Oral anti-coagulants use in Chinese hospitalized patients with atrial fibrillation / 中华医学杂志(英文版)

BACKGROUND@#Oral anti-coagulants (OAC) are the intervention for the prevention of stroke, which consistently improve clinical outcomes and survival among patients with atrial fibrillation (AF). The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with AF in China.@*METHODS@#Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) registry, guideline-recommended OAC use in eligible patients was assessed.@*RESULTS@#A total of 52,530 patients with non-valvular AF were enrolled from February 2015 to December 2019, of whom 38,203 were at a high risk of stroke, 9717 were at a moderate risk, and 4610 were at a low risk. On admission, only 20.0% (6075/30,420) of patients with a diagnosed AF and a high risk of stroke were taking OAC. The use of pre-hospital OAC on admission was associated with a lower risk of new-onset ischemic stroke/transient ischemic attack among the diagnosed AF population (adjusted odds ratio: 0.54, 95% confidence interval: 0.43-0.68; P  <0.001). At discharge, the prescription rate of OAC was 45.2% (16,757/37,087) in eligible patients with high stroke risk and 60.7% (2778/4578) in eligible patients with low stroke risk. OAC utilization in patients with high stroke risk on admission or at discharge both increased largely over time (all P  <0.001). Multivariate analysis showed that OAC utilization at discharge was positively associated with in-hospital rhythm control strategies, including catheter ablation (adjusted odds ratio [OR] 11.63, 95% confidence interval [CI] 10.04-13.47; P <0.001), electronic cardioversion (adjusted OR 2.41, 95% CI 1.65-3.51; P <0.001), and anti-arrhythmic drug use (adjusted OR 1.45, 95% CI 1.38-1.53; P <0.001).@*CONCLUSIONS@#In hospitals participated in the CCC-AF project, >70% of AF patients were at a high risk of stroke. Although poor performance on guideline-recommended OAC use was found in this study, over time the CCC-AF project has made progress in stroke prevention in the Chinese AF population.Registration:ClinicalTrials.gov, NCT02309398.

Prevalence, awareness, and treatment of hypercholesterolemia among inpatients with acute coronary syndrome in China / 中华心血管病杂志

<p><b>OBJECTIVE</b>To estimate the current prevalence, awareness and treatment status of hypercholesterolemia among inpatients with acute coronary syndrome (ACS) in China.</p><p><b>METHODS</b>Sixty-four hospitals across China, including 32 secondary hospitals and 32 tertiary hospitals were selected for baseline survey. Fifty inpatients diagnosed with ACS were recruited consecutively in each participated hospitals. Retrospective information for 2751 patients were collected, and the prevalence, awareness, and treatment status of hypercholesterolemia among the patients were analyzed.</p><p><b>RESULTS</b>(1) Mean age of the patients was 65 +/- 11. Sixty-nine percent of the patients were males and 31.2% were females. Among them, 39.4% were diagnosed as ST-segment elevation MI, 8.8% as non-ST-segment elevation MI and 51.8% as unstable angina. Twenty-seven percent of them had previous ACS history. (2) Hypercholesterolemia was found in 19.6% ACS patients. Among 7 geographic districts (north China, east China, south China, middle China, northeast, northwest and southwest), the prevalence rate of hypercholesterolemia was highest (24.7%) in east China and lowest (10.0%) in middle China. Significant difference was observed among these areas. (3) Awareness rate of hypercholesterolemia was 12.2% among patients with hypercholesterolemia, with significant difference among various areas. Treatment rate was 66.7% among patients with known hypercholesterolemia, with the highest (83.3%) seen in south China and lowest (0%) in southwest area. (4) The prevalence, awareness rate and treatment rate of hypercholesterolemia were higher in recurrent ACS patients than in those without ACS history.</p><p><b>CONCLUSIONS</b>Nearly 20% ACS inpatients have hypercholesterolemia.It is essential to pay more attention on the treatment of hypercholesterolemia for the purpose of secondary prevention of cardiovascular disease.</p>