县级医院非瓣膜性心房颤动住院患者抗凝治疗影响因素分析

Factors influencing anticoagulation therapy for patients with nonvalvular atrial fibrillation in a county-level hospital

目的:探讨县级医院非瓣膜性心房颤动(NVAF)住院患者抗凝治疗影响因素。方法:回顾性分析广德市人民医院收治的416例NAVF患者的临床资料,根据是否应用口服抗凝药分为抗凝组214例和未抗凝组202例,新型口服抗凝药物(NOAC)治疗的170例患者根据剂量是否符合欧洲心律协会指南推荐,分为标准剂量组25例与非标准剂量组145例,经单因素和多因素logistic回归分析,筛选出抗凝治疗及NOAC剂量的影响因素。结果:416例NVAF患者中男性245例,平均年龄(76.3±7.6)岁,CHA2DS2-VASc评分为(4.3±1.6)分,HAS-BLED评分为(1.9±0.9)分。多因素logistic回归分析显示,与未抗凝组相比,抗凝组NVAF患者卒中风险高危、收住心内科、合用β受体阻滞剂和肾素-血管紧张素系统(RAS)抑制剂的比例更高(OR=2.87、1.01、1.83、1.80、3.27,P均<0.05)。与标准剂量组相比,非标准剂量组患者年龄≥75岁、肾小球滤过率降低的比例更高(OR=0.08、0.97、P均<0.05)。结论:县级医院NVAF患者的抗凝治疗明显不足,卒中风险高危、收住心内科、合并应用β受体阻滞剂和RAS抑制剂是提高抗凝治疗率的有利因素。年龄大于75岁、肾功能减低是使用NOAC非标准剂量的独立影响因素。

Objective:To explore the possible factors influencing anticoagulation therapy for patients with nonvalvular atrial fibrillation(NVAF)in a county-level hospital.Methods:Clinical data of 416 patients with NAVF admitted to Guangde People's Hospital were retrospectively analyzed.Among them,214 patients received anticoagulant medications,and the remaining 202 patients were not treated by anticoagulation therapy.New oral anticoagulant agents(NOAC)were prescribed in 170 patients using standard(n=25)or non-standard dose(n=145)according to the recommendation of European Heart Rhythm Association guidelines.Possible factors influencing anticoagulation therapy and the dosage of NOAC were screened by univariate and multivariate logistic regression analysis.Results:In total,there were 245 males and 171 females,with an average age of(76.3±7.6)years.The CHA2DS2-VASc score was(4.3±1.6)and the HAS-BLED score was(1.9±0.9),respectively.Compared to non-anticoagulation therapy group,the proportion of NVAF patients with high stroke risk,admission to the Department of Cardiology,and concomitant use ofβblockers and RAAS inhibitors were higher in anticoagulation therapy group(OR=2.87,1.01,1.83,1.80 and 3.27,respectively,P<0.05).Furthermore,the proportion of patients older than 75 years or reduced glomerular filtration rate was higher in nonstandard-dose group compared to the standard-dose group(OR=0.08 and 0.97,respectively,P<0.05).Conclusion:Anticoagulation therapy for NVAF patients was obviously insufficient in the county-level hospital.High risk for strok and use ofβ-blocker or RAAS inhibitors were favorable factors to improve the anticoagulant rate.Age over 75 years and reduced renal function were independent factors for use of NOAC with non-standard dosage.