Vidaillet Humberto, Granada Juan F, Chyou P o-Huang, Maassen Karen, Ortiz Mario, Pulido Juan N, Sharma Param, Smith Peter N, Hayes John
Marshfield Clinic and St. Joseph's Hospital, Marshfield, Wisconsin, USA.
Am J Med. 2002 Oct 1;113(5):365-70. doi: 10.1016/s0002-9343(02)01253-6.
To determine the mortality associated with atrial flutter and atrial fibrillation in the general population.
Using the Marshfield Epidemiologic Study Area, a database that captures nearly all medical care and deaths among its 58,820 residents, we identified patients diagnosed with atrial flutter or atrial fibrillation from July 1, 1991, through June 30, 1995. Patients were followed prospectively and compared with a group of controls without these arrhythmias.
A total of 4775 person-years of follow-up were completed in 577 patients and 577 controls. Compared with controls, mortality among patients with atrial fibrillation or flutter was nearly 7.8-fold higher at 6 months (95% confidence interval [CI]: 4.1 to 15) and 2.5-fold higher (95% CI: 2.0 to 3.1; P < 0.0001) at the last follow-up (mean [+/- SD] of 3.6 +/- 2.3 years; range, 1 day to 7.3 years). At 6 months, mortality among patients with atrial flutter alone was somewhat greater than in controls and less than one third that of those with atrial fibrillation (with or without atrial flutter) (P = 0.02). At the last follow-up, however, mortality was greater among patients with atrial flutter (hazard ratio [HR] = 1.7; 95% CI: 1.2 to 2.6; P = 0.007), atrial fibrillation (HR = 2.4; 95% CI: 1.9 to 3.1; P < 0.0001), or both atrial arrhythmias (HR = 2.5; 95% CI: 1.9 to 3.3; P < 0.0001) when compared with controls in models that adjusted for cardiovascular risk factors.
In the general population, both atrial flutter and atrial fibrillation are independent predictors of increased late mortality. The relatively benign course during the 6-month period after the initial diagnosis of atrial flutter suggests that early diagnosis and treatment of these patients may improve their long-term survival.
确定普通人群中心房扑动和心房颤动相关的死亡率。
利用马什菲尔德流行病学研究区域（一个记录了其58820名居民几乎所有医疗护理和死亡情况的数据库），我们识别出了1991年7月1日至1995年6月30日期间被诊断为心房扑动或心房颤动的患者。对患者进行前瞻性随访，并与一组无这些心律失常的对照组进行比较。
577例患者和577例对照完成了总计4775人年的随访。与对照组相比，心房颤动或扑动患者在6个月时的死亡率几乎高7.8倍（95%置信区间[CI]：4.1至15），在最后一次随访时（平均[±标准差]为3.6±2.3年；范围为1天至7.3年）高2.5倍（95%CI：2.0至3.1；P<0.0001）。在6个月时，单纯心房扑动患者的死亡率略高于对照组，且不到伴有或不伴有心房扑动的心房颤动患者死亡率的三分之一（P=0.02）。然而，在最后一次随访时，在调整了心血管危险因素的模型中，与对照组相比，心房扑动患者（风险比[HR]=1.7；95%CI：1.2至2.6；P=0.007）、心房颤动患者（HR=2.4；95%CI：1.9至3.1；P<0.0001）或两种房性心律失常患者（HR=2.5；95%CI：1.9至3.3；P<0.0001）的死亡率更高。
在普通人群中，心房扑动和心房颤动都是晚期死亡率增加的独立预测因素。心房扑动初诊后6个月期间相对良性的病程提示，对这些患者进行早期诊断和治疗可能会改善其长期生存。
