农村社区医师对房颤诊疗的认知现况调查

Knowledge of rural community physicians on diagnosis and treatment of atrial fibrillation

目的调查农村社区医师对心房颤动(房颤)疾病及其抗凝治疗的认识水平。方法 2015年对上海市松江区7家农村社区卫生服务中心的128名临床医师进行问卷调查,内容包括社区医师对房颤疾病的认识、社区医师对房颤抗凝治疗的认识、社区医师继续教育情况调查。分析被调查者目前对房颤的认知现状。结果 87.5%(112/128)的社区医师能正确回答房颤是一种心律失常。7.8%(10/128)的社区医师不了解房颤的心电图特征。82.8%(106/128)的社区医师选择中风是房颤的最常见的并发症。未能掌握房颤典型体征的社区医师占4.7%(6/128)。67.2%(86/128)的社区医师认为抗凝治疗对于大多数房颤患者是必不可少的。在房颤患者的首选抗凝药物上,43.8%(56/128)的社区医师认为是阿司匹林,52.5%(67/128)首选华法林和3.9%(5/128)首选氯吡格雷。12.5%(16/128)的社区医师能了解和熟练地使用房颤患者的脑卒中危险分层。7.8%(10/128)的社区医师能够很好地了解和正确评估抗凝血相关的出血风险。42.2%(54/128)的农村社区医师在近3年内没有接受房颤相关的医学继续教育,50.0%(64/128)的社区医师没有关注房颤诊疗指南的更新,65.6%(84/128)的社区医师未曾阅读过房颤诊疗指南,32.0%(41/128)的社区医师在过去的3年中没有接受任何心血管疾病相关的医学继续教育。结论农村社区医师对于房颤抗凝治疗的认识存在严重不足,他们接受的房颤相关的医学继续教育也比较匮乏。

Objective To make a survey of the knowledge of rural community physicians on atrial fibrillation（AF） and antithrombotic therapy. Methods A questionnaire survey was conducted in 128 community physicians from seven rural community health service centers in Songjiang District, Shanghai in 2015. The knowledge of community physicians on AF, antithrombotic therapy for AF, and their continuing medical education status were investigated. Results Of all community physicians enrolled, 87.5%（112/128） answered correctly that AF was an arrhythmia, 7.8%（10/128） did not understand the electrocardiographic characteristics of AF, 82.8%（106/128） chose stroke as the most common complication of AF, and 4.7%（6/128） failed to describe the typical signs of AF; 67.2%（86/128） believed that antithrombotic therapy was essential for most AF patients; 43.8%（56/128） preferred aspirin, 52.5%（67/128） preferred warfarin, and 3.9%（5/128） preferred clopidogrel as the first-line antithrombotic drug for most AF patients; 12.5%（16/128） could understand and skillfully use the risk stratification of stroke in AF patients, and 7.8%（10/128） could well understand and correctly assess the bleeding risk of anticoagulation. In the past 3 years, 42.2%（54/128） of rural community physicians did not receive continuing medical education related to AF, 50.0%（64/128） paid no attention to AF guideline update, 65.6%（84/128） had not read AF guidelines, and 32.0%（41/128） did not receive any continuing medical education on cardiovascular disease. Conclusion There is a serious lack of knowledge on the anticoagulant therapy for AF among rural community physicians, and their continuing medical education related to AF is insufficient.