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

Abstract

Background

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

Acknowledgments

Some of the data in this manuscript were previously presented at the American College of Cardiology’s 60th Annual Scientific Session and i2 Summit, New Orleans, LA, April 2–5, 2011. Editorial support was provided by Dana Fox of Caudex Medical, and funded by Bristol-Myers Squibb Company and Pfizer, Inc.

Disclosure

Financial support for this study was provided entirely by Bristol-Myers Squibb Company and Pfizer Inc. The funding agreement helped ensure the authors’ independence in designing the study, interpreting the data, and writing and publishing the report. BL is an employee of Fudan University, which received financial support from Bristol-Myers Squibb and Pfizer in connection with conducting this study and the development of this manuscript. LZL and JX are employees of Pfizer Inc. ML, YL, CD, HC, and XY received financial support from Bristol-Myers Squibb and Pfizer for collection of data for this study but were not paid for manuscript development. The authors report no other conflicts of interest.