Abstract：
Adherence to guideline-directed oral anticoagulation (OAC) in patients with atrial fibrillation (AF) improves outcomes, but limited data are available from China. We evaluated the adherence to guideline-directed anticoagulation and its impact on clinical outcomes in a high-risk cohort of elderly Chinese patients.
The Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry is a prospective, multicentre study conducted from October 2014 to December 2018. Endpoints of interest were all-cause death, thromboembolic (TE) events and major bleedings in patients with a guideline-directed indication for OACs (CHA2DS2-VASc ≥1 if male or ≥2 if female). The eligible cohort consisted of 5742 patients, of whom 2567 (44.7%) patients were treated with an OAC. Seven independent predictors of OAC undertreatment were identified: age [odds ratio (OR): 1.04; 95% confidence interval (CI): 1.03-1.05; P < 0.001], first diagnosed AF (OR: 1.71; 95%CI: 1.44-2.03; P < 0.001), chronic kidney disease (OR: 1.67; 95%CI: 1.36-2.06; P < 0.001), liver disease (OR: 1.69; 95%CI: 1.19-2.41; P = 0.003), dementia (OR: 1.67; 95%CI: 1.06-2.64; P = 0.026), prior extracranial bleeding (OR: 1.89; 95%CI: 1.35-2.64; P < 0.001), and the use of antiplatelet drug (OR: 6.97; 95%CI: 5.89-8.23; P < 0.001). On multivariate analysis, OAC undertreatment was significantly associated with a higher risk all-cause death (OR: 3.79; 95%CI: 2.61-5.53; P < 0.001) and TE events (OR: 2.28; 95%CI: 1.39-3.72; P = 0.001), and a similar risk of major bleeding as compared with guideline-directed OAC therapy.
Only 44.7% of all eligible patients were prescribed OAC in accordance with guideline recommendations. The independent predictors for OAC undertreatment were age, first diagnosed AF, chronic kidney disease, chronic obstructive pulmonary disease, prior extracranial bleeding, and the use of the antiplatelet drugs. Guideline-adherent thromboprophylaxis was safe and may be associated with improved survival and less TE among elderly Chinese patients with AF.
The Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry is a prospective, multicentre study conducted from October 2014 to December 2018. Endpoints of interest were all-cause death, thromboembolic (TE) events and major bleedings in patients with a guideline-directed indication for OACs (CHA2DS2-VASc ≥1 if male or ≥2 if female). The eligible cohort consisted of 5742 patients, of whom 2567 (44.7%) patients were treated with an OAC. Seven independent predictors of OAC undertreatment were identified: age [odds ratio (OR): 1.04; 95% confidence interval (CI): 1.03-1.05; P < 0.001], first diagnosed AF (OR: 1.71; 95%CI: 1.44-2.03; P < 0.001), chronic kidney disease (OR: 1.67; 95%CI: 1.36-2.06; P < 0.001), liver disease (OR: 1.69; 95%CI: 1.19-2.41; P = 0.003), dementia (OR: 1.67; 95%CI: 1.06-2.64; P = 0.026), prior extracranial bleeding (OR: 1.89; 95%CI: 1.35-2.64; P < 0.001), and the use of antiplatelet drug (OR: 6.97; 95%CI: 5.89-8.23; P < 0.001). On multivariate analysis, OAC undertreatment was significantly associated with a higher risk all-cause death (OR: 3.79; 95%CI: 2.61-5.53; P < 0.001) and TE events (OR: 2.28; 95%CI: 1.39-3.72; P = 0.001), and a similar risk of major bleeding as compared with guideline-directed OAC therapy.
Only 44.7% of all eligible patients were prescribed OAC in accordance with guideline recommendations. The independent predictors for OAC undertreatment were age, first diagnosed AF, chronic kidney disease, chronic obstructive pulmonary disease, prior extracranial bleeding, and the use of the antiplatelet drugs. Guideline-adherent thromboprophylaxis was safe and may be associated with improved survival and less TE among elderly Chinese patients with AF.
摘要：
目的：房颤（AF）患者坚持指南指导的口服抗凝治疗（OAC）可改善预后，但来自中国的数据有限。我们在中国老年患者的高风险队列中评估了指南指导抗凝治疗的依从性及其对临床结局的影响。
结果：中国老年心房颤动患者（ChiOTEAF）的最佳血栓预防是前瞻性的，2014年10月至2018年12月进行的多中心研究。感兴趣的终点是全因死亡，有OAC指南指征的患者的血栓栓塞(TE)事件和严重出血(CHA2DS2-VASc≥1,如果男性,或≥2,如果女性).符合条件的队列包括5742名患者，其中2567例（44.7%）患者接受了OAC治疗。确定了OAC治疗不足的七个独立预测因素：年龄[优势比（OR）：1.04;95％置信区间（CI）：1.03-1.05;P<0.001]，首次诊断房颤（OR：1.71;95CI：1.44-2.03;P<0.001），慢性肾脏病（OR：1.67;95CI：1.36-2.06;P<0.001），肝病（OR：1.69;95CI：1.19-2.41;P=0.003），痴呆（OR：1.67;95CI：1.06-2.64;P=0.026），既往颅外出血（OR：1.89;95CI：1.35-2.64;P<0.001），使用抗血小板药物(OR:6.97;95CI:5.89-8.23;P<0.001)。在多变量分析中，OAC治疗不足与更高风险的全因死亡（OR：3.79;95CI：2.61-5.53;P<0.001）和TE事件（OR：2.28;95CI：1.39-3.72;P=0.001）显着相关，与指南指导的OAC治疗相比，大出血风险相似。
结论：所有符合条件的患者中只有44.7％根据指南建议进行了OAC。OAC治疗不足的独立预测因素是年龄，首次诊断为房颤，慢性肾病,慢性阻塞性肺疾病,先前的颅外出血,以及抗血小板药物的使用。在中国老年房颤患者中，遵循指南的血栓预防是安全的，可能与改善生存率和减少TE有关。
结果：中国老年心房颤动患者（ChiOTEAF）的最佳血栓预防是前瞻性的，
结论：所有符合条件的患者中只有44.7％根据指南建议进行了OAC。
