Stafford R S, Singer D E
Massachusetts General Hospital, Medical Services and Department of Medicine, Harvard Medical School, Boston, USA.
Circulation. 1998 Apr 7;97(13):1231-3. doi: 10.1161/01.cir.97.13.1231.
Studies of selected populations suggest that anticoagulation in atrial fibrillation is underused and that nonclinical factors influence the use of this stroke-preventing therapy. We wished to examine recent national trends and predictors of warfarin sodium use in atrial fibrillation.
A nationally representative sample of office visits from the 1989 to 1996 National Ambulatory Medical Care Surveys was used. We selected 1125 visits by patients with atrial fibrillation, including 877 visits to cardiologists and primary care physicians in which apparent contraindications for anticoagulation were absent. The principal outcome measure was the proportion of visits with warfarin reported. We analyzed trends in warfarin use and statistically evaluated the predictors of warfarin use. Warfarin use increased from 13% of atrial fibrillation visits in 1989 to 40% in 1993 (P for trend <.001) in patients without contraindications. Between 1993 and 1996, however, there was no change in warfarin use. Independent of other factors, warfarin was significantly more likely to be reported in patients with a history of stroke and in patients residing outside of the South.
Warfarin use in atrial fibrillation has not increased recently, indicating inadequate implementation of this highly effective therapy. Barriers to anticoagulation in real-world clinical practice need to be identified and addressed.
对特定人群的研究表明，心房颤动患者的抗凝治疗未得到充分应用，且非临床因素会影响这种预防中风治疗方法的使用。我们希望研究近期全国范围内华法林钠在心房颤动治疗中的使用趋势及预测因素。
使用了1989年至1996年全国门诊医疗护理调查中具有全国代表性的门诊样本。我们选取了1125例心房颤动患者的门诊病例，其中包括877例就诊于心脏病专家和初级保健医生且无明显抗凝治疗禁忌症的病例。主要观察指标是报告使用华法林的门诊病例比例。我们分析了华法林使用趋势，并对使用华法林的预测因素进行了统计学评估。在无禁忌症的患者中，华法林的使用率从1989年心房颤动门诊病例的13%增至1993年的40%（趋势P值<.001）。然而，在1993年至1996年间，华法林的使用率没有变化。与其他因素无关，有中风病史的患者以及居住在南部以外地区的患者使用华法林的可能性显著更高。
近期心房颤动患者使用华法林的情况并未增加，这表明这种高效治疗方法的实施并不充分。需要识别并解决实际临床实践中抗凝治疗的障碍。
