Epidemiology of Anticoagulation in Atrial Fibrillation

房颤抗凝的流行病学

• 批准号: 6631525
• 负责人: DANIEL EDWIN SINGER
• 金额: $ 80.86万
• 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/6631525
• 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.

我们建议继续对北加州凯撒医疗护理计划（“Kaiser”）超过 13,559 名房颤 (AF) 患者的独特信息队列进行研究。 我们的总体目标仍然是通过改善抗凝治疗患者的选择以及改善抗凝管理来优化房颤卒中预防。 AF 是最常见的严重心律失常。 它的发生率随着年龄的增长而显着增加，在 80 岁以上的人群中，患病率接近 10%。房颤也是中风的一个强大危险因素，使这种风险增加 5 倍。随机试验 (RCT) 已证实抗凝治疗可在很大程度上消除 AF 引起的中风风险。尽管如此，华法林仍然是一种繁琐且危险的治疗方法。华法林治疗在现实条件下是否有效尚存在相当大的不确定性。 指南要求长期抗凝，并在老年人中使用抗凝剂。 然而，随机对照试验相对较短，平均随访时间仅为18个月，并且很少研究80岁以上的患者。 在目前资助的 2.7 年中，我们已经建立了方法来组建一个非常大的 AF 队列，描述基线特征和华法林状态，并跟踪血栓栓塞和出血事件。这是通过全面的自动化临床和行政 Kaiser 数据库并辅以病历审查来有效实现的。 对我们的 AF 队列的持续随访将为抗凝治疗的长期影响以及抗凝治疗对年龄最大的 AF 患者的影响提供独特的评估。 此外，我们将能够解决其他重要争议，包括年龄大于或等于 65 岁、没有其他中风危险因素的患者是否需要抗凝治疗，以及老年 AF 患者的最佳抗凝强度。 此外，我们还将讨论一项令人兴奋的新发现，即雌激素替代疗法会显着增加 AF 女性中风的风险。 总而言之，对我们队列的持续研究将为优化许多患有 AF 的美国老年人的中风预防策略提供有效的有力见解。