Ashburner Jeffrey M, Chang Yuchiao, Borowsky Leila H, Khurshid Shaan, McManus David D, Ellinor Patrick T, Lubitz Steven A, Singer Daniel E, Atlas Steven J
Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Department of Medicine, Harvard Medical School, Boston, Massachusetts.
Heart Rhythm O2. 2023 Jul 12;4(8):469-477. doi: 10.1016/j.hroo.2023.07.003. eCollection 2023 Aug.
Despite benefits of oral anticoagulation (OAC), many individuals with diagnosed atrial fibrillation (AF) do not receive OAC.
The purpose of this study was to assess whether cardiac rhythm assessment for AF impacted use of OAC in patients with previously diagnosed AF.
VITAL-AF was a cluster randomized controlled trial conducted in 16 primary care practices assessing the efficacy of AF rhythm assessment with single-lead electrocardiogram in routine care. Patients 65 years and older were offered rhythm assessment at visits. In this secondary analysis, we evaluated rhythm assessment uptake and compared initiation and discontinuation of OAC in patients with previously diagnosed AF from intervention and control arms over 1 year.
The study included 4593 patients with previously diagnosed AF (2250 intervention; 2343 control). In the intervention arm, 2022 (89.9%) completed rhythm assessment (median 2 visits with rhythm assessment) and 40.1% had ≥1 "Possible AF" result. Initiation of OAC was similar in the intervention (17.7%) and control (19.1%) arms but was influenced by the rhythm assessment result: higher with a "Possible AF" (26.1%; adjusted odds ratio [aOR] 1.62; 95% confidence interval [CI] 1.04-2.51), and lower with a "Normal" result (9.9%; aOR 0.45; 95% CI 0.29-0.71) compared to control. OAC discontinuation was similar in the intervention (6.3%) and control (7.2%) arms, with lower discontinuation with a "Possible AF" result (3.8%; aOR 0.51; 95% CI 0.32-0.81).
Including patients with previously diagnosed AF in a point-of-care rhythm assessment strategy did not increase overall OAC use compared to the control arm. However, the rhythm assessment result influenced both initiation and discontinuation of OAC.
尽管口服抗凝药（OAC）有诸多益处，但许多已确诊心房颤动（AF）的患者并未接受OAC治疗。
本研究旨在评估房颤的心律评估是否会影响既往诊断为房颤的患者使用OAC。
VITAL-AF是一项在16个初级保健机构进行的整群随机对照试验，评估单导联心电图进行房颤心律评估在常规护理中的疗效。65岁及以上患者在就诊时接受心律评估。在这项二次分析中，我们评估了心律评估的接受情况，并比较了干预组和对照组中既往诊断为房颤的患者在1年时间内OAC的起始使用和停用情况。
该研究纳入了4593例既往诊断为房颤的患者（2250例干预组；2343例对照组）。在干预组中，2022例（89.9%）完成了心律评估（心律评估的中位就诊次数为2次），40.1%的患者有≥1次“可能为房颤”的结果。干预组（17.7%）和对照组（19.1%）起始使用OAC的情况相似，但受心律评估结果影响：“可能为房颤”的患者起始使用率更高（26.1%；调整优势比[aOR]1.62；95%置信区间[CI]1.04 - 2.51），与对照组相比，“正常”结果的患者起始使用率更低（9.9%；aOR 0.45；95%CI 0.29 - 0.71）。干预组（6.3%）和对照组（7.2%）停用OAC的情况相似，“可能为房颤”结果的患者停用率更低（3.8%；aOR 0.51；95%CI 0.32 - 0.81）。
与对照组相比，将既往诊断为房颤的患者纳入即时心律评估策略并未增加OAC的总体使用量。然而，心律评估结果影响了OAC的起始使用和停用情况。
