Investigation Of Anticoagulant Therapy In Patients With Non-valvular Atrial Fibrillation In Some Areas Of Yunnan Province

[Background]Atrial fibrillation(AF)is one of the most common arrhythmias,with high morbidity,mortality and disability rates.The guidelines recommend that patients with non-valvular AF who are at high risk of thromboembolism should receive anticoagulant therapy to reduce stroke,embolism and death.However,anticoagulant therapy for patients with non-valvular AF is still inadequate in China,The status of anticoagulant therapy for patients with non-valvular AF in yunnan is still unclear.[Objective]This study aim to characterize patterns and factors associated with use of anticoagulant medications in patients with non-valvular AF in some areas of Yunnan province.[Methods]This is a prospective and observational study.100 patients with non-valvular AF and CHA2DS2-VASc score>2 points,who were admitted in the the department of cardiology of first affiliated hospital of kunming medical university in from June to October 2019,were enrolled,.Baseline clinical data,quality of life,laboratory examination,ECG,echocardiography and anticoagulant therapy information were collected.Patients were followed up for 3 months after discharge,and information of the use of anticoagulant drugs,bleeding events,stroke,cardiovascular events,re-hospitalization and death were collected.The patients were divided into anticoagulant therapy group and non-anticoagulant therapy group according to whether choosing anticoagulant therapy,and the clinical characteristics between the two groups were compared.Patient-level factors associated with anticoagulant use were examined.[Results]1.The average age of enrolled patients was 67.86±10.2 years old,male 54%(54/100),and the patients from all over yunnan province,the proportion of urban areas and surrounding counties in kunming is 47%(47/100),other states is 53%(53/100).Major comorbidities:hypertension74%(74/100),heart failure 62%(62/100),coronary heart disease 32%(32/100),diabetes 29%(29/100),hyperuricemia 60%(60/100),etc.2.The proportion of patients with non-valvular AF receiving anticoagulant therapy was 27%(27/100)pre-hospitalization.When out of the hospital 80%(80/100)of the patients were treated with anticoagulant drugs,among them,warfarin 22.5%(18/80)and new oral anticoagulant 77.5%(62/80)[dabigatran 41.94%(26/62),rivaroxaban 58.06%(36/62)].20%(20/100)of the patients did not receive anticoagulant therapy,12%(12/100)only anti-platelet,8%(8/100)of the patients neither anticoagulation nor antiplatelet.3.After discharge for 3 months,60.42%(58/96)patients continued anticoagulant therapy;among them,24.14%(14/58)patients use warfarin,and 75.86%(44/58)patients use new oral anticoagulant[the proportion of dabigatran was 45.45%(20/44),the proportion of rivaroxaban was 54.55%(24/44)].39.58%(38/96)patients did not receive anticoagulant therapy.14.58%(14/96)patients take anti-platelet drugs only,and 25%(24/96)patients receive neither anticoagulant nor anti-platelet therapy..4.Major cardiovascular events,stroke,bleeding and re-hospitalization events after discharge for 3 months:4 patients died(3 patients with worsening heart failure,1 case with cancer);2 patients occurred new ischemic stroke;14 patients occurred bleeding events(mainly included:4 patients with minor black stools,3 patients with gingival bleeding,3 patients with skin petechiae,etc);18 patients re-hospitalization(inciuding 8 patients of heart failure,2 patients of new stroke,2 patients of pulmonary infection,2 patients of atrial fibrillation,etc).5.Anticoagulation in special population(1)Anticoagulation in AF patients with coronary heart disease complicated with:during hospitalization,the proportion of anticoagulant was 78.1%(25/32),21.9%(7/32)patients just received antiplatelet.In patients with anticoagulant therapy,32%(8/25)patients renceived anticoagulant combined with antiplatelet therapy.After discharge for 3 months,53.3%(16/30)patients continued anticoagulant therapy,46.7%(14/30)patients had no anticoagulant therapy.In patients with anticoagulant therapy,31.25%(5/16)anticoagulant combined with antiplatelet.In patients without anticoagulation,30%(9/30)only had antiplatelet therapy,16.7%(5/30)patients receive neither anticoagulant nor anti-platelet therapy.