遵循2019年美国心脏协会/美国心脏病学会/美国心律学会对2014年美国心脏协会/美国心脏病学会/美国心律学会关于中东地区房颤患者口服抗凝剂使用指南的重点更新：约旦房颤（JoFib）研究。
Adherence to the 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline on the Use of Oral Anticoagulant Agents in Middle Eastern Patients with Atrial Fibrillation: The Jordan Atrial Fibrillation (JoFib) Study.
作者信息
Hammoudeh Ayman J, Khader Yousef, Kadri Nazih, Al-Mousa Eyas, Badaineh Yahya, Habahbeh Laith, Tabbalat Ramzi, Janabi Hesham, Alhaddad Imad A
机构信息
Cardiology Department, Istishari Hospital, 44 Kindi Street Amman 11184, Jordan.
Department of Public Health, Jordan University of Science and Technology School of Medicine, 3030 Ramtha Street, P.O. Box 3030, Irbid 22110, Jordan.
出版信息
Int J Vasc Med. 2021 Apr 8;2021:5515089. doi: 10.1155/2021/5515089. eCollection 2021.
BACKGROUND
There is a scarcity of studies that evaluate adherence to the utilization of guideline-recommended oral anticoagulant agents (OACs) in patients with atrial fibrillation (AF) in the Middle East. The Jordan Atrial Fibrillation (JoFib) Study evaluated baseline clinical profiles and the utilization of OACs, including vitamin K antagonists (VKAs) and direct OACs (DOACs), in patients with valvular AF (VAF) and nonvalvular AF (NVAF) according to the 2019 focused update of the 2014 AHA/ACC/HRS guidelines.
METHODS
Consecutive patients with AF were enrolled in 29 hospitals and outpatient clinics. The use of OACs was evaluated in patients with VAF and NVAF according to the prespecified guideline.
RESULTS
Of 2000 patients, 177 (8.9%) had VAF and 1823 (91.1%) had NVAF. A VKA was prescribed for 88.1% of the VAF group. In the NVAF group, 1468 (80.5%) of patients had a high CHADS-VASc score, i.e., a score of ≥3 in women and ≥2 in men; 202 (11.1%) patients had an intermediate CHADS-VASc score, i.e., a score of 2 in women and 1 in men; and 153 (8.4%) patients had a low CHADS-VASc score, i.e., a score of 1 in women and 0 in men. Of patients with a high CHADS-VASc score, 1204 (82.0%) received OACs, including DOACs for 784 (53.4%) and VKA for 420 (28.6%) patients. Among patients with an intermediate score, OACs were prescribed for 148 (73.3%) patients, including 107 (53.0%) who received DOACs and 41 (20.3%) patients who received VKA. In patients with a low score, OACs were omitted in 94 (61.4%) patients and prescribed for 59 (38.6%) patients. Multivariate analysis showed that age between 50 and 70 years, CHADS-VASc score of ≥2, a diagnosis of stroke or systemic embolization, and nonparoxysmal AF were significantly associated with increased odds of OAC prescription.
CONCLUSIONS
The current status of the utilization of OACs in Middle Eastern AF patients appears to be promising and is consistent with the 2019 focused update of the 2014 AHA/ACC/HRS guideline. This trial is registered with NCT03917992.
背景
在中东地区，评估心房颤动（AF）患者对指南推荐的口服抗凝剂（OACs）使用依从性的研究较少。约旦心房颤动（JoFib）研究根据2014年美国心脏协会（AHA）/美国心脏病学会（ACC）/美国心律学会（HRS）指南的2019年重点更新，评估了瓣膜性房颤（VAF）和非瓣膜性房颤（NVAF）患者的基线临床特征以及OACs（包括维生素K拮抗剂（VKAs）和直接口服抗凝剂（DOACs））的使用情况。
方法
连续的房颤患者入组29家医院和门诊诊所。根据预先指定的指南评估VAF和NVAF患者OACs的使用情况。
结果
在2000例患者中，177例（8.9%）患有VAF，1823例（91.1%）患有NVAF。VAF组中88.1%的患者使用了VKA。在NVAF组中，1468例（80.5%）患者的CHADS-VASc评分较高，即女性≥3分，男性≥2分；202例（11.1%）患者的CHADS-VASc评分为中等，即女性2分，男性1分；153例（8.4%）患者的CHADS-VASc评分较低，即女性1分，男性0分。在CHADS-VASc评分较高的患者中，1204例（82.0%）接受了OACs，其中784例（53.4%）接受了DOACs，420例（28.6%）接受了VKA。在中等评分的患者中，148例（73.3%）患者使用了OACs，其中107例（53.0%）接受了DOACs，41例（20.3%）接受了VKA。在评分较低的患者中，94例（61.4%）患者未使用OACs，59例（38.6%）患者使用了OACs。多变量分析显示，年龄在50至70岁之间、CHADS-VASc评分≥2、有中风或全身性栓塞诊断以及非阵发性房颤与OAC处方增加的几率显著相关。
结论
中东地区房颤患者使用OACs的现状似乎很有前景，并且与2014年AHA/ACC/HRS指南的2019年重点更新一致。该试验已在ClinicalTrials.gov注册，注册号为NCT03917992。
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