Am Heart J：新诊断房颤患者抗凝药应用存在专科差异

　　美国学者的一项研究表明，心脏专科治疗可对新诊断房颤患者的抗凝药物应用产生显著影响，并进而有可能影响临床转归。论文于2012年11月21日在线发表于《美国心脏杂志》（Am Heart J）。

　　此项研究共纳入141642例新诊断房颤患者。受试者在诊断房颤后90天内至少一次就诊于内科/社区门诊或心脏科门诊。受试者平均年龄为（72.3±10.2）岁，女性占1.48%，并且有25.8%曾就诊于心脏科门诊。主要转归为华法林开具状况。

　　结果显示，心脏科经治患者伴有更多共病，并且平均CHADS2评分较高。心脏科经治患者的华法林应用率高于经社区门诊治疗者（P<0.001）。对协变量和诊疗机构等级进行校正后，心脏科治疗与华法林应用具有显著相关性[比值比（OR）2.05]。校正模型、倾向匹配和亚组分析亦得出与之一致的结果。2004～2008年间，仅社区门诊治疗者的华法林应用率呈降低趋势，心脏科经治患者的华法林应用机率则呈升高表现。

Differences and trends in stroke prevention anticoagulation in primary care vs cardiology specialty management of new atrial fibrillation: The Retrospective Evaluation and Assessment of Therapies in AF (TREAT-AF) study

Background

Atrial fibrillation and flutter (AF, collectively) cause stroke. We evaluated whether treating specialty influences warfarin prescription in patients with newly diagnosed AF.

Methods

In the TREAT-AF study, we used Veterans Health Administration health record and claims data to identify patients with newly diagnosed AF between October 2004 and November 2008 and at least 1 internal medicine/primary care or cardiology outpatient encounter within 90 days after diagnosis. The primary outcome was prescription of warfarin.

Results

In 141,642 patients meeting the inclusion criteria, the mean age was 72.3 ± 10.2 years, 1.48% were women, and 25.8% had cardiology outpatient care. Cardiology-treated patients had more comorbidities and higher mean CHADS2 scores (1.8 vs 1.6, P < .0001). Warfarin use was higher in cardiology-treated vs primary care only–treated patients (68.6% vs 48.9%, P < .0001). After covariate and site-level adjustment, cardiology care was significantly associated with warfarin use (odds ratio [OR] 2.05, 95% CI 1.99-2.11). These findings were consistent across a series of adjusted models (OR 2.05-2.20), propensity matching (OR 1.98), and subgroup analyses (OR 1.58-2.11). Warfarin use in primary-care-only patients declined from 2004 to 2008 (51.6%-44.0%, P < .0001), whereas the adjusted odds of warfarin receipt with cardiology care (vs primary care) increased from 2004 to 2008 (1.88-2.24, P < .0001).

Conclusion

In patients with newly diagnosed AF, we found large differences in anticoagulation use by treating specialty. A divergent 5-year trend of risk-adjusted warfarin use was observed. Treating specialty influences stroke prevention care and may impact clinical outcomes.