Analysis Of Anticoagulant Therapy And Influencing Factors Among Elderly Patients With Atrial Fibrillation In A Community Of Shanghai

OBJECTIVE:This study aims to investigate the anticoagulant therapy compliance,and analyze the risk factors affecting the adherence in elder patients with atrial fibrillation（AF）,based on a community health service center in Shanghai,China.METHODS:A total of 332 cases were collected in this study,including outpatient visits to AF over a 6-month period（2018.11～2019.06）and follow-up elderly patients with AF recorded in the database.Comparison of elderly patients with AF receiving anticoagulant therapy and those who refused anticoagulant therapy.Descriptive statistics,chi-square test and multivariate logistic regression analysis were used to determine the effects of different factors on therapy compliance.Meanwhile,the reason for not receiving anticoagulation and treatment interruption was recorded.RESULTS:332 elderly patients with AF constituted of 193（58.13%）females and 139（41.87%）males were analyzed.Their mean age was78.37±9.37（range 65～107）.Mean CHA₂DS₂-VASc score was 3.91±1.43.High risk group of stroke risk stratification in elderly patients with AF 330（99.40%）.And mean HASBLED score was 2.69±0.88,with a high bleeding risk AF patients 207（62.35%）.Among 332 elderly patients with AF,92（27.71%）received anticoagulant therapy,including novel oral anticoagulants（NOAC）72（21.69%）,warfarin 20（6.02%）.While the other patients（72.29%,240/332）did not take any anticoagulant drugs.Of these patients,86（25.90%）had never received anticoagulant therapy,54（16.27%）drug withdrawal with none special reason,51（15.36%）anticoagulant therapy was replaced by antiplatelet medication,20（6.02%）did not get oral anticoagulant prescription from clinicians,19（5.72%）drug withdrawal because of bleeding events,10（3.01%）received radiofrequency ablation.The results in a univariate analysis showed that age,education level,disease course,diabetes,coronary heart disease（CHD）,number of comorbid diseases,HASBLED scores,antiplatelet agents significantly influence the therapy compliance.The study cases had poor adherence were significantly more advanced age（OR=2.608;95%CI 1.305～5.212）,lower level of literacy（OR=0.284;95%CI 0.142～0.569）,taking antiplatelet medications（OR=36.441;95%CI 13.254～100.188）.CONCLUSIONS:Anticoagulant therapy was greatly underused.Unauthorized withdrawal and drugs replacement is a widespread phenomenon in elder patients with AF under anticoagulation treatment.This study suggests that clinicians should pay more attention to the older,low-education level,receiving antiplatelet therapy elderly patients with AF.