The Korean Journal of Medicine

  • 제93권4호
  • /
  • Pages.336-343
  • /
  • 2018
  • /
  • 1738-9364(pISSN)
  • /
  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

2018 대한부정맥학회 심방세동 환자의 통합적 관리 지침

The 2018 Korean Heart Rhythm Society Guidelines for Integrated Management of Korean patients with Nonvalvular Atrial Fibrillation

  • 박준범 (이화여자대학교 의료원 순환기내과) ;
  • 정보영 (연세대학교 세브란스병원 심장내과) ;
  • 김준 (울산대학교 의과대학 서울아산병원 순환기내과) ;
  • 김진배 (경희대학교병원 순환기내과) ;
  • 박형욱 (전남대학교병원 순환기내과) ;
  • 박예민 (가천대 길병원 순환기내과) ;
  • 엄재선 (연세대학교 세브란스병원 심장내과) ;
  • 안진희 (부산대학교병원 순환기내과) ;
  • 이대인 (충북대학교병원 순환기내과) ;
  • 김준수 (성균관대학교 의과대학 삼성서울병원 순환기내과) ;
  • 이만영 (가톨릭대학교 여의도성모병원 순환기내과)
  • Park, Junbeom (Division of Cardiology, Department of Internal Medicine, Ewha Womans University Medical Center) ;
  • Joung, Boyoung (Division of Cardiology, Yonsei University Severance Hospital) ;
  • Kim, Jun (Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jin-Bae (Division of Cardiology, Department of Internal Medicine, Kyung Hee University Medical Center) ;
  • Park, Hyung Wook (Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital) ;
  • Park, Yae Min (Division of Cardiology, Department of Internal Medicine, Gachon Uniersity Gil Medical Center) ;
  • Uhm, Jae-Sun (Division of Cardiology, Yonsei University Severance Hospital) ;
  • Ahn, Jinhee (Division of Cardiology, Department of Internal Medicine, Busan National University Hospital) ;
  • Lee, Dae In (Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital) ;
  • Kim, June Soo (Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Man-Young (Divison of Cardiology, Department of Internal Medicine, The Catholic University of Korea Yeouido St. Mary's Hospital)
  • 발행 : 2018.08.01
⟨ 이전 논문 다음 논문 ⟩

초록

Atrial fibrillation (AF) is the most common form of sustained arrhythmia in elderly patients. However, AF is often detected during health screening, or accidentally during testing for other diseases; some patients lack clinical symptoms. Nevertheless, AF increases the incidence of ischemic stroke and other thrombotic events, and compromises cardiovascular prognosis in terms of heart failure, dementia, and hospitalization. Therefore, initial AF management should be performed at the point of primary care, not only in specialized medical centers. We wish to propose a five-step management protocol for AF. We review the evidence supporting integrated management by primary care physicians new to AF, and by specialized physicians who often diagnose and manage AF. Further, we also outline a structured goal-based follow-up protocol; this is an important part of integrated management.

