Department of Medical Gerontology, Trinity College, Dublin 2, Ireland.
QJM. 2013 May;106(5):415-24. doi: 10.1093/qjmed/hct060. Epub 2013 Mar 14.
The aims of this study were to investigate the prevalence of atrial fibrillation (AF), treatment rates of AF and the factors underlying awareness and treatment, in a large nationally representative study.
A population sample of people aged 50+, living in the Republic of Ireland, were recruited as part of The Irish longitudinal study on ageing. Ten-minute electrocardiogram recordings were obtained (n = 4890), and analysed to detect AF. Self-reported arrhythmias, subjective and objective health measures (cardiovascular diseases, CHA2DS2-VASc variables and blood pressure) and medications were also recorded. Logistic regressions were used to determine associations with outcomes of presence of AF, lack of awareness and untreated AF.
Overall prevalence of AF was 3% (95% CI: 2.4-3.7%), with a marked age gradient and sex difference [4.8% (men) vs. 1.4% (women); P < 0.0001]. In total, 67.8% were at high risk of stroke (CHA2DS2-VASc ≥ 2), of whom 59.3% were inadequately treated. A high proportion of 38.1% were unaware of having AF. CHA2DS2-VASc nor HAS-BLED score influenced awareness or treatment. Lack of awareness was associated with lower education (P = 0.01), lower cognition (P = 0.04), rural location (OR = 3.67; P = 0.02) and number of general practitioner visits (P = 0.01), whereas untreated AF was influenced by frailty status (P = 0.04).
With projected doubling of numbers of persons over 80 in the next 30 years in the British Isles, detection and management of AF is pressing. Two-thirds of adults at high risk of stroke were inadequately treated. More regular screening for AF, application of criteria for stroke and bleeding risk and awareness of factors influencing diagnosis and treatment is recommended.
本研究旨在通过一项大型全国代表性研究，调查爱尔兰心房颤动（AF）的患病率、AF 的治疗率以及意识和治疗背后的因素。
作为爱尔兰老龄化纵向研究的一部分，招募了年龄在 50 岁及以上、居住在爱尔兰共和国的人群样本。获得了 10 分钟心电图记录（n=4890），并进行分析以检测 AF。还记录了自述心律失常、主观和客观健康指标（心血管疾病、CHA2DS2-VASc 变量和血压）以及药物治疗情况。使用逻辑回归来确定与 AF 的存在、缺乏意识和未治疗的 AF 相关的因素。
AF 的总体患病率为 3%（95%CI：2.4-3.7%），呈明显的年龄梯度和性别差异[4.8%（男性）比 1.4%（女性）；P<0.0001]。共有 67.8%的人中风风险高（CHA2DS2-VASc≥2），其中 59.3%的人治疗不足。38.1%的人不知道自己患有 AF。CHA2DS2-VASc 或 HAS-BLED 评分均不影响意识或治疗。缺乏意识与受教育程度较低（P=0.01）、认知能力较低（P=0.04）、农村地区（OR=3.67；P=0.02）和全科医生就诊次数较少（P=0.01）有关，而未治疗的 AF 则与虚弱状态有关（P=0.04）。
预计未来 30 年内不列颠群岛 80 岁以上人口将增加一倍，因此迫切需要检测和管理 AF。三分之二的中风高危成年人治疗不足。建议更定期地筛查 AF，应用中风和出血风险标准，并了解影响诊断和治疗的因素。
