心房颤动患者发生多次住院的影响因素分析  

Risk factors for recurrent hospitalizations of patients with atrial fibrillation

作　　者：王雨锋 卢尚欣 夏时俊 贾朝旭[1] 蒋超[1] 何柳 杜昕[1] 马长生[1] Wang Yufeng;Lu Shangxin;Xia Shijun;Jia Zhaoxu;Jiang Chao;He Liu;Du Xin;Ma Changsheng(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心内科,100029

出　　处：《中华心血管病杂志》2020年第4期308-314,共7页Chinese Journal of Cardiology

基　　金：国家重点研发计划课题(2016YFC0900901,2016YFC1301002);国家自然科学基金(81530016)。

摘　　要：目的探讨心房颤动(房颤)患者发生多次住院事件的影响因素。方法从2011年8月1日至2017年12月31日参加中国心房颤动注册研究的非瓣膜性房颤患者中纳入5349例,收集一般信息、合并疾病、用药史及射频消融手术史,连续随访至少48个月,随访终点为患者的年最大全因住院次数(年最大住院次数)。将年最大住院次数≥2次的房颤患者定义为多次住院组,<2次的房颤患者定义为非多次住院组,应用logistic回归模型分析房颤患者发生多次住院事件的影响因素。结果5349例患者的年最大住院次数为0、1、2、3、4、≥5次者分别为2703例(50.5%)、1776例(33.2%)、642例(12.0%)、161例(3.0%)、52例(1.0%)和15例(0.3%)。870例(16.3%)纳入多次住院组,4479例(83.7%)纳入非多次住院组。与非多次住院组比较,多次住院组中年龄≥50岁、女性、房颤病史>1年、合并症[高血压、心力衰竭、冠心病、缺血性卒中/短暂性脑缺血发作(TIA)、糖尿病、消化性溃疡病史]、CHA2DS2-VASc评分≥2分、服用控制心室率药物、他汀类药物及血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂(ACEI/ARB)药物的患者比例更高(P均<0.05)。非多次住院组中吸烟者、饮酒者、大学及以上学历、既往行射频消融术的患者比例更高(P均<0.05)。多因素logistic回归分析显示,年龄50~64岁(OR=1.47,95%CI 1.20~1.80)、≥65岁(OR=1.89,95%CI 1.50~2.38)、女性(OR=1.21,95%CI 1.01~1.46)、高血压(OR=1.42,95%CI 1.16~1.74)、心力衰竭(OR=1.73,95%CI 1.37~2.18)、冠心病(OR=1.63,95%CI 1.31~2.03)、消化性溃疡病史(OR=2.00,95%CI 1.18~3.39)是房颤患者发生多次住院的独立危险因素,而较高的教育程度(OR=0.82,95%CI 0.69~0.99)是发生多次住院的保护因素。结论近1/6的房颤患者年最大住院次数≥2次。年龄≥50岁、女性、高血压、心力衰竭、冠心病、消化性溃疡病史与多次住院风险增加相关。Objective To determine the predictors of recurrent hospitalizations among atrial fibrillation(AF)patients.Methods We analyzed data from the Chinese Atrial Fibrillation Registry(CAFR),a prospective cohort study involving non-valvular atrial fibrillation(NVAF)patients from Augest 2011 to December 2017.A total of 5349 NVAF patients with a minimum of 48 months follow-up were included for analysis.Data including patient demographics,complications,medical and ablation history were collected.The maximum number of all-cause hospitalizations within one-year for each patient served as the primary endpoint.Patients hospitalized less than twice within one-year were defined as non-recurrent hospitalizations group,those hospitalized at least twice within one-year were definned as recurrent hospitalizations group.Logistic regression model was used to identify associated risk factors for recurrent hospitalizations.Results Of 5349 NVAF patients,those hospitalized for 0,1,2,3,4 and at least 5 times within one-year was 2703(50.5%),1776(33.2%),642(12.0%),161(3.0),52(1.0%),15(0.3%),respectively.Eight hundred and seventy(16.3%)patients were included in recurrent hospitalizations group,4479(83.7%)patients were included in non-recurrent hospitalizations group.Compare with non-recurrent hospitalizations group,patients in recurrent hospitalizations group was more likely to be older and female,more frequently had a history of hypertension,heart failure,coronary heart disesase,ischaemic stroke/transient ischaemic attack,diabetes mellitus,peptic ulcer,a AF duration for more than 1 year,medication including drugs for ventricular rate control,statin,angiotensin-converting enzyme inhibitors(ACEI)/angiotensin receptor blocker(ARB)and higher CHA2DS2-VASc scores(P<0.05),but less frequently had higher education,a history of drinking,smoking and ablation(P<0.05).Multivariable analysis showed that age 50-64(OR=1.47,95%CI 1.20-1.80),age≥65(OR=1.89,95%CI 1.50-2.38),female(OR=1.21,95%CI 1.01-1.46),hypertension history(OR=1.42,95%CI 1.16-1.74),heart fa

关 键 词：心房颤动 危险因素 住院 

分 类 号：R541[医药卫生—心血管疾病]