在农村环境中,在非膜心房的患者中使用口服抗凝剂
Camille Brod1, Nicole Groth2, Macaela Rudeck2
1University of Minnesota Medical School - Duluth Campus, Duluth, MN, United States.
American journal of medicine open
|July 22, 2024
概括
直接口服抗凝剂 (DOACs) 在2019年针对非膜性心房动 (AF) 的指导方针之后略有增加. 然而,诸如出血风险和成本等障碍阻碍了DOAC的采用,使许多高风险的AF患者没有抗凝药.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 公共卫生 公共卫生
背景情况:
- 2019年ACC/AHA/HRS指南建议直接口服抗凝剂 (DOAC) 作为非膜性心房动 (AF) 患者的首选一线治疗,而不是华法林.
- 这一转变旨在改善抗凝管理,并降低AF患者中风风险.
研究的目的:
- 评估2019年指导方针对DOACs与华法林在现实世界门诊环境中的采用的影响.
- 为了确定患者的特征和提供者报告的障碍,影响口服抗凝剂 (OAC) 处方模式.
主要方法:
- 在2019年10月至2020年7月期间,对12,014名非膜AF或心房的门诊患者进行了回顾性分析.
- 患者按OAC类型 (华法林,DOAC或没有OAC) 分类. 高风险的AF是通过CHA2DS2-VASc得分来定义的. 通过REDCap调查评估了供应商的知识和障碍.
主要成果:
- 尽管有指导方针的变化,但OAC的整体使用率保持稳定 (75.6%vs75.7%). 华法林使用量下降了2.3%,而DOAC使用量增加了2.4% (p<0.001).
- 增加OAC处方的因素包括年龄,男性性别,较高的CHA2DS2-VASc得分,高血压和以前的中风. 降低OAC使用的因素包括血管疾病,高ATRIA出血分数,脏疾病,先前出血和左心房附属体封闭.
- 提供者调查发现出血风险 (35.1%) 和成本 (25.0%) 是DOAC使用的主要障碍,特别是在农村人口中.
结论:
- 2019年的指导方针导致非膜AF患者的DOAC利用率略有增加.
- 显著的障碍,包括出血风险的感知和成本,阻碍了广泛采用DOAC,特别是在农村环境中.
- 很大一部分高风险的AF患者仍然没有最佳的抗凝治疗,这突显了护理提供方面的差距.
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