住院心房颤动患者抗凝治疗依从性及疾病管理需求分析

Analysis on long-term compliance of anticoagulation treatment and demands of disease management in patients with atrial fibrillation

目的 探讨自然状态下心房颤动（房颤）患者抗凝治疗的依从性、治疗效果以及患者对疾病管理的需求,为开展房颤患者疾病管理,提高抗凝治疗的依从性及治疗效果提供依据.方法 收集2008年1月1日至2008年12月31日在北京安贞医院内科病房住院并且采用抗凝治疗（服华法林）的房颤患者.排除外科、眼科、耳鼻喉科、皮肤科、儿科的住院患者以及住院前已规律服用华法林的患者.通过电子病例回顾收集患者患病及住院治疗信息,通过电话方式了解患者出院后1年时的抗凝治疗情况及对疾病管理的需求.结果 共有268例房颤患者接受电话随访.出院1年时抗凝治疗依从率为54.1%（145/268）,性别、年龄、房颤类型、病程以及是否存在缺血性脑卒中病史对服药依从性的影响无统计学意义,相对危险分别为1.74（95% CI 0.67～4.47）,0.87（95%CI 0.30～2.53）,1.59（95%CI 0.35～1.09）,1.09（95% CI 0.61～1.93）,0.44（95%CI 0.12～1.60）.坚持服用华法林的患者中,60.7%（88/145）每月测量国际标准化测量值（INR）,48.3%（70/145）INR值在2.0～3.0,1.4%（2/145）患者出现轻微鼻出血.停止服药的患者中,71.5%（88/123）在出院6个月内停药,主要原因是不知道需要长期服药（35.0%）,以及治疗效果不好而换用阿司匹林（24.4%）.约80%的患者希望在监测结果的解释、药物调整方面得到指导 73.1%（196/268）患者希望医生能定期随访,89.8%（176/196）患者希望通过电话随访,85.2%（150/176）希望随访频率为1次/月.结论 自然状态下房颤患者抗凝治疗的依从性以及INR达标的比率较低,患者停止服药的主要原因是对长期坚持服药的必要性不了解及治疗效果不理想.在房颤患者中进行疾病管理将满足大多数房颤患者的需求.

Objective To analyze the long-term compliance of oral anticoagulant therapy and the demands of disease management in patient with atrial fibrillation （AF）. Methods Inpatients with AF taking warfairn were collected from Department of Internal Medicine from January 1 to December 31,2008.Inpatients from departments of surgery, ophthalmology, otorhinolaryngology, dermatology and pediatrics and those on a previous warfarin therapy were excluded. The data of patient profiles, medical history and anticoagulant treatment were collected from electronic medical record. And the status of anticoagulant treatment one year later and demands of disease management were inquired by telephone. Results A total of 268 AF patients received a telephone survey. Among them, 145 patients （54. 1% ） continued taking warfarin. Gender, age, type of AF, duration of AF and history of ischemic stroke was not significantly associated with the compliance of anticoagulant treatment. The odds ratio was 1.74 （ 95% CI： 0. 67 -4.47）, 0. 87 （95% CI： 0. 30 - 2. 53 ）, 1.59 （ 95% CI： 0. 35 - 1.09 ）, 1.09 （ 95% CI： 0. 61 - 1. 93 ） and 0. 44（95% CI： 0. 12 - 1.60 ）respectively. Among patients on warfarin, INR was monitored monthly in 88 patients （60. 7% ） and 70 patients （48. 3% ） had an INR value of 2.0 -3.0. Among 123 withdrawal patients, 88 patients （71.5%） terminated treatment within 6 month. The common reasons included patient ignorance about long-term anticoagulant treatment （ 35.0% ） and switching to aspirin because of a poor effect （24. 4% ）. About 80% of patients wished to obtain instructions about INR monitoring and adjustment of drug dosage. Among them, 196/268 patients （73.1%） wished for a regular follow-up. And 176/196 patients （89. 8% ） opted for a telephone follow-up and 150/176 patients （85.2%） wanted to receive monthly instructions. Conclusion The compliance of anticoagulation treatment and the target-meeting proportion of INR value are relative low. And the common reasons of withdrawal are patient ignorance about long-term anticoagulant treatment and switching to aspirin because of a poor effect. Disease management will meet most of AF patients＇ demands.