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土耳其心房颤动患者口服抗凝治疗决策中医生与患者的偏好:一项全国最佳-最差尺度调查的结果

Physician and Patient Preferences for Oral Anticoagulation Therapy Decision Making in Atrial Fibrillation: Results From a National Best-Worst Scaling Survey in Türkiye.

作者信息

Kılıckesmez K, Aras D, Degertekin M, Ozer N, Hacibedel B, Helvacioglu K, Koc U, Ozdengulsun B, Dundar Ahi E, Ergene O

机构信息

Department of Cardiology, Cemil Taşcıoğlu Research and Training Hospital, İstanbul, Türkiye.

Department of Cardiology, Medipol University, İstanbul, Türkiye.

出版信息

Clin Cardiol. 2024 Dec;47(12):e70038. doi: 10.1002/clc.70038.

Abstract

Atrial fibrillation (AF) is the most common cardiac dysrhythmia and a common cause of ischemic stroke. Stroke prevention with oral anticoagulation (OAC) is the cornerstone of AF management. Patients and their treating physicians may have different views on different attributes of OACs. The objective of this study was to quantify the relative importance that patients and physicians in Turkey place on different OAC attributes when making treatment decisions in AF. A cross-sectional survey was administered to AF patients (≥ 50 years) receiving OAC and practising cardiologists, including residents with ≥ 2 years of experience in Turkey. For both patients (N = 230; 50% male) and physicians (N = 194; 74% male), the most important attributes for OAC treatment decision making in AF were "success in preventing stroke" (57% and 73.9% or overall importance, respectively) and "risk of major bleeding" (20% and 23.4%, respectively). For patients, other attributes were much less important, but not altogether unimportant: reversal agent availability (7%), monitoring (5%), food or drug interactions (3%), minor bleeding (3%), and ease of swallowing (2%). For physicians, among the other attributes, only the need for monitoring (1.3%) had a relative importance of > 1%. For all Turkish participants, efficacy and safety were found to be the most important attributes influencing OAC choice in AF with these two attributes accounting for 77% and 97.3% of overall importance for patients and physicians, respectively. Certain considerations, especially reversal agent availability and monitoring appear to be more important to patients than to physicians This is the first study to use BWS to quantify patient and physician preferences for OAC treatments in AF in Turkey.

摘要

心房颤动(AF)是最常见的心律失常,也是缺血性中风的常见病因。口服抗凝药(OAC)预防中风是房颤管理的基石。患者及其治疗医生对于OAC的不同属性可能有不同看法。本研究的目的是量化土耳其患者和医生在房颤治疗决策时对不同OAC属性的相对重视程度。对在土耳其接受OAC治疗的房颤患者(≥50岁)和执业心脏病专家(包括有≥2年经验的住院医生)进行了横断面调查。对于患者(N = 230;50%为男性)和医生(N = 194;74%为男性)而言,房颤OAC治疗决策中最重要的属性是“预防中风的成功率”(分别占总体重要性的57%和73.9%)以及“大出血风险”(分别占20%和23.4%)。对于患者来说,其他属性的重要性要低得多,但并非完全不重要:是否有逆转剂(7%)、监测(5%)、食物或药物相互作用(3%)、轻微出血(3%)以及吞咽难易程度(2%)。对于医生来说,在其他属性中,只有监测需求(1.3%)的相对重要性>1%。对于所有土耳其参与者,疗效和安全性被认为是影响房颤OAC选择的最重要属性,这两个属性分别占患者和医生总体重要性的77%和97.3%。某些因素,尤其是逆转剂的可及性和监测,对患者似乎比对医生更重要。这是第一项在土耳其使用BWS量化患者和医生对房颤OAC治疗偏好的研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ac8d/11628632/ca6ed87e5731/CLC-47-e70038-g001.jpg

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