(2)Anticoagulantion in AF patients after transcatheter ablation:During hospitalization,the proportion of anticoagulant therapy was 93.9%(31/33),non-anticoagulant therapy was 6.1%(2/33).After discharge for 3 months,69.7%(23/33)patients continued anticoagulant therapy,and 30.3%(10/33)did not receive anticoagulant therapy.(3)Anticoagulation in elderly AF patients:29 patients with non-valvular AF≥75 years old.During hospitalization,the proportion of anticoagulant therapy was 82.8%(24/29),and the proportion of non-anticoagulant therapy was 17.2%(5/29).After discharge for 3 months,61.5%(16/26)patients continued anticoagulant therapy,and 38.5%(10/26)did not receive anticoagulant therapy.6.Comparison of clinical features between the anticoagulant group and the non-anticoagulant group:During hospitalization,compared with the anticoagulant group,the proportion of patients with monthly family income<3000 yuan and antiplatelet therapy was higher in the non-anticoagulant group(both P<0.01).The proportion of patients living in remote rural areas and undergoing percutaneous coronary intervention(PCI)was higher(both P<0.05).After discharge for 3 months,compared with the continuous anticoagulant group,the proportion of anti-platelet therapy in the non-anticoagulant group(36.84%vs.17.34%,P<0.05)and the proportion with low medication compliance score of non-anticoagulant group were higher(94.74%vs.62.07%,P<0.05).7.The logistic regression analysis affecting anticoagulant therapy revealed that woman(OR=11.345,95%CI 1.431～89.932,P=0.021)and catheter ablation for AF during hospitalization(OR=52.911,95%CI 1.325～2113.564,P=0.035)were positively correlated with anticoagulant therapy at discharge,systolic pressure≥140mmHg(OR=0.129,95%CI 0.017～0.962,P～0.046)and antiplatelet therapy(OR=0.069,95%CI 0.012～0.387,P～0.002)was negatively correlated with anticoagulant therapy at discharge.There was no significant correlation between the above indexes and anticoagulant therapy after discharge for 3 months(all P>0.05).8.The reasons of non-anticoagulant therapy:The doctors did not prescribe[35.0%(7/20)],patients reluctant to anticoagulant[20.0%(4/20)],recent PCI[20.0%(4/20)],recent/planned surgery[15.0%(3/20)]and previous bleeding events[10.0%(2/20)]are the main reasons for non-anticoagulant during hospitalization.The doctors did not prescribe[39.5%(15/38)],patients reluctant to anticoagulation[18.4%(7/38)],after transcatheter ablation[10.5%(4/38)],recent surgery[10.5%(4/38)],bleeding worries and have a little bleeding events[7.9%(3/38)],traffic inconvenience and poor economic condition[7.9%(3/38)]are the main reasons of non-anticoagulation after discharge for 3 months.[Conclusion]1.In some areas of Yunnan province,the proportion of anticoagulant therapy was higher in patients with non-valvular AF during hospitalization,and the proportion of new oral anticoagulant was higher than warfarin.After discharge for 3 months,the proportion of anticoagulant therapy decreased significantly,while the proportion of non-anticoagulant therapy increased.2.Antiplatelet therapy,poor compliance with medication,doctors did not prescribe,previous bleeding events or bleeding concerns,poor economic conditions and traffic inconvenience are the main reasons for nor-anticoagulant therapy in patients with non-valvular AF.3.Women,catheter ablation of AF during hospitalization may be a predictor of anticoagulant therapy at discharge;antiplatelet therapy and systolic blood pressure≥140mmHg may be predicators of non-anticoagulant therapy.