El-Hajj Maya, Ajrouche Roula, Zein Salam, Rachidi Samar, Awada Sanaa, Al-Hajje Amal
MPH, PhD. Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy. Lebanese University. Beirut (Lebanon).
PharmD. PhD. Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy. Lebanese University. Beirut (Lebanon).
Pharm Pract (Granada). 2020 Apr-Jun;18(2):1860. doi: 10.18549/PharmPract.2020.2.1860. Epub 2020 Jun 3.
Atrial fibrillation (AF) patients are at high risk of developing a stroke and anticoagulant medications are generally prescribed to prevent stroke in AF population.
This study aims to evaluate stroke risk factors among hospitalized patients with AF and to assess the level of adherence to medications in AF patients and their relation with stroke.
This is a case-control study conducted between June 1, 2018 and December 31, 2018 among AF patients admitted to seven tertiary Lebanese hospitals. Data were collected using a standardized questionnaire. Adherence to medications was assessed using the Lebanese Medication Adherence Scale-14. Odds ratios (OR) expressed the strength of association between the independent variables and the dependent variable and were estimated using unconditional logistic regression adjusted for confounding factors. P<0.05 determined statistical significance.
In total, 174 cases of AF patients were included with 87 cases and 87 controls. The risk of stroke among AF significantly increased with the presence of a history of hypertension, aOR 16.04 (95%CI, 2.27-113.37; p=0.005), history of coronary heart disease/myocardial infarction, and history of obesity. Anticoagulant medication significantly decreased the risk of stroke among AF patients, aOR 0.27 (95%CI, 0.07-0.98; P=0.047). High adherence to medications was significantly associated with a reduced risk of stroke, aOR 0.04 (95%CI, 0.01-0.23; p<0.001).
Having a history of hypertension is one of the strongest risk factors for stroke among AF patients in Lebanon. While anticoagulant medication use was associated with a reduced risk for stroke, high adherence to medications is critical for stroke prevention. Public health interventions are needed to tackle low-adherence to medication and prevent stroke among AF patients.
房颤（AF）患者发生中风的风险很高，通常会开具抗凝药物以预防房颤人群中风。
本研究旨在评估住院房颤患者的中风危险因素，并评估房颤患者的药物依从性水平及其与中风的关系。
这是一项病例对照研究，于2018年6月1日至2018年12月31日在黎巴嫩七家三级医院收治的房颤患者中进行。使用标准化问卷收集数据。使用黎巴嫩药物依从性量表-14评估药物依从性。比值比（OR）表示自变量与因变量之间的关联强度，并使用针对混杂因素进行调整的无条件逻辑回归进行估计。P<0.05为具有统计学意义。
总共纳入了174例房颤患者，其中87例为病例组，87例为对照组。房颤患者中风风险随着高血压病史、冠心病/心肌梗死病史和肥胖病史的存在而显著增加。抗凝药物显著降低了房颤患者的中风风险，调整后的比值比（aOR）为0.27（95%置信区间，0.07-0.98；P=0.047）。高药物依从性与中风风险降低显著相关，调整后的比值比（aOR）为0.04（95%置信区间，0.01-0.23；p<0.001）。
在黎巴嫩，高血压病史是房颤患者中风的最强危险因素之一。虽然使用抗凝药物与中风风险降低相关，但高药物依从性对于预防中风至关重要。需要采取公共卫生干预措施来解决药物低依从性问题，并预防房颤患者中风。
