Internal Medicine Residency Training Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Data Science to Patient Value (D2V), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Clin Cardiol. 2023 Aug;46(8):937-941. doi: 10.1002/clc.24077. Epub 2023 Jul 4.
Atrial fibrillation (AF) is the most common sustained arrhythmia in adults and increases stroke risk. Treatment with oral anticoagulants (OACs) may reduce this risk however many patients do not receive OAC therapy. This study aimed to use electronic health record data to identify newly diagnosed AF patients at high risk for stroke and not anticoagulated as well as factors associated with OAC prescription.
Timely prescription of OACs among patients with newly diagnosed AF is poor.
We performed a retrospective study of patients with a new diagnosis of AF. We assessed stroke risk with the CHA DS -VASc score. The primary outcome was prescription of an OAC within 6 months following diagnosis. We used logistic regression to see how the odds of being prescribed an OAC differs for 17 independent variables.
We identified 18 404 patients with a new diagnosis of AF. Among patients at high risk for stroke, 41.3% received an OAC prescription within 6 months. Male sex, Caucasian compared to African American race, stroke, obesity, congestive heart failure, vascular disorder, current antiplatelet, beta blocker, or calcium channel blocker prescription, and increasing CHA DS -VASc score were positively associated with receiving an OAC. Whereas anemia, renal dysfunction, liver dysfunction, antiarrhythmic drug use and increasing HAS-BLED score were negatively associated.
Most newly diagnosed AF patients at high stroke risk do not receive an OAC prescription in the first 6 months following diagnosis. Our analysis suggests that patient sex, race, comorbidities, and additional prescriptions are associated with rates of OAC prescribing.
心房颤动（AF）是成年人中最常见的持续性心律失常，会增加中风风险。口服抗凝剂（OAC）治疗可以降低这种风险，但许多患者并未接受 OAC 治疗。本研究旨在使用电子健康记录数据来识别新诊断为 AF 且中风风险高但未接受抗凝治疗的患者，以及与 OAC 处方相关的因素。
新诊断为 AF 的患者中 OAC 的及时处方情况较差。
我们对新诊断为 AF 的患者进行了回顾性研究。我们使用 CHA2DS2-VASc 评分评估中风风险。主要结局是在诊断后 6 个月内开具 OAC 的情况。我们使用逻辑回归来观察 17 个独立变量对开具 OAC 的可能性的影响。
我们确定了 18404 例新诊断为 AF 的患者。在中风风险高的患者中，41.3%在 6 个月内开具了 OAC 处方。男性、白种人而非非裔美国人、中风、肥胖、充血性心力衰竭、血管疾病、当前抗血小板、β受体阻滞剂或钙通道阻滞剂处方，以及 CHA2DS2-VASc 评分增加与开具 OAC 相关。而贫血、肾功能不全、肝功能不全、抗心律失常药物使用和 HAS-BLED 评分增加与开具 OAC 呈负相关。
大多数新诊断为 AF 且中风风险高的患者在诊断后 6 个月内未开具 OAC 处方。我们的分析表明，患者的性别、种族、合并症和其他处方与 OAC 处方的开具率相关。
