全科医生在心房颤动综合管理中的作用

心房颤动(房颤)是一种临床常见的心律失常，常引起心悸、乏力、胸闷等症状，房颤患者发生卒中、心衰风险增加数倍。在传统的房颤防治模式下，虽然新型口服抗凝药、左心耳封堵术及导管消融术等新治疗方法不断出现，患者的全因死亡率并未得到明显改善，其致残率仍呈上升趋势，医疗负担持续加重，房颤已成为危害人民群众健康的重大公共卫生问题。房颤综合管理是近年提出并证实可明显降低房颤患者住院率及死亡率的治疗策略。该策略需组建一支由全科医生、卒中专家、心脏内科、心脏外科、药学专家等组成的多学科团队，对房颤患者进行综合、全面、连续地管理。全科医生在房颤一级预防中可对其危险因素进行筛查、评估，对居民进行健康教育，促进生活方式、饮食方式的改善，从而控制或消除危险因素对房颤的影响；在房颤二级预防中通过常规体检、门诊复诊等方式做到房颤的早期发现、早期诊断、早期治疗；对已发生房颤的患者，全科医生通过及时有效的抗凝、控制心室率、维持窦性心律等治疗与监测，防治卒中、心衰、出血等并发症。本文从房颤综合管理角度，通过对全科医生在房颤各级预防中的角色进行梳理分析，以期为基层全科医生在房颤管理中的工作方向及流程提供参考和依据。 

Role of general practitioners in the integrated management of atrial fibrillation

Atrial fibrillation (AF) is an important and highly prevalent arrhythmia that increases the risk of stroke and heart failure. It is also associated with palpitation, fatigue and chest tightness. Despite the development of treatment methods such as non-vitamin K antagonist oral anticoagulant, left atrial appendage closure and catheter ablation, the all-cause mortality has not been significantly improved, and the disability rate is still on the rise under traditional treatment modes of AF. AF poses a significant burden to patients and healthcare systems globally. The integrated management of AF has been proposed and proved to significantly reduce hospitalisation and mortality. Integrated AF management requires a coordinated multidisciplinary team composed of general practitioners, stroke specialists, cardiologists, cardiac surgeons and pharmacists to manage patients with AF synthetically, comprehensively and continuously. In the primary prevention of AF, general practitioners can screen and evaluate the risk factors, provide health education to residents and promote a healthy lifestyle and diet, so as to control or eliminate the impact of risk factors on AF. In the secondary prevention of AF, the early detection, diagnosis and treatment of AF can be achieved through routine physical examination and outpatient follow-up. For patients with AF, general practitioners can prevent stroke, heart failure, bleeding and other complications through timely and effective anticoagulation, symptom control with rate or rhythm control treatment and monitoring. From the perspective of integrated management of AF, this article analyses the role of general practitioners in the prevention of AF and provides the basis for the process of general practitioners in the management of AF.