≥75岁急诊心房颤动患者的预后分析--中国急诊心房颤动研究的亚组分析  

Prognostic analysis of emergency department patients with atrial fibrillation≥75 years old-a subgroup analysis of the Chinese Emergency Atrial Fibrillation Study

作　　者：王娟[1] 杨艳敏[1] 朱俊[1] 张晗[1] 邵兴慧[1] Wang Juan;Yang Yanmin;Zhu Jun;Zhang Han;Shao Xinghui(Emergency and Intensive Care Center,State Key Laboratory of Cardiovascular Disease,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Science and Peking Union Medical College,Beijing,100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,心血管疾病国家重点实验室,阜外医院心内科急重症中心,100037

出　　处：《中华急诊医学杂志》2021年第12期1459-1464,共6页Chinese Journal of Emergency Medicine

基　　金：首都卫生发展科研专项(2018-2-4031)。

摘　　要：目的了解老年(年龄≥75岁)急诊心房颤动(房颤)患者的预后情况,分析不良预后的危险因素。方法2009年至2011年在全国20家医院连续入选急诊就诊、年龄≥75岁房颤患者为本研究对象,收集患者基线资料和治疗情况,并进行1年随访,主要终点事件为全因死亡,次要终点事件为心血管死亡、卒中、大出血事件及主要不良事件。应用单因素和多因素Cox回归模型分析上述事件的独立危险因素。结果共入选766例老年急诊房颤患者,年龄(80.76±4.66)岁,女性占56.9%。1年的全因病死率为24.3%,心血管病死率为12.8%,卒中发生率为10.6%,主要不良事件发生率33.6%,再入院率32%。多因素Cox回归模型分析显示年龄(HR1.073,95%CI 1.042~1.105)、心率(HR 1.008,95%CI 1.002~1.013)、痴呆/认知障碍史(HR 1.849,95%CI 1.016~3.365)、既往慢性阻塞性肺疾病史(HR 1.824,95%CI 1.303~2.551)为老年房颤患者1年死亡的独立危险因素。女性(HR 1.664,95%CI 1.036~2.675)、高血压病史(HR 2.035,95%CI 1.080~3.836)、痴呆/认知障碍史(HR 2.773,95%CI 1.220~6.302)、为老年房颤患者1年卒中的独立危险因素。结论老年急诊房颤患者的预后较差,年龄、心率、痴呆/认知障碍史、慢性阻塞性肺疾病史是老年急诊房颤患者1年全因死亡和主要不良事件的独立危险因素;女性、高血压病史、痴呆/认知障碍史为老年急诊房颤患者1年卒中的独立危险因素。Objective To investigate the baseline characteristics and 1-year follow-up prognosis of elderly(age≥75 years)emergency department(ED)patients with atrial fibrillation(AF).Methods From 2009 to 2011,patients with AF aged≥75 years were continuously enrolled in the ED in 20 hospitals.The baseline characteristics and treatment status of the patients were collected and followed up for 1 year.The primary endpoint was all-cause death;Secondary endpoints were cardiovascular death,stroke,major bleeding and major adverse events.Uni-and multivariate Cox regression models were used to analyze the independent risk factors for the above events.Results A total of 766 elderly ED patients with AF were enrolled,the average age was 80.76±4.66 years old,and 56.9%were female.The 1-year all-cause mortality was 24.3%,cardiovascular mortality was 12.8%,stroke rate was 10.6%,major adverse event rate was 33.6%,and the readmission rate was 32%.Multivariate Cox regression analysis showed that age(HR1.073,95%CI 1.042-1.105),heart rate(HR1.008,95%CI 1.002-1.013),history of dementia/cognitive impairment(HR1.849,95%CI 1.016)~3.365),and history of chronic obstructive pulmonary disease(HR1.824,95%CI 1.303-2.551)were independent risk factors for death in elderly patients with AF in 1-year follow-up;female(HR1.664,95%CI 1.036-2.675),and history of hypertension(HR2.035,95%CI 1.080-3.836),history of dementia/cognitive impairment(HR2.773,95%CI 1.220-6.302)were independent risk factors for 1-year stroke in elderly patients with AF.Conclusions The prognosis of elderly ED patients with AF is poor.Age,heart rate,history of dementia/cognitive impairment,and history of chronic obstructive pulmonary disease are independent risk factors for 1-year all-cause death and major adverse events in elderly ED patients with AF.Female,history of hypertension,and history of dementia/cognitive impairment are independent risk factors for stroke in elderly ED patients with AF.

关 键 词：老年 急诊 心房颤动 死亡 卒中 主要不良事件 

分 类 号：R541.75[医药卫生—心血管疾病]