| [Objective]The purpose of this study is to describe prospectively the epidemiological features and the status of antithrombotic therapies in a "real world"single center of a cohort of patients with atrial fibrillation(AF).[Methods]A total of 509 AF patients were prospectively enrolled in the Qingdao District of Qilu Hospital Shandong University during the period of March 2016 to September 2016.We analyzed the epidemiological characteristics,the anticoagulant/antithrombotic treatment rate,embolic risk assessment,embolic and bleeding events during 6 months of follow-up.We also analyzed the main factors affecting the rate of anticoagulant treatment to explore the measures for improving the anticoagulant treatment rate in AF patients with high risk of embolism.[Results]In all 462 AF patients(men 59.3%and women 40.7%,mean age 71.2±12.7 years)finished this observational follow-up,The most common complications were hypertension(71%),diabetic mellitus(23%),coronary artery disease(21%)and heart failure(13%).126(27.3%)subjects were not treated with any antithrombotic drugs,174(37.7%)subjects took antiplatelet drug of aspirin,and 162(35.0%)subjects took oral anticoagulants(OACs),of whom 101(62.3%)ones took warfarin and 51(37.7%)took a non-vitamin K antagonist oral anticoagulant(NOAC)of dabigatran etexilate.Among the 30 patients with valvular AF,24(80%)patients took warfarin,4 patients took aspirin and 2 were not treated with any antithrombotic drugs.For the 432 patients with non-valvular AF,the mean values of CHADS2 score and CHA2DS2-VASc score were 2.1±1.4 and 4.2±1.9,respectively.And for all patients the mean value of HAS-BLED scores was 2.5±1.4.The main reasons why the 126 subjects did not take any antithrombolic medicine included the inconvenience to detect INR values in patients taking warfarin(37%),worrying about thebleeding risk(29%),the high costs of NOACs(21%),and being unaware of the purpose of anticoagulant therapy(13%)and so on.In patients with HAS-BLED scores>5,they all took aspirin and no one took OACs.After a mean follow-up of 6 months,there occurred 38 thromboembolic events with a 8.2%of general embolic incidence.All of the embolic events occurred in non-valvular AF patients,among which 15 events(11.9%)in the untreated group,16(9.2%)in the antiplatelet group and 7(4.3%)in the OACs group(P<0.05).Risk factors,including left atrial diameter,history of prior embolism,advanced age and peripheral arterial diseases,were associated significantly with subsequent thromboembolic events,and multivariate analysis showed that the history of prior embolism markedly increased the risk of embolic events.In comparison with the untreated group,the relative risk of embolic events in the antiplatelet group decreased by 22.7%without no statistically significant difference(P=0.283,OR=0.749,95%Cl 0.356-1.579),whereas the the incidence of embolic events decreased significantly in the OACs group with a decrease of relative risk by 63.9%(P=0.015,OR=0.334,95%CI 0.132-0.847).Although no significant difference of embolic incidence was found between the antiplatelet group and the OACs group,the relative risk of embolism decreased by,53.3%(P=0.059,OR=0.446,95%Cl 0.179-1.114).The incidence of embolism progressively increased with the increases of CHADS2 and CHA2DS2-VASc score values.For patients with and without embolic events,the CHADS2 score values were 3.05± 1.49 versus 2.06± 1.38(P<0.001),and CHA2DS2-VASc score values were 5.53±1.72 versus 4.11 ±1.82(P<0.001)respectively.In the untreated group,the embolic incidence was up to 13.0%in subjects with CHADS2 =0,whereas the embolic incidence was zero in subjects with CHA2DS2-VASc=0 or 1.The C-statistic values calculated by running ROC curve revealed that CHA2DS2-VASc score(0.717,CI 0.635-0.798,P<0.001)was superior to CHADS2 score(0.698,CI 0.608-0.707,P<0.001)in predicting of thromboembolism.A total of 5 major bleeding events occurred:1 in valvular AF patients and 4 in non-valvular patients,3 in the antiplatelet group and 1 in the OACs group.[Conclusions]AF occured mostly in the elderly and its incidence in men were higher than in women.In this study,the rate of anticoagulant treatment was relatively low,and with the increase of CHA2DS2-VASc score,it decreased progressively while the rate of antiplatelet treatment increased.The main reasons why AF patients did not have anticoagulant treatment included the inconvenience to detect INR values in patients taking warfarin,worrying about the bleeding risk,the high costs of NOACs,and being unaware of the purpose of anticoagulant therapy.The antiplatelet therapy failed to notably lower the incidence of thromboembolic events,whereas the anticoagulant therapy could decrease significantly the tromboembolic events.The CHA2DS2-VASc score system has a higher sensitivity over the CHADS2 score system in predicting the embolic risks.In order to improve the rate of anticoagulant therapy and to decrease the incidence of embolic events in AF patients with high risk of embolism,we should improve the physicians’ compliance with the guidelines for the management of AF,promote the NOACs into the national Medcare directories,conduct health educations to AF patients and improve the compliance of patients with the anticoagulant therapy. |
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