1 Duke Clinical Research Institute Duke University Medical Center Durham NC.
2 UCLA Division of Cardiology Los Angeles CA.
J Am Heart Assoc. 2018 Aug 21;7(16):e008764. doi: 10.1161/JAHA.118.008764.
Background Current American College of Cardiology/American Heart Association guidelines suggest that for patients with atrial fibrillation who are at low risk for stroke (CHADSVASc=1) (or women with CHADSVASc=2) a variety of treatment strategies may be considered. However, in clinical practice, patterns of treatment in these "low-risk" patients are not well described. The objective of this analysis is to define thromboembolic event rates and to describe treatment patterns in patients with low-risk CHADSVASc scores. Methods and Results We compared characteristics, treatment strategies, and outcomes among patients with a CHADSVASc=0, CHADSVASc=1, females with a CHADSVASc=2, and CHADSVASc ≥2 in ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) I & II. Compared with CHADSVASc ≥2 patients (84.2%), those with a CHADSVASc=0 (60.3%), 1 (69.9%), and females with a CHADSVASc score=2 (72.4%) were significantly less often treated with oral anticoagulation ( P<0.0001). Stroke rates were low overall and ranged from 0 per 100 patient-years in those with CHADSVASc=0, 0.8 (95% confidence interval [CI] [0.5-1.2]) in those with CHADSVASc=1, 0.8 (95% CI [0.4-1.6]) in females with a CHADSVASc score=2, and 1.7 (95% CI [1.6-1.9]) in CHADSVASc ≥2. All-cause mortality (per 100 patient-years) was highest in females with a CHADSVASc score=2 (1.4) (95% CI [0.8-2.3]), compared with patients with a CHADSVASc=0 (0.2) (95% CI [0.1-1.0]), and CHADSVASc=1 (1.0) (95% CI [0.7-1.4]), but lower than patients with a CHADSVASc ≥2 (5.7) (95% CI [5.4-6.0]). Conclusion The majority of CHADSVASc=0-1 patients are treated with oral anticoagulation. In addition, the absolute risks of death and stroke/transient ischemic attack were low among both male and females CHADSVASc=0-1 as well as among females with a CHADSVASc score=2. Clinical Trial Registration URL: http://www.clinicaltrials.gov . Unique identifier: NCT01701817.
背景 当前美国心脏病学会/美国心脏协会指南建议，对于低卒中风险（CHADSVASc=1）（或女性 CHADSVASc=2）的心房颤动患者，可以考虑多种治疗策略。然而，在临床实践中，这些“低风险”患者的治疗模式并未得到很好的描述。本分析的目的是确定血栓栓塞事件发生率，并描述低 CHADSVASc 评分患者的治疗模式。
方法和结果 我们比较了 ORBIT-AF（心房颤动更好治疗知情登记研究）I 和 II 中 CHADSVASc=0、CHADSVASc=1、女性 CHADSVASc=2 和 CHADSVASc≥2 的患者的特征、治疗策略和结局。与 CHADSVASc≥2 患者（84.2%）相比，CHADSVASc=0（60.3%）、1（69.9%）和女性 CHADSVASc 评分=2（72.4%）患者接受口服抗凝治疗的比例显著降低（P<0.0001）。总体而言，卒中发生率较低，范围从 CHADSVASc=0 患者的每 100 患者年 0 例，CHADSVASc=1 患者的 0.8（95%置信区间[CI] [0.5-1.2]），女性 CHADSVASc 评分=2 的 0.8（95%CI [0.4-1.6]），到 CHADSVASc≥2 的 1.7（95%CI [1.6-1.9]）。每 100 患者年的全因死亡率（CHADSVASc 评分=2）最高（1.4）（95%CI [0.8-2.3]），其次是 CHADSVASc=0（0.2）（95%CI [0.1-1.0]）和 CHADSVASc=1（1.0）（95%CI [0.7-1.4]），但低于 CHADSVASc≥2（5.7）（95%CI [5.4-6.0]）患者。
结论 大多数 CHADSVASc=0-1 患者接受口服抗凝治疗。此外，男性和女性 CHADSVASc=0-1 以及女性 CHADSVASc 评分=2 的患者的死亡和卒中/短暂性脑缺血发作的绝对风险均较低。
http://www.clinicaltrials.gov。
NCT01701817。
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