作者：曹悦，冯悦悦，杜为，贺彤彤，王萌，李静，费亚兰，杨浩，董庆山，李世杰，李先进，韩冰

单位：

1.221009江苏省徐州市中心医院心脏诊疗中心 2.233099安徽省蚌埠市第一人民医院心内科 3.233030安徽省蚌埠市，蚌埠医学院研究生院 通信作者：韩冰，E-mail：hbing777@hotmail.com

Units：

1.Division of Cardiology, Xuzhou Central Hospital, Xuzhou 221009, China 2.Department of Cardiology, Bengbu First People's Hospital, Bengbu 233099, China 3.Graduate School of Bengbu Medical College, Bengbu 233030, China Corresponding author: HAN Bing, E-mail: hbing777@hotmail.com

关键词：

心房颤动; 老年人; 口服抗凝药; 影响因素分析; 人口学特征;

Keywords：

Atrial fibrillation; Aged; Oral anticoagulants; Root cause analysis; Demographic characteristics

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.110

Funds：

江苏省干部保健科研课题（BJ19007）

摘要：

目的 分析人口学特征对老年非瓣膜性心房颤动(以下简称房颤)住院患者出院时被处方口服抗凝药(OAC)的影响。方法 本研究为回顾性研究。选取2017年7月至2019月12月在徐州市中心医院心内科住院的老年(年龄≥75岁)非瓣膜性房颤患者752例,根据出院时是否被处方OAC将患者分为被处方OAC组(n=469)和未被处方OAC组(n=283),被处方OAC组又被分为华法林亚组(n=271)和新型口服抗凝药(NOAC)亚组(n=198)。收集所有患者的病例资料,包括人口学特征、临床特征、实验室和影像学检查结果、其他药物使用情况。老年非瓣膜性房颤住院患者出院时被处方OAC的影响因素分析采用多因素Logistic回归分析。结果 本组患者未被处方OAC者占比为37.6%(283/752)。未被处方OAC组和被处方OAC组患者年龄、居住地、医保类型、受教育程度、房颤类型、房颤发病时间、有脑卒中史者占比、有肿瘤史者占比、有出血史者占比、经皮冠状动脉介入治疗(PCI)史、HAS-BLED出血风险评分、肌酐、左心房前后径及使用控制心室率药物、抗血小板药物者占比比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄、居住地、受教育程度为初中及以上、房颤类型、有脑卒中史、有肿瘤史、有出血史、肌酐及使用抗血小板药物是老年非瓣膜性房颤住院患者出院时被处方OAC的影响因素(P<0.05)。NOAC亚组患者年龄为75～79岁、居住地为农村、医保类型为城乡居民医保、受教育程度为小学及以下者占比低于华法林亚组,受教育程度为初中及高中、专科及以上者占比高于华法林亚组(P<0.05)。结论 37.6%的老年非瓣膜性房颤住院患者出院时未被处方OAC。年龄、居住地及受教育程度是老年非瓣膜性房颤住院患者出院时被处方OAC的影响因素,而华法林仍是目前最常用的OAC,尤其是居住地为农村、医保类型为城乡居民医保、受教育程度为小学及以下的患者。

Abstract：

【Abstract】　Objective To analyze the influence of demographic characteristics on the prescriptions of oralanticoagulants (OAC) at discharge in elderly hospitalized patients with non-valvular atrial fibrillation (NVAF) . Methods A totalof 752 elderly patients (75 years and over) with NVAF hospitalized in Department Cardiology of Xuzhou Central Hospital from July2017 to December 2019 were enrolled in this retrospective study. The patients were divided into OAC prescription group (n=469)and OAC non-prescription group (n=283) based on medical orders at discharge. In the OAC prescription group, warfarin andnovel oral anticoagulants (NOAC) were prescribed for 271 and 198 patients, respectively. The case data, including demographiccharacteristics, clinical features, laboratory and imaging findings, and use of other medications were collected. MultivariateLogistic regression analysis was used to identify the influencing factors of prescriptions of OAC in elderly hospitalized patientswith NVAF. Results In this study, 37.6% (283/752) of patients enrolled were not prescribed OAC at discharge. There weresignificant differences in age, living location, type of health insurance, education level, type of atrial fibrillation, duration of atrialfibrillation, the proportion of patients with stroke history, tumor history and bleeding history, history of percutaneous coronaryintervention, HAS-BLED bleeding risk score, creatinine, left atrial diameter, the proportion of patients using antiarrhythmicdrugs and antiplatelet agents between OAC prescription group and OAC non-prescription group (P < 0.05) . Multivariate Logisticregression analysis showed that age, living location, education level of junior middle school or above, type of atrial fibrillation,history of stroke, history of tumor, history of bleeding, creatinine, and use of antiplatelet agents were influencing factors of the OACprescription in elderly hospitalized patients with NVAF at discharge (P < 0.05) . Compared to the patients prescribed warfarin, theproportion of patients aged 75 to 79, living in rural areas, having medical insurance for urban and rural residents, with educationlevel of primary school and below in patients prescribed NOAC was lower, and the proportion of patients with education level ofjunior and senior high school, junior college or above was higher (P < 0.05) . Conclusion There were 37.6% of elderly patientswith NVAF not prescribed OAC at discharge. Age, living location and education level are the influencing factors of prescription ofOAC in elderly hospitalized patients with NVAF. Warfarin is still the most commonly used OAC at present, especially for patientswith medical insurance for urban and rural residents, living in rural areas and education level of primary school or below.

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