| Part Ⅰ Investigation on the Status of Emergency Treatment of Tachyarrhythmia in Different Grade of HospitalsBackground:The emergency treatment of tachyarrhythmias was assessed to determine overall therapy status and provide a reference for future clinical practice and scientific research.Methods:A cross-sectional,multicenter study was conducted among patients diagnosed with tachyarrhythmia and admitted to the hospital from January 2016 to December 2019.A total of 9 hospitals in 4 different cities of China,including Shenyang in Northeast,Jinan in Eastern,Beijing in north,and Wuhan in central China participated in the study.Each city contains 1 tertiary general hospitals and 1 secondary general hospitals;In addition,Fuwai hospital,a cardiovascular specialist hospital,was also included.Patients with tachyarrhythmia were continuously enrolled in each hospital.Data collected included demographic indicators and treatment received(the use of antiarrhythmic drugs and non-drug treatment).Results:A total of 628 cases of tachyarrhythmia were enrolled,including 399(63.5%)cases of atrial fibrillation/Atrial flutter,146(23.2%)cases of paroxysmal supraventricular tachycardia,50(8.0%)cases of ventricular tachycardia,16(2.5%)cases of atrial tachycardia,12(1.9%)cases of inappropriate sinus tachycardia,and 5(0.8%)cases of wide QRS complex tachycardia.Atrial fibrillation/atrial flutter was the most common type of arrhythmia observed in all grade of hospitals.Application of antiarrhythmic drugs(AADs):In patients with organic heart disease or heart failure,Amiodarone was the most commonly used AADs for atrial fibrillation/atrial flutter,ventricular arrhythmia,and atrial tachycardia in all enrolled grade of hospitals.In paroxysmal supraventricular tachycardia,they were propafenone,non-dihydropyridine calcium channel blockers(NDHP-CCB)and amiodarone in all grade of hospitals;and cedilan was the most prescribed AADs in inappropriate sinus tachycardia.Among patients without organic heart disease or heart failure,Amiodarone accounts for the highest proportion of AADs in atrial fibrillation/atrial flutter,ventricular tachycardia,and atrial tachycardia.In addition,the proportion of amiodarone used to treat atrial fibrillation/atrial flutter in tertiary and secondary genral hospitals were significantly higher than that of cardiovascular specialist hospitals(69.2%vs.23.8%,70.0%vs.23.8%,P<0.05,respectively).NDHP-CCB and propafenone were the most prescribed AADs in paroxysmal supraventricular tachycardia,and amiodarone was also used for these patients in tertiary and secondary general hospitals.Non-drug treatments:the most commonly used treatment for paroxysmal supraventricular tachycardia were vagus nerve stimulation and esophageal atrial pacing,and it was electrical cardioversion in ventricular arrhythmia.Non-drug treatments:the most commonly used treatment for paroxysmal supraventricular tachycardia were vagus nerve stimulation and esophageal atrial pacing,and it was electrical cardioversion in ventricular arrhythmia.Conclusion:The emergency treatment of tachyarrhythmias in all grade of hospitals tended to be performed in accordance with the treatment guidelines,but some variability did exist.Part Ⅱ Investigation of Anticoagulation Status in Emergency Treatment of Atrial fibrillation/Atrial flutter at Different Grade of HospitalsBackground:To investigate the current status and problems of anticoagulation in the emergency treatment of atrial fibrillation/atrial flutter at different grade of hospitals and provide a reference for future research.Methods:Patients admited to hospitals for atrial fibrilation/atrial fluter from January 2016 to December 2019 were enrolled.A total of 9 hospitals in 4 different cities of China,including Shenyang in Northeast,Jinan in Eastern,Beijing in north,and Wuhan in central China participated in the study.Each city contains 1 tertiary general hospitals and 1 secondary general hospitals;In addition,Fuwai hospital,a cardiovascular specialist hospital,was also included.Patients with tachyarrhythmia were continuously enrolled in each hospital.The demographic data and anticoagulants administration were observed.Results:A total of 399 patients with atrial fibrillation/atrial flutter were enrolled in this study,of which 371 patients completed the anticoagulation questionnaire,including 31 patients with valvular atrial fibrillation/atrial flutter(VAF,Rheumatic mitral valve moderate to severe stenosis or mechanical valve replacement)and 340 patients with non-valvular atrial fibrillation/atrial flutter(NVAF,other valvular heart disease and non-valvular heart disease).Among the 266(78.2%)patients of NVAF with anticoagulant indications judged by doctors,200 cases(75.2%)had been prescribed anticoagulant therapy,of which 146 cases were treated with non-oral anticoagulation(145 cases Low-molecular-weight heparin,and 1 others);65 cases(24.4%)had initiated long-term oral anticoagulants,and it was significantly lower in tertiary and secon dary hospitals than the cardiovascular specialist hospitals(22.2%vs.41.3%,17.9%vs.41.3%,P<0.05,respectively),warfarin was the most commonly used oral anticoagulant in all grade of hospitals.Then,the questionnaire