社区老年非瓣膜性心房颤动患者的抗凝治疗现状

Current status of anticoagulant therapy in elderly patients with non-valvular atrial fibrillation in community

目的:探讨社区老年非瓣膜性心房颤动(房颤)患者抗凝治疗现状。方法:采用整群抽样方法,抽取上海市长宁区3个社区中年龄≥65岁的常住居民,入选通过心电图或24 h动态心电图及心脏超声检查确诊为非瓣膜性房颤的患者(n=218),对所有患者进行统一问卷调查,包括基本情况、疾病史以及用药情况,并计算CHADS2评分。结果:入选患者中,卒中高危患者(CHADS2评分≥2)有167例,实际接受抗凝治疗的仅23例(13.8%)。对未抗凝治疗原因分析显示,医生未实施抗凝治疗高达63.2%,是抗凝治疗率低的主要原因。结论:社区老年非瓣膜病房颤卒中高危患者抗凝治疗率低,需规范房颤抗凝治疗。

Objective：To investigate the current status of anticoagulant therapy in elderly patients with non-valvular atrial fibrillation in community. Methods：A random cluster sampling survey was carried out to investigate the elderly（≥ 65 years）living in three communities of Changning District,Shanghai.Non-valvular atrial fibrillation is confirmed by cardiac ultrasound and electrocardiogram or24 h Holter（n=218）.Atrial fibrillation investigation questionnaire including the basic information,history of disease and anticoagulant therapy was set,and the CHADS2 score was calculated. Results：There were 167 cases of patients with high risk of stroke（CHADS2 score≥ 2）,while only 23 cases（13.8%）received anticoagulate therapy.Analysis of reasons for not receiving anticoagulant therapy showed that,the rate of no anticoagulation prescription from doctor was as high as 63.2%,which was the main reason for the lack of anticoagulate therapy. Conclusion：Anticoagulant therapy is far from adequate in elderly patients with non-vavular atrial fibrillation and high-risk of stroke in community,and it requires to be standardized.