臺灣心房顫動患者中醫利用率之調查研究

A Survey of Traditional Chinese Medicine Use Among Patients with Atrial Fibrillation: a Claim Data-Based Cohort Study

背景：中醫治療常用以緩解慢性疾病患者症狀與改善預後。然而對心房顫動（atrial fibrillation, AF）個案而言，其中醫醫療利用率為何，仍無法從現今文獻窺一究竟。本研究旨在探討心房顫動個案之中醫醫療利用率及其採行之中醫治療類型。方法：研究對象取自全民健康保險研究資料庫之2000年百萬承保抽樣歸人檔，後以1998－2007年間被診斷為心房顫動者為研究世代，並透過年齡、性別配對及1：1方式，隨機篩選非心房顫動世代。所有研究對象皆追蹤至2012年，估計兩組之中醫利用發生率比值（incidence rate ratio, IRR）與95%信賴區間（confidence interval, CI）。結果：研究指出，AF世代之中醫醫療利用率之發生密度為每千人年1935.66，非AF世代之中醫醫療利用率則為每千人年1552.47，前者之中醫醫療利用率較常人多出25%。AF個案較常使用之型態以中藥治療為多（76%），其次為針灸或傷科手法治療（14%），合併兩類型之個案則有10%。討論：本研究有助於釐清AF患者之中醫醫療利用率與其常用的治療類型，後續研究可進一步評估中西醫合併對AF患者之照護成效。 Background: Traditional Chinese Medicine (TCM) is commonly used for symptom relief in patients with chronic diseases. Nevertheless, large-scale surveys focusing on the utilization of TCM among patients with atrial fibrillation (AF) are limited, especially in Taiwan, where TCM is highly popular. This cohort study aimed to describe the utilization of TCM among Taiwanese AF patients. Methods: All subjects were extracted from Longitudinal Health Insurance Database 2000, which was a subset of the National Health Insurance Research Database and contained all medical claims data for one million beneficiaries. Study cohort was comprised of the patients who had received a newly diagnosis of AF from 1998 to 2007. Controls were randomly selected from the remaining cases at a ratio of 1:1 frequency matched by age and sex. All subjects were followed up until the end of 2012, and were estimated the incidence rate ratio and the corresponding confidence interval with Poisson regression model. Results: After adjustment for potential confounders, patients with AF were found to have higher utilization of TCM services than those without AF (1935.66 vs 1552.47, respectively, per 1000 PYs), with an adjusted IRR of 1.25 (95% CI:1.15-1.31).With regard to the commonly used categories of TCM, we found that herbal remedies (76%) constituted the most commonly-used therapeutic approach, followed by acupuncture alone (14%), and the combined therapy (10%). Conclusions: The findings allow healthcare providers to identify the pattern of TCM use and commonly used therapeutic approaches among AF patients. Further research is required to fully address the efficiency and safety of TCM in treating AF patients.