高龄老年非瓣膜病心房颤动患者口服新型抗凝药依从性影响因素分析

Compliance of new oral anticoagulants in elderly patients with non-valvular atrial fibrillation:an analysis on influence factors

目的分析高龄老年非瓣膜病心房纤颤(房颤)患者口服新型抗凝药依从性及影响因素。方法回顾性分析2014年2月至2019年2月于解放军总医院第一、二临床中心诊断为非瓣膜病房颤,并口服新型口服抗凝药的高龄老年(年龄≥80岁)728例患者病例资料,其中男性373例,女性355例,年龄80~98岁;治疗1年后随访,参考Mofisky-Green(MG)测评表进行依从性评判,分为依从性好(476例)和依从性差(252例)2组。结果高龄老年非瓣膜病房颤患者口服新型口服抗凝药依从性在冠心病史、房颤类型、心力衰竭(NYHA≥Ⅲ级)、恶性肿瘤、CHA2DS2-VASc≥5分、药物≥5种、脑卒中、出血上的差异有统计学意义(P均<0.05)。经多因素Logistic回归分析后发现,冠心病(OR=405.98,95%CI:64.797~2526.332)、出血(OR=0.07,95%CI:0.021~0.27)、阵发性房颤(OR=0.11,95%CI:0.033~0.389)、脑卒中(OR=19.38,95%CI:3.705~101.393)、CHA2DS2-VASc≥5分(OR=0.05,95%CI:0.016~0.138)、恶性肿瘤(OR<0.01,95%CI:0.000~0.004)为服药依从性的影响因素。结论高龄老年非瓣膜病房颤患者服用新型口服抗凝药的依从性差者影响因素较多,需针对相关因素实施干预,改善抗凝质量。

Objective To analyze the compliance and influence factors of new oral anticoagulants(NOAC)in elderly patients with non-valvular atrial fibrillation(NVAF).Methods The clinical materials were analyzed retrospectively in elderly patients(n=728,aged≥80,male n=373Female n=355 and aged from 80 to 98)taking NOAC chosen from the First and Second Medical Centers of Chinese PLA General Hospital from Feb.2014 to Feb.2019.After treatment for 1 y,all patients were followed up.The compliance was reviewed according to Mofisky-Green(MG),and the patients were divided into good compliance group(n=476)and poor compliance group(n=252).Results The compliance of NOAC had difference in history of coronary heart disease(CHD),types of atrial fibrillation,heart failure(NYHA≥gradeⅢ),malignant tumor,CHA2DS2-VASc≥5,drugs≥5,stroke and bleeding had statistical significance(all P<0.05)in elderly patients with NVAF.The results of multi-factor Logistic regression analysis showed that CHD(OR=405.98,95%CI:64.797~2526.332),bleeding(OR=0.07,95%CI:0.021~0.27),paroxysmal atrial fibrillation(OR=0.11,95%CI:0.033-0.389),stroke(OR=19.38,95%CI:3.705~101.393),CHA2DS2-VASc≥5(OR=0.05,95%CI:0.016~0.138)and malignant tumor(OR<0.01,95%CI:0.000~0.004)were influence factors of compliance.Conclusion Poor compliance of NOAC is affected by many factors in elderly patients with NVAF,and relative interventions should be carried out for improve anticoagulation quality.