达比加群酯在非瓣膜性房颤患者中用药依从性分析

Analysis of adherence to dabigatran among patients with nonvalvular atria fibrillation in a tertiary care hospital

目的:调查达比加群酯在某三甲医院非瓣膜性房颤(non-valvular atrial fibrillation,NVAF)患者中的用药依从性,探讨影响依从性的因素,为制订提高达比加群酯依从性的有效措施提供依据。方法:医院信息系统(hospital information system,HIS)检索2016年2月-2018年1月使用达比加群酯的患者,筛选符合纳入标准的患者。统计随访患者3,6,9,12,18个月达比加群酯的覆盖天数比例(proportion of days covered, PDC),并计算PDC≥0.8的比例。使用SPSS17.0统计软件对影响药物依从性的因素进行统计分析。结果:随访3,6,9,12,18个月的PDC值≥0.8的患者比例分别为75.00%,59.50%,51.52%,49.57%,60.42%。结果显示糖尿病病史(χ^2=8.316,P=0.004),既往抗凝药物使用史(χ^2=8.764,P=0.003)、脑卒中/短暂性脑缺血发作(transient ischemic attack,TIA)史(χ^2=6.304,P=0.012)与随访12个月的PDC≥0.8的患者比例显著相关。结论:患者的用药依从性随服药时间的延长而下降,1年后趋于稳定。有糖尿病病史、既往抗凝药使用史、脑卒中/TIA病史患者的长期依从性高于无既往史的患者。

OBJECTIVE To investigate the adherence of dabigatran among patients with nonvalvular atrial fibrillation(NVAF) in a tertiary hospital, and to explore the factors affecting the compliance, so as to provide the basis for formulating effective measures to improve the compliance of dabigatran etexilate.METHODS Hospital information system(HIS) was used to search the patients who used dabigatran etexilate from February 2016 to January 2018, and the patients who met the inclusion criteria were screened.The proportion of days covered(PDC) of dabigatran etexilate was calculated for patients who were followed up for 3, 6, 9, 12 and 18 months, and the proportion of patients with PDC ≥0.8 was calculated.Statistical analysis of factors affecting medication adherence was performed using SPSS 17.0 statistical software. RESULTS The proportions of patients with PDC values ≥0.8 at 3, 6, 9, 12, and 18 months of follow-up were 75.00%, 59.50%, 51.52%, 49.57%, and 60.42%, respectively.RESULTS show that: history of diabetes mellitus(χ^2=8.316, P=0.004), history of oral anticoagulation use(χ^2=8.764,P=0.003), history of stroke/TIA(χ^2=6.304,P=0.012) were factors significantly associated with the percent of patients with PDC ≥0.8 at 1 year follow up.CONCLUSION The medication compliance of the patients decreased with the prolongation of medication duration and became stable after 1 year. Patients with a history of diabetes, prior anticoagulant use, and stroke/TIA had higher long-term compliance than those without above factors.