Epidemiology of Anticoagulation in Atrial Fibrillation

房颤抗凝的流行病学

• 批准号: 6326464
• 负责人: DANIEL EDWIN SINGER
• 金额: $ 78.91万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 1997
• 资助国家: 美国
• 起止时间: 1997-09-30 至 2006-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6326464
• 关键词: aging; anticoagulants; atrial fibrillation; automated medical record system; cardiovascular disorder epidemiology; cardiovascular disorder prevention; cardiovascular disorder therapy; clinical research; disease /disorder proneness /risk; disease /therapy duration; estrogens; health care facility information system; hormone therapy; human data; human old age (65+); human subject; human therapy evaluation; human very old age (85+); longitudinal human study; prevention; stroke; therapy compliance; thromboembolism; warfarin

We propose to continue our studies of a uniquely informative cohort of greater than 13,559 patients with atrial fibrillation (AF) from Kaiser Medical Care Program of Northern California ("Kaiser"). Our overall goal remains to optimize prevention of stroke in AF by improving selection of patients treated with anticoagulants, and by improving the management of anticoagulation. AF is the most common significant cardiac rhythm disorder. Its frequency increases strikingly with age, reaching a prevalence of nearly 10 percent in those over age 80. AF is also a powerful risk factor for stroke, raising this risk 5-fold. Randomized trials (RCTs) have established that anticoagulation largely removes the stroke risk posed by AF. Nonetheless, warfarin remains a burdensome and risky therapy. There is considerable uncertainty whether warfarin therapy will prove beneficial under real-world conditions. Guidelines call for long-term anticoagulation, and for use of anticoagulants in the elderly. Yet, the RCTs were relatively brief, with a mean follow-up of only 18 months, and few patients greater than or equal to 80 years old were studied. During the 2.7 years of current funding we have established methods to assemble a very large AF cohort, characterize baseline features and warfarin status, and follow for thromboembolic and hemorrhagic events. This has been accomplished efficiently via comprehensive automated clinical and administrative Kaiser databases supplemented by medical chart review. Continued follow-up of our AF cohort will provide unique assessments of both the long-term impact of anticoagulation and the impact of anticoagulation among the oldest patients with AF. Further, we will be able to address other important controversies including the need for anticoagulation in patients greater than or equal to 65 years old without other risk factors for stroke, and the optimal intensity of anticoagulation in older AF patients. In addition, we will address the provocative new finding that estrogen replacement therapy substantially raises the risk of stroke among women with AF. In all, continued study of our cohort will efficiently provide powerful insights into optimizing stroke prevention strategies for the many older Americans with AF.

我们建议继续研究北加州Kaiser医疗保健计划（“ Kaiser”）的13,559例心房颤动（AF）患者的独特信息。 我们的总体目标仍然是通过改善用抗凝剂治疗的患者的选择以及改善抗凝治疗的治疗，以优化预防AF中的中风。 AF是最常见的严重心律障碍。 它的频率随着年龄的增长而显着增加，在80岁以上的年龄中达到了近10％。AF也是中风的强大危险因素，使这种风险增加了5倍。随机试验（RCT）已经确定，抗凝可在很大程度上消除AF带来的中风风险。尽管如此，华法林仍然是一种繁重而有风险的疗法。在现实情况下，华法林治疗是否会有益，存在很大的不确定性。 指南要求长期抗凝，并在老年人中使用抗凝剂。 然而，RCT相对简短，平均随访仅为18个月，很少有人研究大于或等于80岁的患者。 在当前资金的2。7年中，我们建立了组装非常大的AF队列的方法，表征了基线特征和华法林的状态，并遵循血栓栓塞和出血事件。通过医学图审查补充的全面自动化临床和行政KAISER数据库，已有效地实现了这一点。 对AF队列的持续随访将对抗凝作用的长期影响和抗凝作用的长期影响提供独特的评估。 此外，我们将能够解决其他重要的争议，包括大于或等于65岁的患者的抗凝需求，而没有其他中风的危险因素，以及老年AF患者的最佳抗凝强度。 此外，我们将解决挑衅性的新发现，即雌激素替代疗法大大增加了AF女性中风的风险。 总的来说，对我们的队列的持续研究将有效地为许多AF的美国老年人优化预防中风策略，从而有效地提供有力的见解。