키워드

참고문헌

  1. Kim D, Yang PS, Jang E, et al. Increasing trends in hospital care burden of atrial fibrillation in Korea, 2006 through 2015. Heart 2018 Apr 17 [Epub]. http://dx.doi.org/10.1136/heartjnl-2017-312930.
  2. Yoon M, Yang PS, Jang E, et al. Dynamic changes of CHA2DS2-VASc score and the risk of ischaemic stroke in asian patients with atrial fibrillation: a nationwide cohort study. Thromb Haemost 2018;118:1296-1304. https://doi.org/10.1055/s-0038-1651482
  3. Page K, Marwick TH, Lee R, et al. A systematic approach to chronic heart failure care: a consensus statement. Med J Aust 2014;201:146-150. https://doi.org/10.5694/mja14.00032
  4. Stock S, Pitcavage JM, Simic D, et al. Chronic care model strategies in the United States and Germany deliver patient-centered, high-quality diabetes care. Health Aff (Millwood) 2014;33:1540-1548. https://doi.org/10.1377/hlthaff.2014.0428
  5. Lundstrom H, Siersma V, Nielsen AB, et al. The effectiveness of structured personal care of type 2 diabetes on recurrent outcomes: a 19 year follow-up of the study diabetes care in general practice (DCGP). Diabetologia 2014;57:1119-1123.
  6. Nieuwlaat R, Olsson SB, Lip GY, et al. Guideline-adherent antithrombotic treatment is associated with improved outcomes compared with undertreatment in high-risk patients with atrial fibrillation. The Euro Heart Survey on Atrial Fibrillation. Am Heart J 2007;153:1006-1012. https://doi.org/10.1016/j.ahj.2007.03.008
  7. Nuno R, Coleman K, Bengoa R, Sauto R. Integrated care for chronic conditions: the contribution of the ICCC framework. Health Policy 2012;105:55-64. https://doi.org/10.1016/j.healthpol.2011.10.006
  8. Hendriks JM, de Wit R, Crijns HJ, et al. Nurse-led care vs. usual care for patients with atrial fibrillation: results of a randomized trial of integrated chronic care vs. routine clinical care in ambulatory patients with atrial fibrillation. Eur Heart J 2012;33:2692-2699. https://doi.org/10.1093/eurheartj/ehs071
  9. Hendriks J, Tomini F, van Asselt T, Crijns H, Vrijhoef H. Cost-effectiveness of a specialized atrial fibrillation clinic vs. usual care in patients with atrial fibrillation. Europace 2013;15:1128-1135. https://doi.org/10.1093/europace/eut055
  10. Tran HN, Tafreshi J, Hernandez EA, Pai SM, Torres VI, Pai RG. A multidisciplinary atrial fibrillation clinic. Curr Cardiol Rev 2013;9:55-62.
  11. Conti A, Canuti E, Mariannini Y, et al. Clinical management of atrial fibrillation: early interventions, observation, and structured follow-up reduce hospitalizations. Am J Emerg Med 2012;30:1962-1969. https://doi.org/10.1016/j.ajem.2012.04.022
  12. Carter L, Gardner M, Magee K, et al. An integrated management approach to atrial fibrillation. J Am Heart Assoc 2016;5:e002950. https://doi.org/10.1161/JAHA.115.002950
  13. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA 2002;288:1775-1779. https://doi.org/10.1001/jama.288.14.1775
  14. Hibbard JH, Greene J. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Aff (Millwood) 2013;32:207-214. https://doi.org/10.1377/hlthaff.2012.1061
  15. Aliot E, Breithardt G, Brugada J, et al. An international survey of physician and patient understanding, perception, and attitudes to atrial fibrillation and its contribution to cardiovascular disease morbidity and mortality. Europace 2010;12:626-633. https://doi.org/10.1093/europace/euq109
  16. Lip GY, Kamath S, Jafri M, Mohammed A, Bareford D. Ethnic differences in patient perceptions of atrial fibrillation and anticoagulation therapy: the West Birmingham Atrial Fibrillation Project. Stroke 2002;33:238-242. https://doi.org/10.1161/hs0102.101817
  17. Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med 2003;26:1-7.
  18. Alonso-Coello P, Montori VM, Sola I, et al. Values and preferences in oral anticoagulation in patients with atrial fibrillation, physicians' and patients' perspectives: protocol for a two-phase study. BMC Health Serv Res 2008;8:221. https://doi.org/10.1186/1472-6963-8-221
  19. Peterson ED, Ho PM, Barton M, et al. ACC/AHA/AACVPR/AAFP/ANA concepts for clinician-patient shared accountability in performance measures: a report of the American College of Cardiology/American Heart Association task force on performance measures. Circulation 2014;130:1984-1994. https://doi.org/10.1161/CIR.0000000000000139
  20. Stewart S, Ball J, Horowitz JD, et al. Standard versus atrial fibrillation-specific management strategy (SAFETY) to reduce recurrent admission and prolong survival: pragmatic, multicentre, randomised controlled trial. Lancet 2015;385:775-784. https://doi.org/10.1016/S0140-6736(14)61992-9
