Mendoza Pablo A, McIntyre William F, Belley-Côté Emilie P, Wang Jia, Parkash Ratika, Atzema Clare L, Benz Alexander P, Oldgren Jonas, Whitlock Richard P, Healey Jeff S
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Population Health Research Institute, Hamilton, ON, Canada.
J Thromb Thrombolysis. 2022 Jan;53(1):74-82. doi: 10.1007/s11239-021-02530-3. Epub 2021 Aug 2.
Oral anticoagulation (OAC) reduces stroke risk in patients with atrial fibrillation (AF). We sought to determine predictors of OAC initiation in AF patients presenting to the emergency department (ED). Secondary analysis of the RE-LY AF registry which enrolled individuals from 47 countries between 2007 and 2011 who presented to an ED with AF and followed them for 1 year. A total of 4149 patients with AF as their primary diagnosis who were not already taking OAC and had a CHADS-VASc ≥ 1 for men or ≥ 2 for women were included in this analysis. Of these individuals, 26.8% were started on OAC (99.2% vitamin K antagonists) in the ED and 29.8% were using OAC one year later. Factors associated with initiating OAC in the ED included: specialist consultation (relative risk [RR] 1.84, 95%CI 1.44-2.36), rheumatic heart disease (RR 1.60, 95%CI 1.29-1.99), persistence of AF at ED discharge (RR 1.33, 95%CI 1.18-1.50), diabetes mellitus (RR 1.32, 95%CI 1.19-1.47), and hospital admission (RR 1.30, 95%CI 1.14-1.47). Heart failure (RR 0.83, 95%CI 0.74-0.94), antiplatelet agents (RR 0.77, 95%CI 0.69-0.84), and dementia (RR 0.61, 95%CI 0.40-0.94) were inversely associated with OAC initiation. Patients taking OAC when they left the ED were more likely using OAC at 1-year (RR 2.81, 95%CI 2.55-3.09) and had lower rates of death (RR 0.55, 95%CI 0.38-0.79) and stroke (RR 0.59, 95%CI 0.37-0.96). In patients with AF presenting to the ED, prompt initiation of OAC and specialist involvement are associated with a greater use of OAC 1 year later and may result in improved clinical outcomes.
口服抗凝药（OAC）可降低心房颤动（AF）患者的中风风险。我们试图确定急诊科（ED）中房颤患者启动OAC治疗的预测因素。对RE-LY AF注册研究进行二次分析，该研究纳入了2007年至2011年间来自47个国家的因房颤就诊于急诊科的患者，并对他们进行了1年的随访。本分析纳入了4149例以房颤为主要诊断且尚未服用OAC、男性CHADS-VASc评分≥1或女性CHADS-VASc评分≥2的患者。在这些患者中，26.8%在急诊科开始使用OAC（99.2%为维生素K拮抗剂），一年后29.8%的患者仍在使用OAC。与在急诊科启动OAC相关的因素包括：专科会诊（相对风险[RR]1.84，95%置信区间[CI]1.44-2.36）、风湿性心脏病（RR 1.60，95%CI 1.29-1.99）、急诊科出院时房颤持续存在（RR 1.33，95%CI 1.18-1.50）、糖尿病（RR 1.32，95%CI 1.19-1.47）和住院（RR 1.30，95%CI 1.14-1.47）。心力衰竭（RR 0.83，95%CI 0.74-0.94）、抗血小板药物（RR 0.77，95%CI 0.69-0.84）和痴呆（RR 0.61，95%CI 0.40-0.94）与启动OAC呈负相关。离开急诊科时服用OAC的患者在1年时更有可能仍在使用OAC（RR 2.81，95%CI 2.55-3.09），且死亡率（RR 0.55，95%CI 0.38-0.79）和中风发生率（RR 0.59，95%CI 0.37-0.96）较低。在因房颤就诊于急诊科的患者中，及时启动OAC治疗并由专科医生参与与1年后更多地使用OAC相关，且可能改善临床结局。
