参考文献/References:
为预防心血管疾病及其并发症的主力军。而社区医生对AF抗凝的认知较低[27]。可能是AF抗凝的继续教育缺乏，理论知识更新慢，这大大削弱了社区医师在房颤抗凝中的作用。国内基层医师对AF抗凝认知的调查显示，对AF患者卒中和出血危险常用的评分（CHA2DS2-VAS和HASBLED）的知晓率较低，医师凭经验治疗患者而不是参阅指南、对出血等严重并发症有顾虑和恐惧、用药经验缺乏等都是导致抗凝率低的原因。目前，我国AF患者对疾病及抗凝相关知识的缺乏是开始并坚持抗凝治疗的主要障碍[28，29]。这可能是AF相关知识普及不够，导致大多数患者对其并发症的危险性和抗凝治疗的益处了解不够，拒绝接受长期的规范抗凝治疗。一项针对AF患者的问卷调查研究显示，56%的患者不理解自身疾病状况和风险；仅10%的患者能确切的指出AF是一种常见的心律失常；72%的患者认为AF不需要治疗或不急于治疗，或将AF等同于冠心病[30]。而患者对AF的态度认知极差[31]是亟待关注的问题，这可能与医护人员的宣传力度不到位，医生未对AF抗凝做更深层的讲解，导致患者出现恐惧抗凝出血风险与漠视两极分化的现象。教育干预可显著影响患者对房颤的认识和感知。通过媒体进行健康宣教也可以提高患者的认知水平。因此，对AF患者进行有效的健康教育也是AF管理的重要部分。5总结AF已成为最常见的心律失常之一，年龄是AF发病明确的危险因素，随着人口老龄化社会的到来，我国AF负担也越来越重。因AF引发的卒中存在高致死率与高致残率的特点，使得抗凝成为AF治疗的重点。但是我国抗凝治疗及管理主要集中在三级医院而非基层医疗机构，区域协同诊疗体系尚未建成，缺乏社区抗凝管理体系。基层医生对AF及抗凝治疗的了解和实施水平是影响抗凝治疗效果的关键，提高我国AF患者疾病及抗凝相关知识是开始并坚持抗凝的主要保障。由此可得，需进一步调查社区AF患者抗凝治疗管理现状，深入分析其潜在影响抗凝不足的原因。因此建议通过建立多方位实施的、便于全面动态管理的、且让患者满意的适合我国抗凝治疗的社区管理体系，提高房颤管理水平，降低房颤相关并发症，筑好患者健康的防线。参考文献：[1]Du X,Guo L,Xia S,et al.Atrial fibrillation prevalence, awareness and management in a nationwide survey 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