Ryder K M, Benjamin E J
Department of Internal Medicine, the University of Tennessee School of Medicine, Memphis, USA.
Am J Cardiol. 1999 Nov 4;84(9A):131R-138R. doi: 10.1016/s0002-9149(99)00713-4.
Atrial fibrillation (AF) is the most common sustained arrhythmia, affecting an estimated 2.2 million adults in the United States. The median age of people with AF is 75, and it affects 8.8% of the US population > 80 years of age. Prevalence data from other countries are presented. Direct comparisons are limited by study design, but rough comparisons suggest that the prevalence of AF in Europe is similar to the prevalence in the United States, whereas the prevalence in Asia may be lower. The limited comparative data underscore our lack of understanding of AF risk factors and complications in racial subgroups and in developing countries. AF increases stroke risk 5-fold. The clinical features that predict higher risk of stroke in AF are prior stroke, hypertension, advancing age, diabetes, and congestive heart failure. Predicting which patients with atrial fibrillation are at the highest risk of stroke remains a challenge. Echocardiographic findings have been investigated to assist in the risk stratification of patients with AF. Despite evidence from clinical trials that anticoagulation with warfarin reduces stroke incidence and even mortality, anticoagulation remains underutilized, especially in the elderly. Improvement in the rate of anticoagulation in patients with AF at risk of stroke can be expected to decrease the complications and mortality of AF.
心房颤动（AF）是最常见的持续性心律失常，据估计在美国影响着220万成年人。房颤患者的中位年龄为75岁，80岁以上的美国人群中有8.8%受其影响。文中还列出了其他国家的患病率数据。由于研究设计的限制，直接比较存在困难，但粗略比较表明，欧洲房颤的患病率与美国相似，而亚洲的患病率可能较低。有限的比较数据凸显了我们对种族亚组和发展中国家房颤危险因素及并发症缺乏了解。房颤使中风风险增加5倍。在房颤中预测中风风险较高的临床特征包括既往中风、高血压、年龄增长、糖尿病和充血性心力衰竭。预测哪些房颤患者中风风险最高仍然是一项挑战。人们已经研究了超声心动图检查结果，以协助对房颤患者进行风险分层。尽管临床试验证据表明，使用华法林进行抗凝可降低中风发生率甚至死亡率，但抗凝治疗的使用率仍然较低，尤其是在老年人中。预计提高有中风风险的房颤患者的抗凝率可降低房颤的并发症和死亡率。
