心房颤动患者住院的驱动因素：更好地知情治疗心房颤动结局登记（ORBIT-AF）的结果。
Drivers of hospitalization for patients with atrial fibrillation: Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF).
机构信息
Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
Duke Clinical Research Institute, Durham, NC.
出版信息
Am Heart J. 2014 May;167(5):735-42.e2. doi: 10.1016/j.ahj.2014.02.003. Epub 2014 Feb 17.
BACKGROUND
Atrial fibrillation (AF) is the most common cardiac dysrhythmia and contributes significantly to health care expenditures. We sought to assess the frequency and predictors of hospitalization in patients with AF.
METHODS
The ORBIT-AF registry is a prospective, observational study of outpatients with AF enrolled from June 29, 2010, to August 9, 2011. The current analysis included 9,484 participants with 1-year follow-up. Multivariable, logistic regression was used to identify baseline characteristics that were associated with first cause-specific hospitalization.
RESULTS
Overall, 31% of patients with AF studied (n = 2,963) had 1 or more hospitalizations per year and 10% (n = 983) had 2 or more. The most common hospitalization cause was cardiovascular (20 per 100 patient-years vs 3.3 bleeding vs 17 noncardiovascular, nonbleeding). Compared with those not hospitalized, hospitalized patients were more likely to have concomitant heart failure (42% vs 28%, P < .0001), higher mean CHADS2 (1 point for congestive heart failure, hypertension, age ≥75, or diabetes; 2 points for prior stroke or transient ischemic attack) scores (2.5 vs 2.2, P < .0001), and more symptoms (baseline European Heart Rhythm Association class severe symptoms 18% vs 13%, P < .0001). In multivariable analysis, heart failure (adjusted hazard ratio [HR] 1.57 for New York Heart Association III/IV vs none, P < .0001), heart rate at baseline (adjusted HR 1.11 per 10-beats/min increase >66, P < .0001), and AF symptom class (adjusted HR 1.37 for European Heart Rhythm Association severe vs none, P < .0001) were the major predictors of incident hospitalization.
CONCLUSIONS
Hospitalization is common in outpatients with AF and is independently predicted by heart failure and AF symptoms. Improved symptom control, rate control, and comorbid condition management should be evaluated as strategies to reduce health care use in these patients.
背景
心房颤动（AF）是最常见的心律失常，对医疗保健支出有重大影响。我们旨在评估 AF 患者住院的频率和预测因素。
方法
ORBIT-AF 登记是一项针对 2010 年 6 月 29 日至 2011 年 8 月 9 日期间招募的门诊 AF 患者的前瞻性观察性研究。本分析包括 9484 名患者，随访 1 年。多变量逻辑回归用于确定与首次特定病因住院相关的基线特征。
结果
总体而言，研究的 AF 患者中有 31%（n=2963）每年有 1 次或多次住院，10%（n=983）有 2 次或多次住院。最常见的住院原因是心血管（每 100 患者年 20 例与 3.3 例出血，17 例非心血管非出血）。与未住院患者相比，住院患者更有可能同时患有心力衰竭（42%与 28%，P<0.0001），更高的平均 CHADS2 评分（充血性心力衰竭、高血压、年龄≥75 岁或糖尿病各 1 分；既往卒中或短暂性脑缺血发作各 2 分）（2.5 与 2.2，P<0.0001），以及更多的症状（基线欧洲心脏节律协会严重症状 18%与 13%，P<0.0001）。多变量分析显示，心力衰竭（纽约心脏协会 III/IV 级与无心力衰竭相比，调整后的危险比[HR]为 1.57，P<0.0001）、基线时的心率（每增加 10 次/分，调整后的 HR 为 1.11，P<0.0001）和 AF 症状分级（欧洲心脏节律协会严重症状与无症状相比，调整后的 HR 为 1.37，P<0.0001）是事件性住院的主要预测因素。
结论
AF 门诊患者的住院治疗很常见，独立预测因素为心力衰竭和 AF 症状。应评估改善症状控制、心率控制和合并症管理作为降低这些患者医疗保健使用的策略。
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