出院后被诊断为心房颤动的卒中事件。

Incident stroke after discharge from the hospital with a diagnosis of atrial fibrillation.

作者信息

Frost L, Engholm G, Johnsen S, Møller H, Husted S

机构信息

Department of Cardiology, Amtssygehuset, Aarhus University Hospital, Denmark.

出版信息

Am J Med. 2000 Jan;108(1):36-40. doi: 10.1016/s0002-9343(99)00415-5.

DOI:10.1016/s0002-9343(99)00415-5

PMID:11059439

Abstract

PURPOSE

Atrial fibrillation is an important risk factor for stroke. We analyzed stroke risk over time in patients discharged from the hospital with a diagnosis of incident atrial fibrillation as compared with the risk of stroke in the Danish population.

SUBJECTS AND METHODS

In a random sample of half of the Danish population, we identified 13,625 men and 13,577 women, aged 50 to 89 years, with a hospital diagnosis of atrial fibrillation and no prior diagnosis of stroke during 1980 to 1993. Data on other medical conditions were also available from 1977 to 1993, but medication data were not available. Patients were followed from the diagnosis of atrial fibrillation until the first diagnosis of stroke (nonfatal or fatal cerebral ischemic infarct and cerebral hemorrhage), death, or the end of 1993. The risk of stroke in these patients was compared with the risk in the Danish population using Poisson regression modeling to estimate relative risks (RR) and 95% confidence intervals (CI).

RESULTS

For men with atrial fibrillation, the stroke rates increased by age, from 13 per 1,000 person-years in those ages 50 to 59 years, to 22 per 1,000 person-years in those ages 60 to 69 years, to 42 per 1,000 person-years in those ages 70 to 79 years, to 51 per 1,000 person-years in those ages 80 to 89 years. Age-specific stroke rates were similar in women with atrial fibrillation. Patients with a hospital diagnosis of atrial fibrillation had an increased risk of stroke (RR = 2.4; 95% CI, 2.3 to 2.5 in men and RR = 3.0; 95% CI, 2.9 to 3.2 in women) compared with the Danish population. Stroke risk was greatest during the first year after discharge and decreased thereafter. Hypertension, diabetes, and peripheral atherosclerosis were also associated with an increased risk of stroke among patients with atrial fibrillation. Ischemic heart disease and heart failure were risk factors in men only. There was no reduction in the risk of stroke from 1980 to 1993.

CONCLUSIONS

Men and women with atrial fibrillation are at a substantially increased risk of stroke, particularly in the first year after the diagnosis.

摘要

目的

心房颤动是中风的一个重要危险因素。我们分析了确诊为新发心房颤动的出院患者随时间推移的中风风险，并与丹麦人群的中风风险进行比较。

对象与方法

在丹麦一半人口的随机样本中，我们确定了13625名男性和13577名女性，年龄在50至89岁之间，在1980年至1993年期间有医院诊断的心房颤动且既往无中风诊断。1977年至1993年期间也有其他医疗状况的数据，但没有用药数据。患者从心房颤动诊断开始随访，直至首次诊断为中风（非致命性或致命性脑缺血梗死和脑出血）、死亡或1993年底。使用泊松回归模型估计相对风险（RR）和95%置信区间（CI），将这些患者的中风风险与丹麦人群的风险进行比较。

结果

对于患有心房颤动的男性，中风发生率随年龄增加，50至59岁人群为每1000人年13例，60至69岁人群为每1000人年22例，70至79岁人群为每1000人年42例，80至89岁人群为每1000人年51例。患有心房颤动的女性年龄特异性中风发生率相似。与丹麦人群相比，有医院诊断的心房颤动患者中风风险增加（男性RR = 2.4；95% CI，2.3至2.5；女性RR = 3.0；95% CI，2.9至3.2）。中风风险在出院后的第一年最大，此后降低。高血压、糖尿病和外周动脉粥样硬化也与心房颤动患者中风风险增加有关。缺血性心脏病和心力衰竭仅是男性的危险因素。1980年至1993年期间中风风险没有降低。