  21. Seaburg L, Hess EP, Coylewright M, Ting HH, McLeod CJ, Montori VM. Shared decision making in atrial fibrillation: where we are and where we should be going. Circulation 2014;129:704-710. https://doi.org/10.1161/CIRCULATIONAHA.113.004498
  22. Stiggelbout AM, Van der Weijden T, De Wit MP, et al. Shared decision making: really putting patients at the centre of healthcare. BMJ 2012;344:e256. https://doi.org/10.1136/bmj.e256
  23. Elwyn G, Frosch D, Thomson R, et al. Shared decision making: a model for clinical practice. J Gen Intern Med 2012;27:1361-1367. https://doi.org/10.1007/s11606-012-2077-6
  24. Hendriks JM, de Wit R, Vrijhoef HJ, Tieleman RG, Crijns HJ. An integrated chronic care program for patients with atrial fibrillation: study protocol and methodology for an ongoing prospective randomised controlled trial. Int J Nurs Stud 2010;47:1310-1316. https://doi.org/10.1016/j.ijnurstu.2009.12.017
  25. Lip GYH. The ABC pathway: an integrated approach to improve AF management. Nat Rev Cardiol 2017;14:627-628. https://doi.org/10.1038/nrcardio.2017.153
  26. Lee SS, Ae Kong K, Kim D, et al. Clinical implication of an impaired fasting glucose and prehypertension related to new onset atrial fibrillation in a healthy Asian population without underlying disease: a nationwide cohort study in Korea. Eur Heart J 2017;38:2599-2607. https://doi.org/10.1093/eurheartj/ehx316
  27. Baek YS, Yang PS, Kim TH, et al. Associations of abdominal obesity and new-onset atrial fibrillation in the general population. J Am Heart Assoc 2017;6:e004705. https://doi.org/10.1161/JAHA.116.004705
  28. Benjamin EJ, Levy D, Vaziri SM, D'Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. The framingham heart study. JAMA 1994;271:840-844. https://doi.org/10.1001/jama.1994.03510350050036
  29. Wang TJ, Parise H, Levy D, et al. Obesity and the risk of new-onset atrial fibrillation. JAMA 2004;292:2471-2477. https://doi.org/10.1001/jama.292.20.2471
  30. Gami AS, Hodge DO, Herges RM, et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol 2007;49:565-571. https://doi.org/10.1016/j.jacc.2006.08.060
  31. Heeringa J, Kors JA, Hofman A, van Rooij FJ, Witteman JC. Cigarette smoking and risk of atrial fibrillation: the rotterdam study. Am Heart J 2008;156:1163-1169. https://doi.org/10.1016/j.ahj.2008.08.003
  32. Conen D, Tedrow UB, Cook NR, Moorthy MV, Buring JE, Albert CM. Alcohol consumption and risk of incident atrial fibrillation in women. JAMA 2008;300:2489-2496. https://doi.org/10.1001/jama.2008.755
  33. Roh SY, Choi JI, Lee JY, et al. Catheter ablation of atrial fibrillation in patients with chronic lung disease. Circ Arrhythm Electrophysiol 2011;4:815-822. https://doi.org/10.1161/CIRCEP.110.960435
  34. Kong KA, Park J, Hong SH, Hong YS, Sung YA, Lee H. Associations between body mass index and mortality or cardiovascular events in a general Korean population. PLoS One 2017;12:e0185024. https://doi.org/10.1371/journal.pone.0185024
  35. Manning WJ, Weintraub RM, Waksmonski CA, et al. Accuracy of transesophageal echocardiography for identifying left atrial thrombi. A prospective, intraoperative study. Ann Intern Med 1995;123:817-822. https://doi.org/10.7326/0003-4819-123-11-199512010-00001
  36. Hwang JJ, Chen JJ, Lin SC, et al. Diagnostic accuracy of transesophageal echocardiography for detecting left atrial thrombi in patients with rheumatic heart disease having undergone mitral valve operations. Am J Cardiol 1993;72:677-681. https://doi.org/10.1016/0002-9149(93)90884-F
  37. Lip G, Freedman B, De Caterina R, Potpara TS. Stroke prevention in atrial fibrillation: past, present and future. Comparing the guidelines and practical decision-making. Thromb Haemost 2017;117:1230-1239. https://doi.org/10.1160/TH16-11-0876
  38. Kim TH, Shim CY, Park JH, et al. Left ventricular diastolic dysfunction is associated with atrial remodeling and risk or presence of stroke in patients with paroxysmal atrial fibrillation. J Cardiol 2016;68:104-109. https://doi.org/10.1016/j.jjcc.2015.10.008
  39. Yu HT, Yang PS, Lee H, et al. Outcomes of rate-control treatment in patients with atrial fibrillation and heart failure - a nationwide cohort study. Circ J 2018;82:652-658. https://doi.org/10.1253/circj.CJ-17-0669
  40. Kirchhof P, Breithardt G, Aliot E, et al. Personalized management of atrial fibrillation: proceedings from the fourth atrial fibrillation competence network/European heart rhythm association consensus conference. Europace 2013;15:1540-1556. https://doi.org/10.1093/europace/eut232

피인용 문헌

  1. Guideline of atrial fibrillation management vol.62, pp.5, 2019, https://doi.org/10.5124/jkma.2019.62.5.265
  2. Outcomes in relation to antithrombotic therapy among patients with atrial fibrillation after percutaneous coronary intervention vol.15, pp.10, 2018, https://doi.org/10.1371/journal.pone.0240161