Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
Eur Heart J. 2014 Jan;35(4):250-6. doi: 10.1093/eurheartj/eht483. Epub 2013 Nov 25.
Atrial fibrillation increases the risks of stroke, heart failure, and death, and anticoagulation therapy increases the risk of gastrointestinal haemorrhage. However, the relative event rates for these outcomes are not well described. We sought to define the risks of major clinical events in older adults after a new diagnosis of atrial fibrillation.
We undertook a population-based, retrospective cohort study of a nationally representative sample of fee-for-service Medicare beneficiaries 65 years or older with incident atrial fibrillation diagnosed between 1999 and 2007. The main outcome measures were mortality and hospitalization or emergency department care for heart failure, myocardial infarction, stroke, or gastrointestinal haemorrhage. Among 186 461 patients with atrial fibrillation and no recent hospitalizations for heart failure, myocardial infarction, stroke, or gastrointestinal haemorrhage, mortality was the most frequent of these major clinical events (19.5% at 1 year; 48.8% at 5 years). By 5 years, 13.7% of patients were hospitalized for heart failure, 7.1% developed new-onset stroke, and 5.7% had gastrointestinal haemorrhage. Myocardial infarction was less frequent (3.9% at 5 years). Rates of mortality, heart failure, myocardial infarction, stroke, and gastrointestinal bleeding increased with older age and higher CHADS2 scores. Among 44 479 patients with previous events, the 5-year risk of death was greatest among patients with recent bleeding events (70.1%) and stroke (63.7%) and lowest among those with recent myocardial infarction (54.9%).
After the diagnosis of incident atrial fibrillation in older adults, mortality was the most frequent major outcome during the first 5 years. Among non-fatal cardiovascular events, heart failure was the most common event.
心房颤动会增加中风、心力衰竭和死亡的风险，而抗凝治疗会增加胃肠道出血的风险。然而，这些结果的相对事件发生率尚未得到很好的描述。我们旨在确定老年人在新诊断为心房颤动后发生重大临床事件的风险。
我们进行了一项基于人群的回顾性队列研究，研究对象为 1999 年至 2007 年间被诊断为新发心房颤动且无近期心力衰竭、心肌梗死、中风或胃肠道出血住院治疗的全国代表性样本中的按服务收费医疗保险受益人的 65 岁及以上人群。主要观察指标为死亡率以及因心力衰竭、心肌梗死、中风或胃肠道出血而住院或急诊治疗。在 186461 例无近期心力衰竭、心肌梗死、中风或胃肠道出血住院治疗的心房颤动患者中，这些主要临床事件中最常见的是死亡率（1 年时为 19.5%；5 年时为 48.8%）。5 年内，13.7%的患者因心力衰竭住院，7.1%发生新发中风，5.7%发生胃肠道出血。心肌梗死发生率较低（5 年时为 3.9%）。死亡率、心力衰竭、心肌梗死、中风和胃肠道出血的发生率随年龄的增长和 CHADS2 评分的升高而增加。在 44479 例有既往事件的患者中，近期出血事件（70.1%）和中风（63.7%）患者的 5 年死亡风险最高，近期心肌梗死（54.9%）患者的死亡风险最低。
在老年人新发心房颤动的诊断后，在最初的 5 年内，死亡率是最常见的主要结局。在非致命性心血管事件中，心力衰竭是最常见的事件。
