Prevalence of Use of Anticoagulation Therapy and Associated Factors in Elderly Patients with Nonvalvular Atrial Fibrillation in Communities

Abstract

Background Stroke is highly prevalent in patients with atrial fibrillation (AF) , a most common cardiac arrhythmia with high morbidity, and anticoagulation therapy is a key strategy to prevent AF-related stroke. However, there is short of research on the use of anticoagulation therapy in patients with AF in the community. Objective To explore the prevalence of use of anticoagulation therapy and influencing factors in elderly patients with nonvalvular atrial fibrillation (NVAF) in Shanghai's communities. Methods A cross-sectional survey design was used. Stratified sampling was used to select elderly patients with AF who received the 2018 annual physical examination at four community health centers in Shanghai during July to December 2019, and they were surveyed using a questionnaire (consisting of three parts: demographics, CHA2DS2-VASc score and ORBIT score) compiled by our research team for collecting information on their AF prevalence and associated medication use, awareness of AF, comorbidities, and complication, as well as risk for stroke and bleeding. Based on the results of the survey, we excluded those without previous AF-related medical experience and valvular AF, then analyzed the prevalence of anticoagulation therapy in those with NVAF. Anticoagulation therapy was recommended for patients at high risk for stroke in accordance with the CHA2DS2-VASc score. Univariate and multivariate Logistic regression analyses were used to identify influencing factors of anticoagulation therapy in NVAF patients at high risk of stroke. Results Three hundred and two patients with NVAF were finally included, of whom the prevalence of current use of anticoagulant and antiplatelet drugs was 29.5% (89/302) , and 39.7% (120/302) , respectively, and that of non-use of anticoagulant or antiplatelet drugs was 30.8% (93/302) . By the CHA2DS2-VASc score, 279 of the 302 NVAF patients (92.4%) were assessed with high risk of stroke, among whom the prevalence of current use of anticoagulant and antiplatelet drugs was 30.5% (85/279) , 40.1% (112/279) , respectively, and the rest 29.4% (82/279) did not take anticoagulant or antiplatelet drugs. Univariate Logistic regression analysis demonstrated that age, marital status, type of AF, onset of AF symptoms, duration of AF, prescription of anticoagulants at the first visit for AF, knowledge of the harmfulness of AF, prevalence of hyperlipidemia, and risk of bleeding were associated with the use of anticoagulation therapy in NVAF patients at high risk of stroke (P<0.05) . Multivariate Logistic regression analysis showed that age, type of AF, prescription of anticoagulants at the first visit for AF, and knowledge of the harmfulness of AF were associated with the use of anticoagulation therapy in NVAF patients at high risk of stroke (P<0.05) . Conclusion The prevalence of the use of anticoagulation therapy in community-living NVAF patients at higher risk of stroke is unsatisfactory, so the use of anticoagulation therapy for this population needs to be further standardized, especially in patients with advanced age and low awareness of the harmfulness of AF.

Keywords

• atrial fibrillation|anticoagulant therapy|aged|community health services|root cause analysis