Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Canadian Heart Research Centre, Toronto, Ontario, Canada.
Can J Cardiol. 2019 Feb;35(2):160-168. doi: 10.1016/j.cjca.2018.11.023. Epub 2018 Dec 3.
Physicians treating nonvalvular atrial fibrillation (AF) assess stroke and bleeding risks when deciding on anticoagulation. The agreement between empirical and physician-estimated risks is unclear. Furthermore, the association between patient and physician sex and anticoagulation decision-making is uncertain.
We pooled data from 2 national primary care physician chart audit databases of patients with AF (Facilitating Review and Education to Optimize Stroke Prevention in Atrial Fibrillation and Coordinated National Network to Engage Physicians in the Care and Treatment of Patients with Atrial Fibrillation Chart Audit) with a combined 1035 physicians (133 female, 902 male) and 10,927 patients (4567 female and 6360 male).
Male physicians underestimated stroke risk in female patients and overestimated risk in male patients. Female physicians estimated stroke risk well in female patients but underestimated the risk in male patients. Risk of bleeding was underestimated in all. Despite differences in risk assessment by physician and patient sex, > 90% of patients received anticoagulation across all subgroups. There was modest agreement between physician estimated and calculated (ie, CHADS score) stroke risk: Kappa scores were 0.41 (0.35-0.47) for female physicians and 0.34 (0.32-0.36) for male physicians.
Our study is the first to examine the association between patient and physician sex influences and stroke and bleeding risk estimation in AF. Although there were differences in agreement between physician estimated stroke risk and calculated CHADS scores, these differences were small and unlikely to affect clinical practice; further, despite any perceived differences in the accuracy of risk assessment by sex, most patients received anticoagulation.
在决定是否抗凝时，治疗非瓣膜性心房颤动（AF）的医生会评估中风和出血风险。经验性风险与医生估计风险之间的一致性尚不清楚。此外，患者和医生性别与抗凝决策之间的关系也不确定。
我们汇总了来自 2 个全国初级保健医生图表审计数据库的数据，这些数据来自 AF 患者（促进房颤预防治疗审查和教育以及协调国家网络，使医生参与房颤图表审计患者的护理和治疗），共有 1035 名医生（133 名女性，902 名男性）和 10927 名患者（4567 名女性和 6360 名男性）。
男性医生低估了女性患者的中风风险，高估了男性患者的风险。女性医生在女性患者中准确估计了中风风险，但低估了男性患者的风险。所有患者的出血风险都被低估了。尽管医生和患者性别对风险评估存在差异，但在所有亚组中，超过 90%的患者接受了抗凝治疗。医生估计和计算（即 CHADS 评分）中风风险之间存在适度的一致性：女性医生的 Kappa 评分分别为 0.41（0.35-0.47）和 0.34（0.32-0.36）。
我们的研究首次检查了 AF 中患者和医生性别对中风和出血风险评估的影响。尽管医生估计的中风风险与计算的 CHADS 评分之间存在差异，但这些差异很小，不太可能影响临床实践；此外，尽管性别对风险评估的准确性存在任何差异，但大多数患者都接受了抗凝治疗。
