Stanford University School of Medicine, Stanford, CA.
Am Heart J. 2013 Sep;166(3):573-80. doi: 10.1016/j.ahj.2013.07.003. Epub 2013 Aug 12.
Limited data exist on the burden and relationship of cardiovascular (CV) hospitalization to mortality after newly diagnosed with atrial fibrillation (AF).
Using a 20% sample of nationwide Medicare Part A and B claims data, we performed a retrospective cohort study of Medicare beneficiaries with newly diagnosed AF (2004-2008). Cox proportional hazards time-varying exposures were used to determine the risk of death among patients with CV hospitalization after AF diagnosis.
Of 228,295 patients (mean age 79.6 ± 7.4 years, 56% female), 57% had a CV hospitalization after diagnosis of AF (41% in the first year). The most common primary CV hospitalization diagnoses were AF/supraventricular arrhythmias (21%), heart failure (19%), myocardial infarction (11%), and stroke/transient ischemic attack (7.7%). Incidence rates per 1,000 person-years among patients with and without CV hospitalization were 114 and 87, respectively, for all-cause mortality. After adjustment for covariates and time to CV hospitalization, the hazard of mortality among newly diagnosed AF patients with CV hospitalization, compared with those without CV hospitalization, was higher (hazard ratio 1.22, 95% CI 1.20-1.24).
Cardiovascular hospitalization is common in the first year after AF diagnosis. Atrial fibrillation, heart failure, myocardial infarction, and stroke/transient ischemic attack account for half of primary hospitalization diagnosis. Cardiovascular hospitalization is independently associated with mortality, irrespective of time from diagnosis to first hospitalization, and represents a critical inflection point in survival trajectory. These findings highlight the importance of CV hospitalization as a marker of disease progression and poor outcomes. Efforts to clarify the determinants of hospitalization could inform interventions to reduce admissions and improve survival.
关于新诊断心房颤动（AF）后心血管（CV）住院与死亡率的负担和关系，数据有限。
使用全国性 Medicare 部分 A 和 B 索赔数据的 20%样本，我们对新诊断为 AF（2004-2008 年）的 Medicare 受益人进行了回顾性队列研究。使用时变暴露 Cox 比例风险来确定 AF 诊断后 CV 住院患者的死亡风险。
在 228295 名患者中（平均年龄 79.6 ± 7.4 岁，56%为女性），57%在 AF 诊断后有 CV 住院（41%在第一年）。最常见的主要 CV 住院诊断为 AF/室上性心律失常（21%）、心力衰竭（19%）、心肌梗死（11%）和中风/短暂性脑缺血发作（7.7%）。有和无 CV 住院的患者每 1000 人年的发生率分别为 114 和 87，全因死亡率。在调整协变量和 CV 住院时间后，与无 CV 住院的患者相比，有 CV 住院的新诊断 AF 患者的死亡风险更高（风险比 1.22，95%CI 1.20-1.24）。
CV 住院在 AF 诊断后的第一年很常见。AF、心力衰竭、心肌梗死和中风/短暂性脑缺血发作占主要住院诊断的一半。CV 住院与死亡率独立相关，与从诊断到首次住院的时间无关，代表了生存轨迹的关键转折点。这些发现强调了 CV 住院作为疾病进展和不良结局的标志物的重要性。努力阐明住院的决定因素可以为减少住院和提高生存率的干预措施提供信息。
