| Objective: In this study,according to the medical orders and medical records of patients at discharge,by incorporating more influencing factors(including demographic information and clinical case data),the selected patients(patients in the prescribed OAC group)were followed up for a long time,and further in-depth analysis of the factors affecting the anticoagulation treatment and poor adherence to long-term medication of elderly patients with atrial fibrillation in China was carried out to provide a basis for improving the utilization rate of OAC in elderly patients with atrial fibrillation and preventing the occurrence of atrial fibrillation stroke.Methods: Elderly(age ≥75 years)patients with non-valvular atrial fibrillation who were hospitalized in our hospital from January 2017 to December 2019 were divided into the prescribed OAC group and the unprescribed OAC group according to the discharge doctor’s order.Demographic information and clinical data were included in the Logistic regression model for analysis to determine the influencing factors of prescription OAC in elderly patients with atrial fibrillation.The patients in the prescription OAC group were followed up to ask whether the patients were discontinued and the reasons for discontinuation.Demographic information and clinical data were included in the COX regression model for analysis to determine the influencing factors of discontinuation of OAC in elderly patients with atrial fibrillation.Results: A total of 752 elderly patients with AF were enrolled,aged(81.1 ± 4.3)years,and 388(51.5%)were male.At discharge,469 patients were prescribed OAC(62.4%),and the results of logistic multiple regression analysis showed that residence in town(OR=1.942),specialized and above education(OR=3.654),persistent AF(OR=2.680),and history of stroke(OR=2.566)were positively associated with being prescribed OAC,with age > 80 years(OR=0.402),tumor history(OR=0.055),bleeding history(OR=0.145),and serum creatinine(OR=0.992),antiplatelet medication use(OR=0.132)were negatively associated with being prescribed OAC.During 6-35 months follow-up(median 20 months),281(59.9%)patients were adherent to their medication.The common reasons for the discontinuation of anticoagulants are that patients and their families think that anticoagulant therapy is too troublesome,patients and their families have insufficient understanding of the necessity of anticoagulant therapy,and the economic cost of anticoagulant therapy exceeds the affordability of patients.Cox multivariate regression analysis showed that cardiac device implantation(HR=1.999),use of antiarrhythmic drugs(HR=2.401),and antiplatelet use(HR=2.947)were positively associated with OAC discontinuation,while employee Medicare(HR=0.608),living with children(HR=0.760),specialized and above education(HR=0.037)and large left atrial anteroposterior diameter(HR=0.971)were negatively associated with OAC discontinuation.Conclusions:(1)In the elderly population with atrial fibrillation,patients receiving anticoagulant therapy at discharge have reached a high level(62.4%),but a considerable number of patients are still unable to adhere to medication for a long time(40.1%).(2)Similar to the use of antiplatelet drugs and other clinical factors affecting the use of anticoagulants and long-term medication compliance in elderly patients with atrial fibrillation,demographic factors such as low educational level and non-staff medical insurance also affect the use of anticoagulants and long-term medication compliance in elderly patients with atrial fibrillation,which should be taken into account in future work in order to further increase the proportion of anticoagulant treatment among older patients with AF. |
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