白内障术前房颤人群综合路径管理现状横断面调查

Current status of comprehensive pathway management atrial fibrillation before cataract surgery:a cross-sectional survey

目的 调查白内障术前房颤人群房颤综合路径管理及卒中认知现状,分析危险因素,优化及推动综合路径管理,预防和降低卒中风险。方法 选取2021年6月至2022年3月眼科白内障术前心电图检查诊断为房颤的人群。对白内障术前房颤人群发放自制房颤综合路径管理及卒中认知的调查问卷,CHA2DS2-VASc评分,应用SPSS 22.0统计软件进行统计学分析。结果 发放自制房颤综合路径管理及卒中认知调查问卷133份,收回133份,有效问卷133份,有效率100%。被调查的白内障术前房颤人群年龄60~95岁,平均年龄(76.83±7.452)岁,房颤人群患病占比为1.44%,房颤患者随年龄增长而增加,男性多于女性。白内障术前房颤人群综合路径管理知晓率及卒中认知率为36.09%,遵循综合路径管理的患者12.03%。抗凝抗血小板治疗率为36.09%,节律控制治疗率为64.66%,卒中率11.28%。白内障术前房颤人群中61.65%的患者有伴随疾病,这其中24.06%的患者同时伴有2种及以上的伴随疾病。133例房颤患者中有66.17%的患者伴随疾病控制不满意,59.40%的患者存在不健康生活方式,54.88%的患者有不良嗜好。CHA2DS2-VASc评分中高风险患者占73.68%。结论 白内障术前房颤人群高龄、伴随疾病高血压、糖尿病以及既往有卒中史,是导致房颤人群卒中风险升高的主要危险因素。对房颤综合路径管理认知度差,卒中知识匮乏认知率低,发现房颤后早期抗凝治疗率低,伴随疾病多且控制不满意,不健康生活方式,不良嗜好等因素是房颤人群卒中风险的潜在危险因素。既往有卒中史未遵循综合路径管理的白内障房颤患者是再卒中高风险人群。应加强白内障术前房颤人群房颤认知的健康教育,指导优化并推动综合路径管理策略。

Objective To investigate the status of comprehensive pathway management of atrial fibrillation and stroke cognition in a pre-cataract atrial fibrillation population, analyze the associated risk factors, optimize and promote comprehensive pathway management, and prevent and reduce the risk of stroke. Methods From June 2021 to March 2022, a self-made questionnaire on the comprehensive pathway management of atrial fibrillation and stroke cognition was provided to patients with atrial fibrillation before cataract surgery. The CHA2 DS2-VASc score was used for statistical analysis using the SPSS 22.0 statistical software. Results We distributed 133 self-made questionnaires on comprehensive pathway management of atrial fibrillation and stroke cognition, and recovered 133 valid responses;the effective rate was 100%. The age of the investigated preoperative atrial fibrillation population was 60-95 years old,(average age: 76.83±7.452 years), and the prevalence rate of atrial fibrillation was 1.44%. The number of patients with atrial fibrillation increased with age, with more men than women. The awareness rate of comprehensive pathway management and the stroke awareness rate in the pre-cataract atrial fibrillation population was 36.09%, and patients who followed the comprehensive pathway management accounted for 12.03%. The anticoagulation/antiplatelet treatment, rhythm control treatment, and stroke rates were 36.09%, 64.66%, and 11.28%, respectively, while 61.65% of the patients with atrial fibrillation before cataract surgery had concomitant diseases, and 24.06% had two or more concomitant diseases simultaneously. Among 133 patients with atrial fibrillation, 66.17% had unsatisfactory disease control, 59.40% had unhealthy lifestyles, and 54.88% had bad habits. High-risk patients accounted for 73.68% in the CHA2 DS2-VASc score. Conclusion Among elderly individuals who experience atrial fibrillation before cataract surgery, along with poor awareness of comprehensive management of atrial fibrillation, lack of knowledge about stroke, low rate of early anticoagulation treatment after the identification of atrial fibrillation, many concomitant diseases and unsatisfactory control, unhealthy lifestyle and bad habits are major and potential risk factors for stroke. Cataract and atrial fibrillation patients with a history of stroke who do not follow the comprehensive pathway management are at high risk of re-stroke. Health education on atrial fibrillation cognition in pre-cataract patients with atrial fibrillation should be reinforced to guide optimization and promote comprehensive pathway management strategies.