The Use Status Of Anticoagulation Drugs For Patients With Nonvalvular Atrial Fibrillation In Hospitals Of Chongqing: A Cross-sectional Study

Objective: This study aimed to investigate the use of anticoagulation therapy for inpatients with nonvalvular atrial fibrillation in Chongqing, a city in Southwest China, and offer ideas to optimize the anticoagulation management of atrial fibrillation.Methods: As a cross-sectional study, a total of 4760 hospitalized patients with atrial fibrillation were enrolled from 21 hospitals of the Chongqing city from January 1, 2013 to December 31, 2013. The following characteristics were collected from their medical records: age, sex, type of AF, co-existing diseases, anticoagulant strategy, international normalized ratio(INR) values, and reasons for underuse oral anticoagulant. CHADS2, CHA2DS2-VASc, and HASBLED scores were computed based on those data collected. All statistical analyses were performed using SPSS 20.0.Results: This study mainly analyzed 3785 of hospitalized patients with nonvalvular atrial fibrillation(female 55.2%), the mean age was 74.4±10.1 years, and 56.1% of them were ≥75 years of age. 27.3% of all the enrolled patients were paroxysmal AF and the other 72.7% were persistent/permanent AF. The mean CHADS2 score of all the subjects was 2.60±1.34 and the percentages of patients got 0, 1, and ≥2 were 4.0%, 15.3% and 80.7%, respectively. Oral anticoagulants(OACs) were prescribed for only 11.5% of the patients. Compared with those from tertiary hospitals, patients from secondary hospitals were prescribed much less OACs(6.1% vs.16.7%, P<0.001). The main reason for not prescribing OACs to patients at a high risk of stroke(CHADS2 score of ≥2) was physician’s choices. Among all the warfarin-treated patients, only 13.5% reached the target INR(INR 2.00~3.00), and more than 60% had an INR lower than 1.50 during their hospital stay.Conclusion: This study demonstrated that the underuse of anticoagulation therapy in patients with AF is particularly serious in Chongqing, especially in secondary hospitals. Urgent and effective measures are desperately needed to improve the alarming situation in China.