Wang Juan, Yang Yan-min, Zhu Jun, Zhang Han, Shao Xing-hui, Huang Bi, Tian Li
Department of Emergency and Intensive Care Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Department of Emergency and Intensive Care Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China. Email:
Zhonghua Yi Xue Za Zhi. 2013 Sep 24;93(36):2871-5.
To explore the independent risk factors associated with one-year mortality in patients with atrial fibrillation (AF).
This study consecutively enrolled AF patients presenting to an emergency department at 20 Chinese hospitals from November 2008 to October 2011. Their baseline data and therapies were recorded. They were followed up for one year. Their major cardiovascular outcomes were recorded. And the predictors of one-year mortality were identified by uni- and multi-variate Cox regression analysis with baseline, therapy variables and follow-up therapy variables.
The one-year all-cause mortality was 13.8% among a total of 2016 AF patients. They were divided into mortality group (A, n = 279) and survival group (B, n = 1737). The baseline data of two groups were analyzed. The group A patients were older ((76.1 ± 11.6) vs (67.2 ± 13.1) years, P < 0.01) and had smaller body mass index compared with group B ((23.7 ± 3.6) vs (22.3 ± 3.4) kg/m(2), P < 0.01); the proportion of permanent AF and CHADS2 score ≥ 2 points was higher in the group A (71.8% vs 47.5%, P < 0.01). History of heart failure, previous stroke, left ventricular systolic dysfunction, diabetes, dementia and chronic obstructive pulmonary disease (COPD) were in a higher proportion of group A (51.2% vs 35.1%, 26.3% vs 17.6%, 26.7% vs 17.9%, 21.0% vs 14.6%, 6.0% vs 1.6%, 21.4% vs 10.1%, all P < 0.01). With regards to drug treatment, usage of diuretics, digoxin and other anticoagulants (heparin, etc), the values were greater in group A (50.9% vs 42.2%, 41.3% vs 34.7%, 10.0% vs 5.9%, all P < 0.01). The Kaplan-Meier survival curves showed that the mortality rate increased along with rising CHADS2 score. Multi-variate Cox regression analysis showed that age (HR = 1.053, 95%CI: 1.040-1.066), permanent AF (HR = 1.374, 95%CI: 1.003-1.883), history of heart failure (HR = 1.385, 95%CI: 1.009-1.901), previous stroke (HR = 1.345, 95%CI: 1.009-1.795), COPD (HR = 1.379, 95%CI: 1.030-1.848), unused angiotensin II receptor blocker (ARB) (HR = 1.955, 95%CI: 1.349-2.832), aspirin unused (HR = 1.770, 95%CI: 1.375-2.278) and warfarin unused (HR = 3.262, 95%CI:1.824-5.834) were independent risk factors for one-year mortality of AF patients.
Age, history of heart failure, previous stroke, COPD history, ARB unused, aspirin and warfarin unused are independent risk factors for one-year all-cause mortality of AF patients.
探讨心房颤动（AF）患者一年死亡率的独立危险因素。
本研究连续纳入了2008年11月至2011年10月在中国20家医院急诊科就诊的AF患者。记录其基线数据和治疗情况。对他们进行一年的随访。记录其主要心血管结局。并通过单因素和多因素Cox回归分析，结合基线、治疗变量和随访治疗变量，确定一年死亡率的预测因素。
在总共2016例AF患者中，一年全因死亡率为13.8%。他们被分为死亡组（A组，n = 279）和存活组（B组，n = 1737）。分析了两组的基线数据。A组患者年龄更大（（76.1±11.6）岁 vs （67.2±13.1）岁，P < 0.01），且与B组相比体重指数更小（（23.7±3.6） vs （22.3±3.4）kg/m²，P < 0.01）；A组永久性AF和CHADS2评分≥2分的比例更高（71.8% vs 47.5%，P < 0.01）。心力衰竭病史、既往卒中史、左心室收缩功能障碍、糖尿病、痴呆和慢性阻塞性肺疾病（COPD）在A组中的比例更高（51.2% vs 35.1%，26.3% vs 17.6%，26.7% vs 17.9%，21.0% vs 14.6%，6.0% vs 1.6%，21.4% vs 10.1%，所有P < 0.01）。关于药物治疗，利尿剂、地高辛和其他抗凝剂（肝素等）的使用情况，A组的值更高（50.9% vs 42.2%，41.3% vs 34.7%，10.0% vs 5.9%，所有P < 0.01）。Kaplan-Meier生存曲线显示，死亡率随CHADS2评分升高而增加。多因素Cox回归分析显示，年龄（HR = 1.053，95%CI：1.040 - 1.066）、永久性AF（HR = 1.374，95%CI：1.003 - 1.883）、心力衰竭病史（HR = 1.385，95%CI：1.009 - 1.901）、既往卒中史（HR = 1.345，95%CI：1.009 - 1.795）、COPD（HR = 1.379，95%CI：1.030 - 1.848）、未使用血管紧张素II受体阻滞剂（ARB）（HR = 1.955，95%CI：1.349 - 2.832）、未使用阿司匹林（HR = 1.770，95%CI：1.375 - 2.278）和未使用华法林（HR = 3.262，95%CI：1.824 - 5.834）是AF患者一年死亡率的独立危险因素。
年龄、心力衰竭病史、既往卒中史、COPD病史、未使用ARB、未使用阿司匹林和未使用华法林是AF患者一年全因死亡率的独立危险因素。
