老年非瓣膜性心房颤动患者抗凝治疗中节律控制与心率控制策略比较：ANA-FIE（日本老年人心房颤动研究）注册研究的亚组分析。
Rhythm versus rate control strategies regarding anticoagulant use in elderly non-valvular atrial fibrillation patients: Subanalysis of the ANAFIE (All Nippon AF In the Elderly) Registry.
机构信息
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Saiseikai Toyama Hospital, Toyama, Japan.
出版信息
J Cardiol. 2020 Jul;76(1):87-93. doi: 10.1016/j.jjcc.2020.01.010. Epub 2020 Feb 18.
BACKGROUND
Data on real-world antiarrhythmic and anticoagulant therapy use in elderly atrial fibrillation (AF) patients are lacking; thus, we performed a subanalysis of data from the ANAFIE registry to clarify the current management of Japanese patients aged ≥75 years with non-valvular AF.
METHODS
The ANAFIE registry was a multicenter, prospective, observational study. Patients were stratified into three groups: rhythm control group, rate control group, and no antiarrhythmic group. The CHADS, CHADS-VASc, and HAS-BLED scores were used to estimate embolic and bleeding risk.
RESULTS
Among 32,490 patients, the overall frequencies of AF by type were 42.0 % (paroxysmal), 30.1 % (persistent and long-standing persistent), and 27.9 % (permanent). Significant differences (p < 0.0001, each) in age were observed among the three groups; more patients aged 75-79 years received rhythm control (44.2 %) vs rate control (38.8 %). Patients aged ≥85 years received either rate control therapy or no antiarrhythmic agent (∼20 %, each). In the overall population, 36.9 % and 19.6 % of patients were receiving rate and rhythm control therapy, respectively; 43.4 % were not receiving antiarrhythmic therapy. The rate control group consisted mainly of patients with persistent (16.3 %) and permanent AF (38.6 %), and the rhythm control group, of patients with paroxysmal AF (79.0 %). Significantly lower embolic and bleeding risk scores and significantly higher embolic risk scores were observed in patients in the rhythm and rate control groups, respectively. In total, 92.1 % of elderly Japanese patients with AF were receiving anticoagulant therapy. The frequency of direct-acting oral anticoagulant (DOAC) use was similar (∼66 %) among the three groups. Significantly more patients in the rate control group (28.6 %) were being treated with warfarin than in the rhythm control group (21.6 %) (p < 0.0001).
CONCLUSIONS
Use versus non-use and antiarrhythmic therapy varied significantly by age, stroke risk scores, type of AF, and DOAC use between subgroups.
背景
缺乏关于老年人房颤（AF）患者真实世界抗心律失常和抗凝治疗的数据；因此，我们对 ANAFIE 登记处的数据进行了亚组分析，以阐明日本非瓣膜性房颤且年龄≥75 岁患者的当前治疗情况。
方法
ANAFIE 登记处是一项多中心、前瞻性、观察性研究。患者分为三组：节律控制组、心率控制组和无抗心律失常组。使用 CHADS、CHADS-VASc 和 HAS-BLED 评分来估计栓塞和出血风险。
结果
在 32490 名患者中，AF 类型的总体频率为 42.0%（阵发性）、30.1%（持续性和持久性）和 27.9%（永久性）。三组之间年龄存在显著差异（p<0.0001，均有）；更多年龄在 75-79 岁的患者接受节律控制（44.2%）而非心率控制（38.8%）。年龄≥85 岁的患者接受的是心率控制治疗或无抗心律失常药物（各约 20%）。在总体人群中，分别有 36.9%和 19.6%的患者接受了心率和节律控制治疗；43.4%的患者未接受抗心律失常治疗。心率控制组主要由持续性（16.3%）和永久性 AF（38.6%）患者组成，而节律控制组主要由阵发性 AF（79.0%）患者组成。节律和心率控制组患者的栓塞和出血风险评分显著较低，栓塞风险评分显著较高。总的来说，92.1%的老年日本 AF 患者正在接受抗凝治疗。三组之间直接口服抗凝剂（DOAC）的使用频率相似（各约 66%）。心率控制组（28.6%）接受华法林治疗的患者明显多于节律控制组（21.6%）（p<0.0001）。
结论
在亚组中，根据年龄、卒中风险评分、AF 类型和 DOAC 使用情况，使用与不使用抗心律失常治疗以及抗心律失常治疗的使用情况存在显著差异。
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