Akao Masaharu, Ogawa Hisashi, Masunaga Nobutoyo, Minami Kimihito, Ishigami Kenjiro, Ikeda Syuhei, Doi Kosuke, Hamatani Yasuhiro, Yoshizawa Takashi, Ide Yuya, Fujino Akiko, Ishii Mitsuru, Iguchi Moritake, Wada Hiromichi, Hasegawa Koji, Tsuji Hikari, Esato Masahiro, Abe Mitsuru
Department of Cardiology, National Hospital Organization Kyoto Medical Center.
Division of Translational Research, National Hospital Organization Kyoto Medical Center.
Circ J. 2022 Mar 25;86(4):726-736. doi: 10.1253/circj.CJ-22-0023. Epub 2022 Mar 13.
Atrial fibrillation (AF) increases the risk of stroke and death. Oral anticoagulants (OAC) are highly effective in reducing the risk of stroke, and direct oral anticoagulants (DOAC) became available worldwide in 2011.
The Fushimi AF Registry is an on-going prospective survey of AF patients in Fushimi-ku, Kyoto, Japan. The study cohort consisted of 4,489 patients (mean age 73.6 years, 59.6% male, mean CHADSscore 2.03), enrolled in 2011-2017. From 2011 to 2021, antithrombotic therapy has undergone a major transition; the proportion of patients receiving OAC has increased from 53% to 70%, with a steady uptake of DOAC (from 2% to 52%), whereas the proportion of patients receiving antiplatelet agents has decreased from 32% to 14%. Over a median follow-up of 5.1 years, the incidence of stroke/systemic embolism (SE), major bleeding, and all-cause death was 2.2%, 1.9%, and 4.9% per patient-year, respectively. The incidence of stroke/SE (1.6% vs. 2.3%; P<0.01), major bleeding (1.6% vs. 2.0%; P=0.07), and death (4.2% vs. 5.0%; P<0.01) was lower among patients enrolled in 2014-2017 than in 2011-2013, despite comparable baseline characteristics (age 73.2 vs. 73.7 years, CHADSscore 2.03 vs. 2.04, and HAS-BLED score 1.67 vs. 1.77, respectively).
Over the past 10 years, there has been a major transition in antithrombotic therapy and a decline in the incidence of adverse events in AF patients.
心房颤动（AF）会增加中风和死亡风险。口服抗凝药（OAC）在降低中风风险方面非常有效，直接口服抗凝药（DOAC）于2011年在全球范围内上市。
伏见房颤登记研究是一项正在进行的对日本京都伏见区房颤患者的前瞻性调查。研究队列包括2011年至2017年纳入的4489例患者（平均年龄73.6岁，男性占59.6%，平均CHADS评分2.03）。从2011年到2021年，抗栓治疗发生了重大转变；接受OAC治疗的患者比例从53%增加到70%，DOAC的使用稳步上升（从2%到52%），而接受抗血小板药物治疗的患者比例从32%下降到14%。在中位随访5.1年期间，中风/全身性栓塞（SE）、大出血和全因死亡的发生率分别为每位患者每年2.2%、1.9%和4.9%。2014 - 2017年纳入的患者中风/SE发生率（1.6%对2.3%；P<0.01）、大出血发生率（1.6%对2.0%；P = 0.07）和死亡率（4.2%对5.0%；P<0.01）低于2011 - 2013年纳入的患者，尽管基线特征相当（年龄分别为73.2岁对73.7岁，CHADS评分2.03对2.04，HAS - BLED评分1.67对1.77）。
在过去10年中，抗栓治疗发生了重大转变，房颤患者不良事件的发生率有所下降。
