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01.10.2015 | Embolieprophylaxe und Antikoagulation | Übersichten

Unterversorgung von Vorhofflimmer-Patienten mit oralen Antikoagulanzien in Deutschland

Systematische Literaturübersicht zu Ausmaß und Ursachen

verfasst von: A. Groth, F. Halder, A. Fuchs, U. Maywald, Prof. Dr. T. Wilke

Erschienen in: Die Kardiologie | Ausgabe 5/2015

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Zusammenfassung

Hintergrund und Ziel

Eine orale Antikoagulation (OAK) mit Vitamin-K-Antagonisten (VKA) oder neuen oralen Antikoagulanzien (NOAK) wird nach deutschen und internationalen Leitlinien für Patienten mit Vorhofflimmern (VHF) und hohem Schlaganfallrisiko (CHA₂DS₂-VAS_C > 1) empfohlen. Ziel des Reviews ist es, die bisherige Evidenz zum Ausmaß an OAK-Unterversorgung von VHF-Patienten in Deutschland sowie potenzielle Gründe für eine bestehende Unterversorgung systematisch darzustellen.

Methode

In Bezug auf das Ausmaß an OAK-Unterversorgung erfolgte eine Auswertung der deutsch- und englischsprachigen Literatur, die das deutsche Versorgungsumfeld thematisierte. Bei der Ermittlung von Ursachen für OAK-Unterversorgung wurde mangels deutscher Daten die gesamte relevante internationale Literatur in die Übersicht einbezogen.

Ergebnisse

Es wurden 4 Beiträge, die sich dem Thema der OAK-Unterversorgung von VHF-Patienten in Deutschland widmeten sowie 87 Publikationen, die Ursachenfaktoren für OAK-Unterversorgung thematisierten, identifiziert. Etwa 50 % der in Deutschland behandelten VHF-Patienten sind von OAK-Unterversorgung betroffen. OAK-Unterversorgung ist dabei ein Versorgungsdefizit, das auf multivariate Ursachenfaktoren zurückzuführen bzw. mit unterschiedlichen Faktoren assoziiert ist. Dabei können 4 wesentliche Gruppen von Ursachenfaktoren mit einigen dominierenden spezifischen Ursachen unterschieden werden: patientenbezogene medizinische Faktoren (frühere Blutungen und Blutungsrisiko, Sturzgefahr, Krebserkrankungen, paroxysmales VHF statt permanentes/persistierendes VHF), allgemeine Charakteristika von Patienten (hohes Alter, Non-Adhärenz), arztassoziierte Faktoren (Arztwissen und arztseitige Nutzeneinschätzung der OAK) sowie sonstige, i. d. R. im Versorgungsumfeld der Patienten befindliche Faktoren (Logistik, u. a. im Kontext der „Internal-normalized-ratio“(INR)-Kontrollen).

Schlussfolgerung

Eine korrekte OAK-Versorgung von VHF-Patienten stellt eine große Herausforderung dar. Versorgungsprogramme, die die OAK-Versorgung von VHF-Patienten zu optimieren versuchen, sollten die Multivariabilität der Ursachen der Unterversorgung beachten.

Nur mit Berechtigung zugänglich

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Titel: Unterversorgung von Vorhofflimmer-Patienten mit oralen Antikoagulanzien in Deutschland
Systematische Literaturübersicht zu Ausmaß und Ursachen
verfasst von: A. Groth
F. Halder
A. Fuchs
U. Maywald
Prof. Dr. T. Wilke
Publikationsdatum: 01.10.2015
Verlag: Springer Berlin Heidelberg
Schlagwörter: Embolieprophylaxe und Antikoagulation
Internistische Arzneimitteltherapie
Erschienen in: Die Kardiologie / Ausgabe 5/2015
Print ISSN: 2731-7129
Elektronische ISSN: 2731-7137
DOI: https://doi.org/10.1007/s12181-015-0005-9

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Springer Medizin

Zusammenfassung

Hintergrund und Ziel

Methode

Ergebnisse

Schlussfolgerung

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Abbott Structural Heart