Department of Cardiology, Institute of Clinical Medicine, University of Tartu, 8 Puusepa Street, 50406, Tartu, Estonia.
Heart Clinic, Tartu University Hospital, 8 Puusepa Street, 50406, Tartu, Estonia.
BMC Cardiovasc Disord. 2023 Aug 11;23(1):398. doi: 10.1186/s12872-023-03415-4.
Routine oral anticoagulation (OAC) is recommended for almost all high-risk patients with atrial fibrillation, yet registries show that OACs are still underused. Our aim was to study the lifeday coverage (LDC) of OAC prescriptions and its relationship with one-year mortality rates of AF patients aged ≥ 65 in Estonia for the years 2019 and 2020.
Medical data for AF patients aged ≥ 65 years from 2018 and alive as of 01.01.2019 (cohort I) and new AF documentation from 2019 and alive as of 01.01.2020 (cohort II) was obtained from the Health Insurance Fund's electronic database. The data was linked to the nationwide Estonian Medical Prescription Centre's database of prescribed OACs. For LDC analysis, daily doses of guideline-recommended OACs were used. The patients were categorized into three LDC groups: 0%, 1-79%, and ≥ 80%. The data was linked to the Estonian Causes of Death Registry to establish the date of death and mortality rate for the whole Estonian population aged ≥ 65.
There were 34,018 patients in cohort I and 9,175 patients with new AF documentation (cohort II), previously not included in cohort I. Of the patients, 77.7% and 68.6% had at least one prescription of OAC in cohorts I and II respectively. 57.4% in cohort I and 44.5% in cohort II had an LDC of ≥ 80%. The relative survival estimates at 1 year for LDC lifeday coverage groups 0%, 1-79%, and ≥ 80% were 91.2%, 98.2%, and 98.5% (cohort I), and 91.9%, 95.2%, and 97.6% (cohort II), respectively.
Despite clear indications for OAC use, LDC is still insufficient and anticoagulation is underused for stroke prevention in Estonia. Further education of the medical community and patients is needed to achieve higher lifeday coverage of prescribed OACs.
几乎所有高危房颤患者都推荐常规口服抗凝治疗（OAC），但登记处显示 OAC 的使用率仍然较低。我们的目的是研究爱沙尼亚 2019 年和 2020 年≥65 岁房颤患者 OAC 处方的终生覆盖率（LDC）及其与一年死亡率的关系。
从 2018 年≥65 岁的房颤患者的健康保险基金电子数据库中获取 2019 年 1 月 1 日之前存活的患者（队列 I）和 2019 年新记录的房颤患者（队列 II）的医疗数据，并与全国爱沙尼亚医疗处方中心的 OAC 处方数据库相关联。对于 LDC 分析，使用指南推荐的 OAC 的日剂量。患者分为三组：0%、1-79%和≥80%。数据与爱沙尼亚死因登记处相关联，以确定≥65 岁的整个爱沙尼亚人口的死亡日期和死亡率。
队列 I 中有 34018 名患者，队列 II 中有 9175 名新的房颤记录患者（队列 II），这些患者之前未包括在队列 I 中。队列 I 和 II 中分别有 77.7%和 68.6%的患者至少有一份 OAC 处方。队列 I 中有 57.4%和队列 II 中有 44.5%的患者 LDC≥80%。队列 I 和队列 II 中 LDC 终生覆盖率组 0%、1-79%和≥80%的相对生存率估计值分别为 91.2%、98.2%和 98.5%（队列 I）和 91.9%、95.2%和 97.6%（队列 II）。
尽管有明确的 OAC 使用指征，但爱沙尼亚的 LDC 仍然不足，抗凝治疗在预防中风方面的使用率仍然较低。需要进一步对医疗界和患者进行教育，以提高 OAC 处方的终生覆盖率。
