De Ruijter Wouter, Assendelft Willem J J, Macfarlane Peter W, Westendorp Rudi G J, Gussekloo Jacobijn
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Scand J Prim Health Care. 2008;26(3):147-53. doi: 10.1080/02813430802095812.
To evaluate whether routinely performed ECGs in older people from the general population have added value for cardiovascular risk management beyond the information that is already available from their medical records.
Observational, prospective cohort study.
General population.
A total of 566 participants aged 85 years (377 women, 189 men).
Lifelong history of cardiovascular disease was assessed through medical records obtained from general practitioners. Baseline ECGs were evaluated for prior myocardial infarction and atrial fibrillation. During a 5-year follow-up period, complete cardiovascular mortality and morbidity data were gathered.
During 5 years of follow-up, 262/566 (46%) participants died, of whom 102/262 (39%) died from cardiovascular disease. Participants with a history of cardiovascular disease at age 85 years (284/566, 50%) had an increased cardiovascular mortality (HR 2.7, 95% CI 1.8-4.1) and morbidity (HR (myocardial infarction) 2.1, 95% CI 1.3-3.6; HR (stroke) 2.7, 95% CI 1.6-4.9) compared with those without such a history. Participants with major ECG abnormalities (102/566, 18%) had an increased cardiovascular mortality (HR 1.8, 95% CI 1.1-2.8), but no increase of cardiovascular morbidity compared with those without major ECG abnormalities. In both participants with and without a history of cardiovascular disease, the presence of major ECG abnormalities was not associated with increased cardiovascular mortality or morbidity.
In older people from the general population, a history of cardiovascular disease is a strong predictor of cardiovascular mortality and morbidity. Although abnormal findings on routine ECGs predict cardiovascular mortality, they do not provide additional prognostic information beyond the information available from medical records. Therefore, when accurate medical records are available, programmatic ECG recording is not effective in older people.
评估在普通人群的老年人中常规进行心电图检查，除了从其病历中已有的信息之外，是否对心血管风险管理具有附加价值。
观察性前瞻性队列研究。
普通人群。
共566名85岁的参与者（377名女性，189名男性）。
通过从全科医生处获取的病历评估心血管疾病的终生病史。对基线心电图进行评估，以确定既往心肌梗死和心房颤动情况。在5年的随访期内，收集完整的心血管疾病死亡率和发病率数据。
在5年的随访期间，262/566（46%）的参与者死亡，其中102/262（39%）死于心血管疾病。85岁时有心血管疾病史的参与者（284/566，50%）与没有此类病史的参与者相比，心血管疾病死亡率（风险比2.7，95%置信区间1.8 - 4.1）和发病率（风险比（心肌梗死）2.1，95%置信区间1.3 - 3.6；风险比（中风）2.7，95%置信区间1.6 - 4.9）均有所增加。有主要心电图异常的参与者（102/566，18%）与没有主要心电图异常的参与者相比，心血管疾病死亡率有所增加（风险比1.8，95%置信区间1.1 - 2.8），但心血管疾病发病率没有增加。在有和没有心血管疾病史的参与者中，主要心电图异常的存在均与心血管疾病死亡率或发病率的增加无关。
在普通人群的老年人中，心血管疾病史是心血管疾病死亡率和发病率的有力预测指标。虽然常规心电图检查的异常结果可预测心血管疾病死亡率，但它们并未提供超出病历信息的额外预后信息。因此，当有准确的病历时，计划性心电图记录对老年人无效。
