口服抗凝治疗（OAC）的使用方面存在差异，这可能与不同的结果有关。
我们旨在对来自英国（UK）和中东（ME）的两个 AF 患者队列进行患者水平的比较。
对纳入达灵顿 AF 注册中心（英国，n=2258）和海湾 SAFE（房颤事件调查）注册中心（ME，n=1740）的 AF 患者的临床特征、OAC 处方、一年内卒中风险和死亡率进行比较。
达林顿登记册中的患者有很大一部分是 OAC 的候选者（即男性 CHADS-VASc 评分≥2 或女性 CHADS-VASc 评分≥3；达林顿为 82.0%，海湾 SAFE 为 57.1%）。OAC 的使用并不理想（达林顿为 52.0%，海湾 SAFE 为 58.4%）。两个地区的卒中发生率和死亡率都很高，尤其是男性 CHADS-VASc 评分≥2 和女性 CHADS-VASc 评分≥3 的患者（达林顿与海湾 SAFE：卒中发生率分别为 3.51%和 5.63%；死亡率分别为 11.4%和 16.8%）。多变量分析显示，女性和既往卒中与卒中事件独立相关；而年龄较大、女性、血管疾病和心力衰竭是死亡的独立危险因素（均 P<0.05）。与达林顿登记册的患者相比，海湾 SAFE 登记册的患者发生卒中（比值比，2.18 [1.47-3.23]）和死亡（比值比，1.67 [1.31-2.14]）的风险更高。CHADS-VASc 评分在预测整个研究人群（非抗凝患者的曲线下面积为 0.71 [0.65-0.76]）和卒中（曲线下面积为 0.70 [0.68-0.72]）和死亡率方面具有良好的区分度，以及达林顿或海湾 SAFE 登记册分别。
来自两个登记处的患者队列中，卒中预防总体上并不理想，这与较高的卒中风险和死亡率相关，特别是来自海湾 SAFE 登记处的患者。与英国队列相比，来自海湾 SAFE 登记处的 AF 患者发生卒中（与死亡率）的风险更高，需要进一步实施心血管预防策略。
