Summer Student, Department of Medicine, University of Otago, Wellington, New Zealand.
Cardiologist, Department of Cardiology, Auckland Hospital, Auckland, New Zealand.
N Z Med J. 2023 Aug 4;136(1580):12-25. doi: 10.26635/6965.6195.
To describe atrial fibrillation (AF) patient characteristics and anticoagulation patterns in stroke patients in Aotearoa.
Reducing Ethnic and Geographic Inequities to Optimise New Zealand Stroke (REGIONS) Care study is a prospective, nation-wide observational study of consecutive adult stroke patients admitted to hospital between 1 May and 31 October 2018. AF and anticoagulation prescribing, intracerebral haemorrhage (ICH) and differences by Māori ethnicity and hospital location are described.
Of 2,379 patients, 807 (34.3%) had a diagnosis of AF. AF patients were older than non-AF patients (mean 79.9 [SD 11] versus 72.5 [14.2], p<0.0001). AF was diagnosed before stroke in 666 patients (82.5%), of whom 442 (66.4%) were taking an anticoagulant. The most common documented reasons for non-anticoagulation were prior bleeding (20.5%), patient preference (18.1%), frailty, comorbidities/side effects (13.2%) and falls (6.8%). The ICH rate was similar for AF patients on versus not on an anticoagulant (adjusted odds ratio [aOR] 0.99, 95% confidence interval [CI] 0.55-1.80). Rates and reasons for oral anticoagulant non-prescribing were similar for Māori, non-Māori, urban and non-urban populations.
Although anticoagulation prescribing in AF has improved, one third of stroke patients with known AF were not taking an anticoagulant prior to admission and the majority did not appear to have an absolute contraindication offering a multidisciplinary opportunity for improvement. There were no significant differences for Māori and non-urban populations in anticoagulant prescribing.
描述新西兰奥塔哥地区房颤（AF）患者的特征和卒中患者的抗凝模式。
降低新西兰卒中的族裔和地域差异（REGIONS）护理研究是一项前瞻性、全国性的连续成年卒中患者观察性研究，于 2018 年 5 月 1 日至 10 月 31 日期间纳入住院的连续成年卒中患者。描述 AF 和抗凝药物的使用、脑实质出血（ICH）以及与毛利族裔和医院地理位置的差异。
2379 例患者中，807 例（34.3%）诊断为 AF。AF 患者比非 AF 患者年龄更大（平均 79.9 [11]岁比 72.5 [14.2]岁，p<0.0001）。666 例（82.5%）患者在卒中前诊断为 AF，其中 442 例（66.4%）正在服用抗凝药物。非抗凝治疗最常见的记录原因是既往出血（20.5%）、患者偏好（18.1%）、虚弱、合并症/副作用（13.2%）和跌倒（6.8%）。AF 患者服用与未服用抗凝药物的 ICH 发生率相似（调整后的优势比[OR]0.99，95%置信区间[CI]0.55-1.80）。在毛利族裔、非毛利族裔、城市和非城市人群中，口服抗凝药物未开具的比例和原因相似。
尽管 AF 患者的抗凝治疗有所改善，但三分之一已知 AF 的卒中患者在入院前未服用抗凝药物，而且大多数患者似乎没有绝对禁忌证，这为改善提供了一个多学科机会。毛利族裔和非城市人群的抗凝药物开具无显著差异。
