县级医院医生使用华法林预防非瓣膜性房颤患者脑卒中的调查

Investigation on the use of warfarin in the prevention of stroke in patients with non-valvular atrial fibrillation among physicians from county-level hospitals

摘要:

目的：我国非瓣膜性房颤患者使用华法林抗凝治疗率低，特别是在基层医院。本研究的目的在于调查县级医生使用华法林预防脑卒中的困惑以及医生对非瓣膜性房颤患者使用华法林的实际抗凝治疗情况。方法：本研究为横断面调查，对县级医生发放问卷，问卷内容包括（1）医生使用华法林预防脑卒中的困惑；（2）医生对非瓣膜性房颤患者的管理。结果：从2013年6月至2013年11月，从9家县级医院收回292份调查问卷，对其中208（72.2%）份问卷进行统计学分析。11.5%（24）医生非常同意“经常不确定是否应该给予华法林抗凝”，20.2%（42）医生非常同意“我充分了解了患者对华法林获益和风险”的观点。CHADS2评分、CHA2DS2-VASc评分均≥2的高危患者中，医生使用华法林抗凝治疗的比例仅22.1%（46）（病例3）、19.2%（40）（病例4）、34.1%（71）（病例5）及21.2%（44）（病例12），HAS-BLED评分≥3的出血高危患者中， 使用华法林的比例仅8.2%（17例）（病例6）、10.6%（22例） （病例7）、9.1%（19例）（病例8）。结论：研究发现县级医生对非瓣膜性房颤抗凝治疗的相关知识和危险分层匮乏。影响县级医院医生使用华法林抗凝治疗的最大困惑是不确定是否应该给予华法林抗凝治疗和我充分了解了患者对华法林获益和风险的观点。县级医生对于非瓣膜性房颤患者的缺血性卒中和出血危险的评估等知识的掌握还需要进一步提高。

Abstract:

Objective：To investigate the prevalence of the use of warfarin in prevention of stroke in non-valvular atrial fibrillation （NVAF） among physicians from county-level hospitals. Methods：A cross-sectional questionnaire survey was conducted in 292 physicians who were chosen randomly from 9 county-level hos－pitals. The questionnaire mainly consisted of the following con－tents：problems affecting the prescribing of warfarin by physi－cians and the administration of the use of warfarin in patients with NVAF. Results：From June to November in 2013，292 ques－tionnaires were collected and 208（72.2%） of them were analyzed. Around 11.5%（24） of physicians strongly agreed that “they often were not sure whether or not to prescribe warfarin”. 20.2%（42） of physicians strongly agreed that “they fully understood their patients’ views on the benefits and risks of warfarin”. In patients with CHADS2 score or CHA2DS2-VASC score≥2，only 22.1%（46）（case3），19.2%（40）（case4），34.1%（71）（case5） and 21.2%（44）（case12）of physicians prescribed warfarin for the prevention of stroke. In patients with HAS-BLED score≥3patients，only 8.2%（17）（case6），10.6%（22）（case7） and 9.1%（19）（case8） of physicians pre－scribed warfarin for the prevention of stroke in NVAF. Conclusion：This study highlights the deficiency of knowledge regarding the risk stratification and anticoagulant treatment about NVAF in physicians from county-level hospitals. Decisional conflicts of the use of warfarin in the prevention of stroke and being not able to evaluate the benefits and risks brought by warfarin patients appear to be the biggest barriers for anticoagulant in NVAF. Educational programs are needed to improve the situation of the right use of warfarin in NVAF patients.