心房細動に対するガイドライン指向型脳卒中予防療法の適用は可能である

Jonathan P Piccini¹, Haolin Xu¹, Margueritte Cox¹

¹Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (J.P.P., H.X., M.C., R.A.M.).

Circulation

|February 1, 2019

まとめ

経口抗凝固薬 (OAC) の処方量は,質改善プログラムで時間の経過とともに有意に改善しました. ガイドラインで推奨される脳卒中予防の高度な遵守は達成可能で,79. 9%から96. 6%に増加しました.

科学分野:

心臓病科
公衆衛生
薬理学について

背景:

心房細動 (AF) の患者における口腔抗凝固薬 (OAC) のガイドラインの遵守は依然として課題です.
OACの処方箋を改善するための以前の努力は,限られた成功を収めました.

研究の目的:

CHA2DS2- VAScスコア ≥2のAF患者におけるOAC性能測定値の遵守を評価する.
OACの処方箋の傾向と病院での結果との関連を評価する.

主な方法:

アメリカン・ハート・アソシエーションのGet With The Guidelines-AFIBレジストリから33,235人のAF患者を分析した (2013年−2017年).
入院と退院時のOAC処方率の評価
OACの使用に関連する入院アウトカムの調整された分析.

主要な成果:

入院時のOAC使用は,不全性脳卒中の確率の低下と関連していた (OR,0. 38).
研究期間中,退院時のOACの処方量は79. 9%から96. 6%に大幅に増加した (P< 0. 0001).
OACの使用はヒスパニック系患者 (90. 2%) で低く,若い患者,男性,心不全患者では高かった.

結論:

Get With The Guidelines-AFIBの品質改善プログラムにより,OACの処方量が大幅に増加しました.
AF患者では,ガイドラインで推奨される脳卒中予防の高度な遵守が可能である.

キーワード:

心房細動ガイドラインの遵守行動結果について

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