Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.
Heart Vessels. 2022 May;37(5):867-874. doi: 10.1007/s00380-021-01984-y. Epub 2021 Nov 19.
Atrial fibrillation (AF) is a common disease encountered in daily practice; however, few patients with AF received oral anticoagulant (OAC) therapy. This study focused on differences in OAC prescriptions and influencing factors between specialists (neurological and cardiovascular) and non-specialists. A retrospective comparative analysis was conducted on 480 patients with acute cardioembolic stroke caused by non-valvular AF who were admitted to our hospital between January 1, 2015, and December 31, 2020. All patients had visited our hospital or other hospitals for their underlying diseases. Overall, 232 (specialist group SG) and 248 patients (non-specialist group NSG) were examined by specialists and non-specialists, respectively. The NSG had a significantly lower percentage of OAC prescriptions on admission than the SG (P < 0.01), even after propensity score matching. Factors influencing OAC prescription in the SG were age, hypertension, paroxysmal AF, dementia, CHADS score, and antiplatelet drug use, while those in the NSG were a history of cerebral infarction, paroxysmal AF, dementia, and antiplatelet drug use [SG: age, odds ratio (OR) 0.919, 95% confidence interval (CI) 0.865-0.976; hypertension, OR 0.266, 95% CI 0.099-0.713; paroxysmal AF, OR 0.189, 95% CI 0.055-0.658; dementia, OR 0.253, 95% CI 0.085-0.758; CHADS score, OR 2.833, 95% CI 1.682-4.942; and antiplatelet drug use, OR 0.072, 95% CI 0.025-0.206; NSG: cerebral infarction, OR 5.940, 95% CI 1.581-22.309; paroxysmal AF, OR 0.077, 95% CI 0.010-0.623; dementia, OR 0.077, 95% CI 0.014-0.438; and antiplatelet drug use, OR 0.024, 95% CI 0.004-0.152]. In conclusion, the OAC prescription rate was higher in patients with non-valvular AF whose family physicians were specialists at the time of cerebral infarction onset. In addition, in the SG, advanced age and hypertension were associated with not prescribing OAC, whereas a higher CHADS score was associated with the prescription of OACs. In the NSG, a history of cerebral infarction was associated with the prescription of OACs. Further, paroxysmal AF, antiplatelet drug use, and dementia were associated with non-OAC therapy in both the groups.
心房颤动（AF）是日常实践中常见的疾病；然而，很少有 AF 患者接受口服抗凝剂（OAC）治疗。本研究专注于专家（神经科和心血管科）和非专家之间 OAC 处方和影响因素的差异。对 2015 年 1 月 1 日至 2020 年 12 月 31 日因非瓣膜性 AF 引起的急性心源性脑栓塞的 480 例患者进行了回顾性对比分析。所有患者均因基础疾病在我院或其他医院就诊。共有 232 例（专家组 SG）和 248 例（非专家组 NSG）患者分别由专家和非专家检查。入院时，NSG 的 OAC 处方比例明显低于 SG（P < 0.01），即使经过倾向评分匹配后也是如此。影响 SG 中 OAC 处方的因素为年龄、高血压、阵发性 AF、痴呆、CHADS 评分和抗血小板药物使用，而影响 NSG 中 OAC 处方的因素为脑梗死史、阵发性 AF、痴呆和抗血小板药物使用[SG：年龄，比值比（OR）0.919，95%置信区间（CI）0.865-0.976；高血压，OR 0.266，95%CI 0.099-0.713；阵发性 AF，OR 0.189，95%CI 0.055-0.658；痴呆，OR 0.253，95%CI 0.085-0.758；CHADS 评分，OR 2.833，95%CI 1.682-4.942；抗血小板药物使用，OR 0.072，95%CI 0.025-0.206；NSG：脑梗死，OR 5.940，95%CI 1.581-22.309；阵发性 AF，OR 0.077，95%CI 0.010-0.623；痴呆，OR 0.077，95%CI 0.014-0.438；抗血小板药物使用，OR 0.024，95%CI 0.004-0.152]。结论，非瓣膜性 AF 患者的家庭医生在脑梗死发病时为专家时，OAC 处方率更高。此外，在 SG 中，高龄和高血压与不使用 OAC 相关，而 CHADS 评分较高与使用 OAC 相关。在 NSG 中，脑梗死史与 OAC 处方相关。此外，阵发性 AF、抗血小板药物使用和痴呆与两组非 OAC 治疗相关。
