摘要
目的:评价心房颤动及心房扑动智能评分系统在门诊的应用情况及来诊患者特点。方法:收集2020年8月至2022年6月于中国医学科学院阜外医院门诊就诊的25 223例心房颤动及心房扑动患者的所有就诊记录。比较系统更新(2021年9月)前后来诊患者的特点。另从25 223例患者中筛选出系统更新前后1年内相邻2次就诊的患者404例,比较2次评分的变化趋势及抗凝药物使用情况。结果:与系统更新前比,系统更新后CHA_(2)DS_(2)-VASc评分中男性≥2分或女性≥3分的患者比例差异无统计学意义(P>0.05),这些患者中抗凝治疗比例升高(25.2%vs. 35.9%,P<0.001)。无不评分理由患者比例系统更新前为37.9%,更新后下降至21.2%。比较404例系统更新前后1年内相邻2次就诊记录发现,与更新前比,更新后患者的CHA_(2)DS_(2)-VASc评分升高[(2.12±1.48)分vs.(2.35±1.51)分,P=0.029],同时CHA_(2)DS_(2)-VASc评分中男性≥2分或女性≥3分的患者比例升高(49.5%vs. 58.7%,P=0.011),这些患者中抗凝治疗比例也升高(28.5%vs. 41.4%,P<0.001)。HAS-BLED评分及HAS-BLED评分≥3分患者的比例在系统更新前后差异均无统计学意义(P均>0.05)。结论:本院门诊所应用的智能评分系统可有效帮助医生掌握来诊心房颤动及心房扑动患者的血栓栓塞和出血风险及相应的变化趋势,并帮助改善抗凝药物的使用。但还需进一步优化评分流程,规范患者评估及治疗。
Objectives:To assess the application effectiveness of the intelligent atrial fibrillation/flutter scoring system in the outpatient department and analyze the characteristics of patients diagnosed with atrial fibrillation/flutter.Methods:Medical records of 25223 patients with atrial fibrillation and atrial flutter,who visited our outpatient department from August 2020 to June 2022,were collected.Characteristics of patients visited before and after the system update(September 2021)were compared.Then,404 patients,with scoring before and after system update within one year period,were selected for analysis,and the study compared the trend of score changes and the utilization of anticoagulants among these patients.Results:There was no significant change in the proportion of patients with a CHA_(2)DS_(2)-VASc score of male≥2 points or female≥3 points before and after the system update.However,the percentage of patients who received anticoagulation treatment increased post system update compared to the pre-update period(35.9%vs.25.2%,P<0.001).The proportion of patients who did not receive a score without any specified reason for not scoring decreased after the system update(21.2%vs.37.9%,P<0.001).For the 404 patients,who visited our outpatient department twice before and after the system update,it was observed that the CHA_(2)DS_(2)-VASc score exhibited an upward trend(2.12±1.48 vs.2.35±1.51,P=0.029).Concurrently,there was an increase in the proportion of patients with a high thrombosis risk(58.7%vs.49.5%,P=0.011),and a rise in the proportion of patients receiving anticoagulant treatment(41.4%vs.28.5%,P<0.001).There was no significant change in the HAS-BLED score and the proportion of patients with a HAS-BLED score of≥3 points(bothP>0.05).Conclusions:The intelligent scoring system implemented in our outpatient department effectively helps doctors grasp the risk of thromboembolism and bleeding in patients with atrial fibrillation/flutter,and aids in improving the use of anticoagulants.Further optimization of the
作者
孙一博
张博
于飞
杨晴
杨国胜
丁立刚
窦克非
朱俊
梁岩
SUN Yibo;ZHANG Bo;YU Fei;YANG Qing;YANG Guosheng;DING Ligang;DOU Kefei;ZHU Jun;LIANG Yan(Department of Medical Intensive Care Unit,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Information Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Outpatient Department,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Arrhythmia Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Internal Medicine Management Committee,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Emergency Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)
出处
《中国循环杂志》
CSCD
北大核心
2024年第4期364-369,共6页
Chinese Circulation Journal