基于社区的心房颤动中风预防分析及公共干预效果：ARENA项目的结果
Community-based analysis of stroke prevention and effect of public interventions in atrial fibrillation: results from the ARENA project.
作者信息
Zylla Maura M, Özdemir Belgin, Hochadel Matthias, Zeymer U, Akin Ibrahim, Grau Armin, Schneider Steffen, Alonso Angelika, Waldecker Bernd, Süselbeck Tim, Schwacke Harald, Haass Markus, Zahn Ralf, Borggrefe Martin, Senges Jochen, Frey Norbert, Thomas Dierk
机构信息
Department of Cardiology, University of Heidelberg, Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
HCR (Heidelberg Center for Heart Rhythm Disorders), Medical University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
出版信息
Clin Res Cardiol. 2025 Jan;114(1):138-149. doi: 10.1007/s00392-024-02510-6. Epub 2024 Aug 8.
BACKGROUND
Community-based interventions may promote awareness and adherence to atrial fibrillation (AF)-related therapies, potentially reducing adverse events. The ARENA project investigated the health status, therapies and events in AF patients in the Rhein-Neckar Region, Germany. The subproject "ARENA intervention" studied the effect of community-based interventions on AF-associated outcomes.
METHODS
From 2016 onward, patients with diagnosed AF were recruited for the observational ARENA registry. In 2018, an intervention period was initiated involving population-based information campaigns on AF diagnosis and therapies. The "control group" was recruited prior to initiation, and the "intervention group" afterward. Patients underwent standardized follow-up > 1 year after recruitment. Clinical outcomes, therapy and quality of life were compared between the two groups.
RESULTS
A total of 2769 patients were included. This real-world cohort showed high adherence to oral anticoagulation therapy (OAC) and an increased use of NOACs over vitamin K antagonists over time. In the intervention group (n = 1362), more patients continued OAC at follow-up (87.1% vs. 81.5%, P = 0.002). However, this difference was not significant in the patient subgroup with class I/IIa indications for OAC (90.1% vs. 87.5%, P = 0.11). AF-related re-hospitalization was lower in the intervention group (6.8% vs. 12.3%, P < 0.001). There was no significant difference in quality of life. AF-related anxiety was reduced at follow-up. Of note, nearly a quarter of all patients stated that ARENA had influenced their health perception.
CONCLUSION
Tailored community-based campaigns may raise awareness for AF-related health issues, supporting therapy adherence. Future public strategies to improve quality of life in AF patients should be investigated, as the ARENA project hints at a potential benefit of population-based campaigns.
TRIAL REGISTRATION
ClinicalTrials.gov (Identifier: NCT02978248).
背景
基于社区的干预措施可能会提高对房颤（AF）相关治疗的认识和依从性，从而有可能减少不良事件。ARENA项目调查了德国莱茵-内卡地区房颤患者的健康状况、治疗方法和事件。子项目“ARENA干预”研究了基于社区的干预措施对房颤相关结局的影响。
方法
从2016年起，招募确诊为房颤的患者加入观察性ARENA登记处。2018年，启动了一个干预期，开展基于人群的房颤诊断和治疗宣传活动。“对照组”在启动前招募，“干预组”在启动后招募。患者在入组后接受了超过1年的标准化随访。比较两组的临床结局、治疗方法和生活质量。
结果
共纳入2769例患者。这个真实世界的队列显示口服抗凝治疗（OAC）的依从性较高，并且随着时间的推移，新型口服抗凝药（NOACs）的使用相对于维生素K拮抗剂有所增加。在干预组（n = 1362）中，更多患者在随访时继续接受OAC治疗（87.1%对81.5%，P = 0.002）。然而，在有OAC I/IIa类适应证的患者亚组中，这种差异并不显著（90.1%对87.5%，P = 0.11）。干预组房颤相关再住院率较低（6.8%对12.3%，P < 0.001）。生活质量方面没有显著差异。随访时房颤相关焦虑有所减轻。值得注意的是，近四分之一的患者表示ARENA影响了他们对健康的认知。
结论
量身定制的基于社区的宣传活动可能会提高对房颤相关健康问题的认识，支持治疗依从性。由于ARENA项目提示了基于人群的宣传活动的潜在益处，未来应研究改善房颤患者生活质量的公共策略。
试验注册
ClinicalTrials.gov（标识符：NCT02978248）。
Zotero 插件