Study On The Management Status Of Hospitalized Elderly Patients With Non-valvular Atrial Fibrillation In Dali

Objective: To investigate the clinical characteristics and current status of anticoagulant therapy in hospitalized elderly patients with non-valvular atrial fibrillation(NVAF)in Dali area,and to analyze the influencing factors.Methods: Elderly patients with non-valvular atrial fibrillation aged ≥60 years old were hospitalized in the Geriatrics Department of the First Affiliated Hospital of Dali University from July 1,2020,to December 31,2021,were collected through medical record data collection and telephone questionnaire survey.A total of 208 hospitalized elderly patients with atrial fibrillation were included,including 166 patients with atrial fibrillation in Dali Prefecture,155 patients with NVAF(93.37%),and 11 patients with valvular atrial fibrillation.155 NVAF patients in the Dali prefecture were analyzed for awareness rate of atrial fibrillation,clinical characteristics,rate of anticoagulant therapy,and influencing factors.One year after discharge,a telephone follow-up was conducted to investigate the survival status,rehospitalization treatment,anticoagulant therapy,cerebrovascular events,and bleeding events.The t-test,chi-square test,and Logistic regression analysis were used comprehensively to analyze the baseline data and clinical characteristics of patients in the anticoagulant treatment group and non-anticoagulant treatment group at the time of admission,discharge,and one year after discharge,and the Cox proportional hazards regression model was used to analyze the NVAF patients Risk factors for all-cause mortality one year after discharge.Result1.The average age of 155 NVAF patients in Dali Prefecture was 75.77 years old;The155 patients included 77 cases(49.68%)of Han ethnic group,62 cases of Bai ethnic group(40.00%),16 cases of other ethnic minorities(10.32%),45 cases(29.03%)of smokers,22 cases(14.19%)were alcohol drinkers;the average CHA2DS2-VASC score was 5.26,and the average HAS-BLED score was 2.28.2.The awareness rate of atrial fibrillation at admission was 47.74%,and the anticoagulation treatment rate was 21.94%;the use rate of new oral anticoagulants was 70.59%,and the antiplatelet treatment rate was 11.61%,of which aspirin accounted for 77.78%,clopidogrel accounted for 16.67%.The anticoagulant treatment rate for atrial fibrillation at discharge was 70.97%,of which 89.09%used new oral anticoagulants,and 22.58% used antiplatelet therapy,of which aspirin accounted for 68.57%,and clopidogrel accounted for 31.43%.Logistic regression analysis found that thromboembolic disease(OR=70.014,95%CI3.220 ～ 1522.320,P=0.007),persistent atrial fibrillation(OR=4.052,95%CI1.172 ～ 14.007,P=0.027)Predicted anticoagulant therapy.Male patients(OR=0.232,95%CI 0.061-0.880,P=0.032),previous bleeding history(OR=0.014,95%CI 0.002-0.098,P<0.001),antiplatelet therapy(OR=0.048,95 %CI 0.013～0.168,P<0.001)was the predictor of no anticoagulant treatment at discharge.3.One hundred thirty-three patients were followed up for one year after discharge,of which 31 died(23.31%).One year later,the anticoagulant treatment rate for atrial fibrillation was only 51.96%.Logistic regression analysis showed that thromboembolic disease(OR = 212.536,95%CI 7.110-6352.904,P=0.002),stroke history(OR=48.251,95% CI 2.054-1133.352,P=0.016),persistent atrial fibrillation(OR=12.656,95%CI 2.861-55.984,P = 0.001)were the predictors of anticoagulant treatment after one year.Bleeding history(OR = 0.082,95% CI 0.011-0.616,P =0.015)predicted no anticoagulant treatment after one year.Cox proportional hazards regression model analysis showed that age(HR=1.057,95%CI1.005-1.111,P=0.031),New York Heart Function Class IV(HR=2.503,95%CI1.148-5.458,P=0.021)were Risk factors for all-cause mortality in NVAF patients.Among the reasons for not taking anticoagulant treatment within one year after discharge,27.03% of the patients said they did not know that they needed to take medicine for a long time,24.32% of the patients felt that the effect of taking medicine was not good,10.81% of the patients stopped taking medicine after their symptoms improved,and 10.81% of the patients had bleeding.4.During the 1-year follow-up after discharge,there were 4 cases of new cerebral infarction,of which 3 cases were not treated with anticoagulant therapy,1 case was treated with anticoagulant therapy,and 4 cases of new bleeding occurred,of which 2 cases were treated with anticoagulant therapy and 2 cases were treated with antiplatelet therapy.Conclusion: The awareness rate of atrial fibrillation and the rate of anticoagulant treatment are low in elderly patients with non-valvular atrial fibrillation in the Dali area,and the risk of stroke is high;the rate of anticoagulant treatment is high at discharge,but the all-cause mortality rate within one year is also high.The rate of anticoagulant therapy decreased significantly after discharge,and it is urgent to establish an effective,comprehensive intervention strategy to standardize the management of patients with atrial fibrillation and improve the prognosis.