住院人群心房颤动发病风险的动态评估  

Dynamic risk assessment for incident atrial fibrillation in a hospital-based population

作　　者：李延广 刘逸杰 吴钦超 李巧元[1] 刘旭[1] 尹言 张涛[1] 陈少敏[2] 白瑾[2] 刘书旺[2] 梁卓[1] 王云龙[1] LI Yanguang;LIU Yijie;WU Qinchao;LI Qiaoyuan;LIU Xu;YIN Yan;ZHANG Tao;CHEN Shaomin;BAI Jin;LIU Shuwang;LIANG Zhuo;WANG Yunlong(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内科,100029 [2]北京大学第三医院心内科

出　　处：《心肺血管病杂志》2024年第2期134-139,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学基金(82300349)。

摘　　要：目的:本研究旨在评估随访中的C2HEST评分在预测住院人群新发心房颤动风险中的作用。方法:本研究采由北京大学第三医院大数据管理中心建立的临床随访数据库。标记随访过程中包含在C2HEST评分内的新发疾病。计算基线状态及随访中的C2HEST评分。评价随访C2HEST评分在预测新发心房颤动风险中的表现。结果:共计120133例患者(346,400人-年随访)纳入分析,2304例研究对象出现心房颤动(发病率0.67/100人/年)。C2HEST评分在随访过程中显著增长,其中发生心房颤动的患者平均C2HEST评分从1.62增长至2.96,高于无心房颤动发生组。相当比例的患者出现新诊断疾病(心房颤动组:61.9%delta-C2HEST≥1;非心房颤动组:14.6%delta-C2HEST≥1)。心房颤动组患者的主要新增合并症为心力衰竭(绝对增长22.4%)与冠心病(绝对增长20.2%)。非心房颤动组患者主要新增合并症为高血压(绝对增长7.5%)。随访中的C2HEST评分在预测新发心房颤动中的表现显著优于基线时的C2HEST评分(曲线下面积:0.874比0.758),净临床改善指数显著(24.7%),同时临床决策曲线更佳。结论:在该住院随访人群中,个体新发心房颤动风险随时间推移、年龄增长逐渐增加。随访中的C2HEST评分在预测新发心房颤动中的表现明显优于基线状态下的C2HEST评分。Objective:Individuals’risk of developing incident atrial fibrillation(AF)is increasing.A risk scoring system calculated at baseline may be not suitable for predicting incident AF many years later.We aimed to evaluate the performance of the C2HEST score at follow-up in assessing the risk of incident AF.Methods:A comprehensive database established by the information management and big data center of Peking University Third Hospital group was applied.Patients who did not have AF at baseline were enrolled.Newlyonset comorbidities were identified during follow-up.The dynamic change of the C2HEST score at baseline and follow-up were analyzed.The baseline and follow-up C2HEST scores were compared in predicting incident AF.Results:A total of 120133 patients were included in the analysis.During 346400 patient-years,2304 developed incident AF(0.67 per 100 patient-years).The C2HEST score increased significantly during followup,especially for those who developed incident AF(from 1.62-2.96).A significant proportion of patients had newly-diagnosed comorbidities(61.9%and 14.6%with delta-C2HEST≥1 in AF and non-AF,respectively).The major newly occurred comorbidities were heart failure(22.4%)and coronary artery disease(20.2%)for AF patients and hypertension for non-AF patients(7.5%).The follow-up C2HEST score showed improved performance compared with the baseline C2HEST score,assessed by area under curves(0.874 vs.0.758),decision curve analysis,and positive net reclassification index(24.7%).Conclusions:In this hospitalized population,the risk for the development of incident AF is not static and increases with the accumulation of new comorbidities and aging.The C2HEST score at follow-up is more accurate in assessing individual risk of AF.

关 键 词：心房颤动 风险评估 C2HEST评分 动态 

分 类 号：R54[医药卫生—心血管疾病]