survey was continued in these 201 patients(75.6%)who had not yet initiated long-term oral anticoagulation therapy,which showed that the main reasons for patients who had not initiated long-term oral anticoagulation in these three grade of hospitals(cardiovascular specialist hospitals,tertiary general hospitals,secondary general hospitals)include:doctors advised patients to go to outpatient/cardiology departments to reevaluate anticoagulation indications(38.5%,52.7%,and 48.1%respectively);patients were reluctant to receive anticoagulant therapy(46.2%,30.9%,and 30.8%,respectively);patients chose antiplatelet drugs(19.2%,14.5%,and 44.2%,respectively),which was significantly higher in secondary general hospitals than that in tertiary hospitals(P<0.05).As to the patients who completed the anticoagulation questionnaire,227 patients with a CHA2DS2-VASc score more than 2(men)or 3(women),in which 148 cases had received anticoagulant therapy,109 cases(48.0%)accepted non-oral anticoagulation therapy,and 50 cases(22.0%)had started long-term oral anticoagulants,there was no significant statistical difference between all grade of hospitals.36 patients(55.4%)had received anticoagulant therapy in the 65 patients with a CHA2DS2-VASc score of 1(men)or 2(women),of which 31 patients(47.7%)received non-oral anticoagulant drugs,and there was no statistical difference among different grade of hospitals,and long-term oral anticoagulation was prescribed in 11 cases(16.9%),which was significantly higher in the cardiovascular specialist hospitals than the tertiary general hospitals and secondary general hospitals(66.7%vs.2.6%,66.7%vs.13.3%,P<0.05,respectively).However,in 48 patients with CHA2DS2-VASc score of 0(male)or 1(female),21 cases(43.8%)had recieved anticoagulants,which was significantly higher in cardiovascular specialist hospitals and secondary general hospitals than the tertiary general hospitals(88.9%vs.21.9%,85.7%vs.21.9,P<0.05,respectively),and 18 patients(37.5%)received non-oral anticoagulant therapy,which was significantly higher in cardiovascular hospitals(66.7%)and secondary general hospitals(85.7%)than in tertiary general hospitals(18.8%),P<0.05.Moreover,4 patients(8.3%)had initiatied long-term oral anticoagulation,it was also no statistic difference among these hospitals.Conclusion:The proportion of long-term oral anticoagulant treatment in patients with NVAF at all grade of hospitals was still low,which were significantly lower in tertiary and secondary general hospitals.The task of standardized treatment for the prevention of atrial fibrillation/atrial flutter embolism is still arduous.Part Ⅲ A Survey on Emergency Managements of Tachyarrhythmias by Physicians Working at Different grade of HospitalsBackground:To investigate the emergency treatment of tachyarrhythmias among doctors working in different grade of hospitals so as to provide a research basis for further standardized treatment of tachyarrhythmias.Methods:Questionnaire survey was conducted among doctors in relevant departments(including emergency department,cardiology department,coronary care unit,intensive care unit,etc.)at each center from January 2016 to December 2019.A total of 8 hospitals in 4 different cities of China,including Shenyang in Northeast,Jinan in Eastern,Beijing in north,and Wuhan in central China participated in the study.Each city contains 1 tertiary general hospitals and 1 secondary general hospitals(except Jinan);In addition,Fuwai hospital,a cardiovascular specialist hospital,was also included.Results:A total of 305 physician questionnaires were collected from the 8 hospitals.The percentage of doctors familiar with amiodarone was the highest at all enrolled hospitals,which was 94.8%in tertiary general hospitals,100%in cardiovascular specialty hospitals,and 97%in secondary general hospitals.Compared with cardiovascular specialist hospitals,the proportion of doctors administering amiodarone independently was lower(74.6%vs.95.7%,P<0.05)and percentage of doctors requiring guidance from superior doctors were higher(21.8%vs.4.3%,P<0.05)in tertiary general hospitals.The proportion of doctors,who might consider anticoagulant therapy in patients with atrial fibrillation,was significantly lower in tertiary and secondary general hospitals than in the cardiovascular specialist hospitals(66.8%vs.95.7%,69.7%vs.95.7%,P<0.05,respectively).The proportion of accepting electro-cardioversion treatment follwing failed drug therapy with stable hemodynamics by patients and their relatives was no more than 50%in all enrolled hospitals.More than 50%of doctors working on enrolled hospitals stated that they were unable to manage emergency tachyarrhythmias adequately.More than 70%doctors at enrolled hospitals wished to have the chance to attend relevant academic conferences,participate training courses,promote relevant guidelines in departments,and to learn more guidelines by themselves to improve their skill on the arrhythmia management.Conclusions:The standardized emergency management of tachyarrhythmias by doctors working at all grade of hospitals is still not adequately achieved,which could be improved by various measures. |
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