新型冠状病毒肺炎疫情期间心房颤动患者就诊模式的改变  

Changes in the visiting patterns of patients with atrial fibrillation during COVID-19 epidemic

作　　者：古茂成 周鹏 赵奕凯 王玉涛 熊楠青 谢坤 高秀芳 施海明 罗心平 李剑 Gu Maocheng;Zhou Peng;Zhao Yikai;Wang Yutao;Xiong Nanqing;Xie Kun;Gao Xiufang;Shi Haiming;Luo Xinping;Li Jian(Department of Cardiology,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院心内科,上海200040

出　　处：《中华心律失常学杂志》2023年第4期328-334,共7页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的观察新型冠状病毒肺炎(新冠)疫情期间心房颤动(房颤)患者的就诊模式变化。方法本研究为横断面研究。使用房颤综合管理平台数据库,筛选2018年1月至2021年12月在复旦大学附属华山医院就诊的诊断为"房颤"或"心房颤动"的患者,将新冠疫情前(2018年1月至2019年12月)来院的房颤患者设为A组,将新冠疫情后(2020年1月至2021年12月)来院的房颤患者设为B组。收集并比较两组患者的年龄、性别、CHA2DS2-VASc评分、就诊科室、合并疾病等信息,并对两组患者就诊分布、合并症占比,规律就诊及影响因素进行分析。结果①基本信息:纳入10077例房颤患者,平均年龄74.1岁,其中男5030例。A组3420例(就诊次数11804),B组6657例(就诊次数21268)。B组就诊患者平均年龄小于A组(74.62岁对73.81岁,P<0.001),女性就诊占比高于A组[50.3%(5936/11804)对52.7%(11214/21268),P<0.001],CHA_(2)DS_(2)-VASc评分高于A组(2分对3分,P<0.001)。B组患者门急诊就诊占比增加,住院人数占比减少。②相关合并疾病:B组患者脑卒中占比增加[10.0%(1175/11804)对12.0%(2545/21268),P<0.001]、心力衰竭占比增加[5.8%(679/11804)对9.4%(1996/21268),P<0.001]。③门急诊患者规律就诊的关联因素:本市户籍(OR=5.624,95%CI 4.173~7.579)、年龄>65岁(OR=1.676,95%CI 1.351~2.079)与规律就诊呈正相关,新冠疫情发生后(OR=0.746,95%CI 0.623~0.892)、合并心力衰竭(OR=0.568,95%CI 0.365~0.883)及高血压(OR=0.807,95%CI 0.663~0.982)与规律就诊呈负相关。④就诊患者分布:B组患者心内科就诊占比减少[70.5%(6893/9777)对63.6%(12095/19004),P<0.001],神经内科就诊占比增加[6.1%(599/9777)对9.8%(1853/19004),P<0.001]。B组心内科就诊患者平均就诊次数减少(3.16次/年对2.24次/年,P<0.001),神经内科就诊患者平均就诊次数增多(1.51次/年对2.72次/年,P<0.001)。结论疫情发生后,房颤患者的就诊模式发生变化,总就诊人数增加,且合并症较多。规律就诊的Objective To observe changes in the visiting patterns of patients with atrial fibrillation(AF)during COVID-19 epidemic.Methods This was a cross-sectional study.The patients diagnosed with"atrial fibrillation"in Huashan Hospital of Fudan University from January 2018 to December 2021 were selected using AF comprehensive management platform database.And the patients from January 2018 to December 2019 were recorded as the pre-epidemic group(group A),while the patients from January 2020 to December 2021 were named as the post-epidemic group(group B).Information on age,gender,CHA2DS2-VASc score,department of consultation,and comorbidities were collected and compared between two groups.And the distribution of visits,the percentage of comorbidities,the regularity of visits and their influencing factors were analyzed.Results①All of 10077 AF patients with a mean age of 74.1 years,including 5030 males were selected.There were 3420 patients in group A(number of visits 11804)and 6657 patients in group B(number of visits 21268).The average age of group B was lower than group A(74.62 years old vs.73.81 years old,P<0.001).The proportion of female patients of group B was higher than group A[50.3%(5936/11804)vs.52.7%(11214/21268),P<0.001].And the median CHA_(2)DS_(2)-VASc score of group B was higher than group A(2 vs.3,P<0.001).For group B,the proportion of outpatient and emergency visits increased,while the proportion of inpatients decreased.②The percentage of strokes in group B patients increased[10.0%(1175/11804)vs.12.0%(2545/21268),P<0.001],and the percentage of heart failure decreased[5.8%(679/11804)vs.9.4%(1996/21268),P<0.001].③Factors of regular visits of outpatient and emergency patients:City household registration(OR=5.624,95%CI 4.173-7.579),age>65 years old(OR=1.676,95%CI 1.351-2.079)were positively associated with regularity of visits.The COVID-19 epidemic(OR=0.746,95%CI 0.623-0.892),heart failure(OR=0.568,95%CI 0.365-0.883),and hypertension(OR=0.807,95%CI 0.663-0.982)were negatively associated with regularity of

关 键 词：心房颤动 新冠疫情 就诊模式 规律就诊 CHA_(2)DS_(2)-VASc评分 脑卒中 

分 类 号：R541.75[医药卫生—心血管疾病]