Year-to-year change of antithrombotic strategy and clinical outcomes of atrial fibrillation patients with vascular disease in this decade: The Fushimi AF Registry
Notice bibliographique
Résumé
Abstract Background Many atrial fibrillation (AF) patients have concomitant vascular diseases, and therefore, antithrombotic therapy is crucial for prevention of cardiovascular events in AF patients. In the last decade, antithrombotic therapy of AF patients has undergone major change due to launch of direct oral anticoagulants (DOAC). After the release of DOAC, several national guidelines for the management of AF were updated. The Japanese Circulation Society published the new guideline for the management of AF incorporating the recommendation of DOAC in 2014, which made a great impact on clinical practice in Japan. Purpose In this study, we investigated the year-to-year change of antithrombotic therapy of AF patients with vascular disease from 2011 to 2021 and compared the clinical characteristics and outcomes of those patients enrolled before and after the guideline (2011-2013 vs. 2014-2021) by using data of the Fushimi AF Registry. Methods The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients who visited the participating medical institutions in Fushimi-ku, Kyoto, Japan. We started to enroll patients from March 2011 and follow up data including prescription status were available in 4,464 patients from March 2011 to August 2021. We defined vascular disease as coronary artery disease, peripheral artery disease, ischemic stroke or transient ischemic attack. Results In 2011, 61% of AF patients with vascular disease received OAC and 53% received antiplatelet drug (APD). Proportion of the patients receiving OAC increased year by year and that receiving APD decreased year by year. In 2021, 76% of the patients received OAC and 31% received APD. Proportion of the patients with combination of OAC and APD was 27% in 2011 and decreased year by year. In 2021, 18% received the combination therapy. In 2011, when the first DOAC was launched, 2% of the patients received DOAC and 59% received warfarin. After that, proportion of the patients receiving DOAC increased progressively. In 2021, 55% of patients received DOAC and 21% of patients received warfarin. Of 4,464 patients, 1,386 patients (31.0% of the entire cohort) had history of vascular disease at enrollment. Of 1,386 patients, 1,120 patients were enrolled before 2013 and 266 patients were enrolled after 2014. The incidence of composite of cardiac death, stroke or myocardial infarction was similar between the two groups (patients enrolled before 2013 vs. patients enrolled after 2014: 5.0 vs. 4.1 per 100 person-years; log-rank p=0.27). The incidence of major bleeding tended to be lower in patients enrolled after 2014 than those enrolled before 2013 although it was not statistically significant (2.8 vs. 2.0 per 100 person-years; log-rank p=0.15). Conclusion Antithrombotic strategy of AF patient with vascular disease has undergone major change in this decade, but the incidences of cardiovascular events of those patients have not significantly changed.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».