Naccarelli Gerald V, Ruzieh Mohammed, Wolbrette Deborah L, Sendra-Ferrer Mauricio, van Harskamp John, Bentz Barbara, Caputo Gregory, McConkey Nathan, Mills Kevin, Wasemiller Stephen, Plamenac Jovan, Leslie Douglas, Glasser Frendy D, Abendroth Thomas W
Penn State University Heart and Vascular Institute, Penn State University College of Medicine, Hershey, Pa.
Division of Cardiology, University of Florida, Gainesville.
Am J Med. 2021 Jun;134(6):e366-e373. doi: 10.1016/j.amjmed.2020.11.024. Epub 2020 Dec 24.
Multiple registries have reported that >40% of high-risk atrial fibrillation patients are not taking oral anticoagulants. The purpose of our study was to determine the presence or absence of active atrial fibrillation and CHADS-VASc (Congestive heart failure, Hypertension, Age ≥75 y, Diabetes mellitus, prior Stroke [or transient ischemic attack or thromboembolism], Vascular disease, Age 65-74 y, Sex category) risk factors to accurately identify high-risk atrial fibrillation (CHADS-VASc ≥2) patients requiring oral anticoagulants and the magnitude of the anticoagulant treatment gap.
We retrospectively adjudicated 6514 patients with atrial fibrillation documented by at least one of: billing diagnosis, electronic medical record encounter diagnosis, electronic medical record problem list, or electrocardiogram interpretation.
After review, 4555/6514 (69.9%) had active atrial fibrillation, while 1201 had no documented history of atrial fibrillation and 758 had a history of atrial fibrillation that was no longer active. After removing the 1201 patients without a confirmed atrial fibrillation diagnosis, oral anticoagulant use in high-risk patients increased to 71.1% (P < .0001 compared with 62.9% at baseline). Oral anticoagulant use increased to 79.7% when the 758 inactive atrial fibrillation patients were also eliminated from the analysis (P < .0001 compared with baseline). In the active high-risk atrial fibrillation group, there was no significant difference in the use of oral anticoagulants between men (80.7%) and women (78.8%) with a CHADS-VASc ≥2, or in women with a CHADS-VASc ≥3 (79.9%).
Current registries and health system health records with unadjudicated diagnoses over-report the number of high-risk atrial fibrillation patients not taking oral anticoagulants. Expert adjudication identifies a smaller treatment gap than previously described.
多个登记处报告称，超过40%的高危心房颤动患者未服用口服抗凝剂。我们研究的目的是确定是否存在活动性心房颤动以及CHADS-VASc（充血性心力衰竭、高血压、年龄≥75岁、糖尿病、既往中风[或短暂性脑缺血发作或血栓栓塞]、血管疾病、年龄65 - 74岁、性别类别）风险因素，以准确识别需要口服抗凝剂的高危心房颤动（CHADS-VASc≥2）患者以及抗凝治疗差距的大小。
我们回顾性判定了6514例心房颤动患者，这些患者通过以下至少一项记录：计费诊断、电子病历会诊诊断、电子病历问题列表或心电图解读。
经审查，4555/6514（69.9%）有活动性心房颤动，而1201例无心房颤动记录史，758例有既往心房颤动史但目前已无活动性。在排除1201例未确诊心房颤动的患者后，高危患者口服抗凝剂的使用率增至71.1%（与基线时的62.9%相比，P <.0001）。当分析中也排除758例非活动性心房颤动患者时，口服抗凝剂使用率增至79.7%（与基线相比，P <.0001）。在活动性高危心房颤动组中，CHADS-VASc≥2的男性（80.7%）和女性（78.8%）之间，以及CHADS-VASc≥3的女性（79.9%）中，口服抗凝剂的使用无显著差异。
当前登记处和健康系统中未经判定诊断的健康记录高估了未服用口服抗凝剂的高危心房颤动患者数量。专家判定发现的治疗差距比之前描述的要小。
