Treatment patterns associated with stroke prevention in patients with atrial fibrillation in three major cities in the People’s Republic of China

Abstract

Bao Liu,1 Larry Z Liu,2,3 Jianwei Xuan,2 Man Luo,4 Yansheng Li,5 Chaohui Duan,6 Hongqin Cheng,7 Xiaohui Yang81School of Public Health, Fudan University, Shanghai, People’s Republic of China; 2Pfizer Inc, New York, NY, USA; 3Weill Medical College of Cornell University, New York, NY, USA; 4Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 5Renji Hospital, Shanghai Jiaotong University, Shanghai, People’s Republic of China; 6The Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China; 7Xuanwu Hospital, Beijing, People’s Republic of China; 8Beijing Anzhen Hospital, Capital University of Medical Science, Beijing, People’s Republic of ChinaBackground: Atrial fibrillation (AF) is associated with an increased risk of stroke. This study assessed treatment patterns associated with stroke prevention among patients with AF in three major cities of the People’s Republic of China.Methods: A random sample of 2,862 medical charts for patients with AF at six tertiary hospitals located in Beijing, Shanghai, and Guangzhou between 2003 and 2008 were reviewed. Patient demographics, clinical characteristics, and treatment patterns were extracted from medical charts. Antithrombotic regimens included antiplatelets, anticoagulants, and a combination of both. Descriptive analyses were performed to summarize basic antithrombotic patterns. A logistic regression model examined demographic and clinical factors associated with antithrombotic treatment patterns.Results: Of the patient sample, 55% were male, the average age was 72 years (49% ≥75 years), 15% had valvular AF, 78% had nonvalvular AF, and the remainder had unspecified AF. CHADS2 scores ≥2 were reported for 53% of patients. Antithrombotic treatment was not received by 17% of patients during hospitalization, and 66% did not receive warfarin. Among patients with valvular or nonvalvular AF, 33%, 30%, and 20% received antiplatelet, anticoagulation, and antiplatelet plus anticoagulation treatments, respectively. For patients with CHADS2 scores of 0, 1, 2, 3, and ≥4, 52%, 42%, 28%, 21%, and 21%, respectively, were treated with warfarin. Predictors of no antithrombotic treatment included age and hospital location.Conclusion: Anticoagulation therapy was underused in Chinese patients with AF. Antithrombotic treatment was not associated with stroke risk. Further studies need to examine the clinical consequences of various antithrombotic treatment patterns in Chinese patients with AF.Keywords: atrial fibrillation, stroke prevention, antithrombotic treatment, China