Internal Medicine Service of the Hospital Universitari de Bellvitge, IDIDELL, L'Hospitalet de Llobregat, Barcelona, Spain.
Cañaveral Health Center, Cáceres, Spain.
Semergen. 2020 Sep;46(6):392-399. doi: 10.1016/j.semerg.2020.02.001. Epub 2020 Mar 28.
In non-valvular atrial fibrillation (NVAF) patients at risk of stroke, anticoagulant drugs are less likely to be received by older patients than younger patients. In this study, an attempt is made to discover whether the reasons reported by physicians for denying anticoagulant drugs prescription differ between older and younger atrial fibrillation patients.
A retrospective, cross-sectional, multicentre study was conducted from October 2014 to July 2015. The study comprised patients aged ≥18 years diagnosed with NVAF, with a moderate to high stroke risk (CHADS2 score ≥2). Patients were stratified according to age (<80 and ≥80 years).
A total of 1309 NVAF patients were evaluated, of whom 40.1% were ≥80 years old. Older patients were predominantly women with higher mean time since diagnosis of AF, with a higher rate of permanent NVAF, and with higher thromboembolic risk. In patients for whom physicians decided not to prescribe any anticoagulant agents, the following reasons were significantly more frequent in patients aged ≥80 years compared to younger patients: cognitive impairment, perceived high bleeding risk, falls, difficult access to monitoring, non-neoplastic terminal illness, and perceived low thromboembolic risk. Uncontrolled hypertension was a significantly more frequent reason for non-prescription of anticoagulant agents in patients aged <80 year.
Octogenarian patients with NVAF and a moderate to high risk of stroke had a different as regards reasons for not being prescribed anticoagulant agents, which should be taken into account in order to improve.
在有卒中风险的非瓣膜性心房颤动（NVAF）患者中，年龄较大的患者接受抗凝药物治疗的可能性低于年龄较小的患者。本研究试图发现，医师拒绝为老年和年轻心房颤动患者开具抗凝药物处方的原因是否存在差异。
一项回顾性、横断面、多中心研究于 2014 年 10 月至 2015 年 7 月进行。该研究纳入了年龄≥18 岁、诊断为 NVAF、具有中高度卒中风险（CHADS2 评分≥2）的患者。根据年龄（<80 岁和≥80 岁）对患者进行分层。
共评估了 1309 例 NVAF 患者，其中 40.1%年龄≥80 岁。老年患者主要为女性，AF 诊断后的平均时间更长，永久性 NVAF 发生率更高，血栓栓塞风险更高。对于那些医师决定不开具任何抗凝药物的患者，与年轻患者相比，年龄≥80 岁的患者有以下几个显著更常见的原因：认知障碍、认为出血风险高、跌倒、难以监测、非肿瘤终末期疾病和认为血栓栓塞风险低。未控制的高血压是年龄<80 岁的患者未开具抗凝药物的一个显著更常见的原因。
患有 NVAF 且具有中高度卒中风险的 80 岁以上患者，不给予抗凝药物治疗的原因存在差异，为改善这种情况，应充分考虑这些原因。
