Stroke is highly prevalent in patients with atrial fibrillation (AF) , a most common cardiac arrhythmia with high morbidity, and anticoagulation therapy is a key strategy to prevent AF-related stroke. However, there is short of research on the use of anticoagulation therapy in patients with AF in the community.

To explore the prevalence of use of anticoagulation therapy and influencing factors in elderly patients with nonvalvular atrial fibrillation (NVAF) in Shanghai's communities.

A cross-sectional survey design was used. Stratified sampling was used to select elderly patients with AF who received the 2018 annual physical examination at four community health centers in Shanghai during July to December 2019, and they were surveyed using a questionnaire (consisting of three parts: demographics, CHA2DS2-VASc score and ORBIT score) compiled by our research team for collecting information on their AF prevalence and associated medication use, awareness of AF, comorbidities, and complication, as well as risk for stroke and bleeding. Based on the results of the survey, we excluded those without previous AF-related medical experience and valvular AF, then analyzed the prevalence of anticoagulation therapy in those with NVAF. Anticoagulation therapy was recommended for patients at high risk for stroke in accordance with the CHA2DS2-VASc score. Univariate and multivariate Logistic regression analyses were used to identify influencing factors of anticoagulation therapy in NVAF patients at high risk of stroke.

Three hundred and two patients with NVAF were finally included, of whom the prevalence of current use of anticoagulant and antiplatelet drugs was 29.5% (89/302) , and 39.7% (120/302) , respectively, and that of non-use of anticoagulant or antiplatelet drugs was 30.8% (93/302) . By the CHA2DS2-VASc score, 279 of the 302 NVAF patients (92.4%) were assessed with high risk of stroke, among whom the prevalence of current use of anticoagulant and antiplatelet drugs was 30.5% (85/279) , 40.1% (112/279) , respectively, and the rest 29.4% (82/279) did not take anticoagulant or antiplatelet drugs. Univariate Logistic regression analysis demonstrated that age, marital status, type of AF, onset of AF symptoms, duration of AF, prescription of anticoagulants at the first visit for AF, knowledge of the harmfulness of AF, prevalence of hyperlipidemia, and risk of bleeding were associated with the use of anticoagulation therapy in NVAF patients at high risk of stroke (P<0.05) . Multivariate Logistic regression analysis showed that age, type of AF, prescription of anticoagulants at the first visit for AF, and knowledge of the harmfulness of AF were associated with the use of anticoagulation therapy in NVAF patients at high risk of stroke (P<0.05) .

The prevalence of the use of anticoagulation therapy in community-living NVAF patients at higher risk of stroke is unsatisfactory, so the use of anticoagulation therapy for this population needs to be further standardized, especially in patients with advanced age and low awareness of the harmfulness of AF.

心房颤动（简称房颤）是常见心律失常之一，其发病率高、易诱发脑卒中，而抗凝治疗是预防房颤相关性卒中的核心策略。目前，社区房颤患者抗凝治疗相关研究较为缺乏。

探索上海市社区老年非瓣膜性房颤（NVAF）患者抗凝治疗现状及其影响因素。

本研究采用横断面调查研究方法。于2019年7—12月，采用分层抽样法，选取至上海市4家社区卫生服务中心接受2018年度健康体检的老年房颤患者为研究对象，使用一般资料调查表、CHA2DS2-VASc和ORBIT评分量表对其进行调查，采集其房颤患病与用药情况、疾病认知情况、共病情况、并发症发生情况与风险等信息。依据问卷调查结果排除既往无房颤相关就诊经历及瓣膜性房颤患者，分析NVAF患者抗凝治疗现状。根据CHA2DS2-VASc评分量表的推荐意见：脑卒中高风险人群应进行抗凝治疗。本研究采用单因素Logistic回归和多因素Logistic回归分析NVAF合并脑卒中高风险患者抗凝治疗的影响因素。

共纳入302例NVAF患者，其中89例（29.5%）正在服用抗凝药物，120例（39.7%）例正在服用抗血小板药物，93例（30.8%）患者未服用上述两类药物中的任一类药物。CHA2DS2-VASc评分结果显示，302例NVAF患者中，合并脑卒中高风险者占92.4%（279/302）。其中正在服用抗凝药者占30.5%（85/279），正在服用抗血小板药者占40.1%（112/279），未服用上述两类药物中的任一类药物者占29.4%（82/279）。单因素Logistic回归分析结果显示：年龄、婚姻状况、房颤类型、房颤症状发生情况、房颤病程、首次因房颤就诊时抗凝药开具情况、房颤危害知晓情况、高脂血症患病情况和出血风险为NVAF合并脑卒中高风险患者抗凝治疗的影响因素（P<0.05）。多因素Logistic回归分析结果显示：年龄、房颤类型、首次因房颤就诊时抗凝药开具情况、房颤危害知晓情况为NVAF合并脑卒中高风险患者抗凝治疗的影响因素（P<0.05）。

社区NVAF合并脑卒中高风险患者抗凝治疗率仍不理想，需进一步规范该类人群的抗凝治疗，尤其是高龄和对房颤危害认知不足的患者。