Biomedical Department of Internal Medicine and Subspecialities (DiBiMIS), University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy; Department of Internal Medicine 2, National Relevance and High Specialization Hospital Trust, ARNAS Civico, Di Cristina Benfratelli, Palermo, Italy.
Biomedical Department of Internal Medicine and Subspecialities (DiBiMIS), University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy.
Eur J Intern Med. 2015 May;26(4):243-9. doi: 10.1016/j.ejim.2015.02.018. Epub 2015 Mar 5.
It is well known that atrial fibrillation (AF) and chronic kidney disease (CKD) are associated with a higher risk of stroke, and new evidence links AF to cognitive impairment, independently from an overt stroke (CI). Our aim was to investigate, assuming an underlying role of atrial microembolism, the impact of CI and CKD in elderly hospitalized patients with AF.
We retrospectively analyzed the data collected on elderly patients in 66 Italian hospitals, in the frame of the REPOSI project. We analyzed the clinical characteristics of patients with AF and different degrees of CI. Multivariate logistic analysis was used to explore the relationship between variables and mortality.
Among the 1384 patients enrolled, 321 had AF. Patients with AF were older, had worse CI and disability and higher rates of stroke, hypertension, heart failure, and CKD, and less than 50% were on anticoagulant therapy. Among patients with AF, those with worse CI and those with lower estimated glomerular filtration rate (eGFR) had a higher mortality risk (odds ratio 1.13, p=0.006). Higher disability levels, older age, higher systolic blood pressure, and higher eGFR were related to lower probability of oral anticoagulant prescription. Lower mortality rates were found in patients on oral anticoagulant therapy.
Elderly hospitalized patients with AF are more likely affected by CI and CKD, two conditions that expose them to a higher mortality risk. Oral anticoagulant therapy, still underused and not optimally enforced, may afford protection from thromboembolic episodes that probably concur to the high mortality.
众所周知，心房颤动（AF）和慢性肾脏病（CKD）与中风风险增加有关，新的证据表明 AF 与认知障碍有关，与明显的中风（CI）无关。我们的目的是研究 AF 老年住院患者中 CI 和 CKD 的影响，假设 AF 与心房微栓塞有关。
我们回顾性分析了在意大利 66 家医院进行的 REPOSI 项目中收集的老年患者数据。我们分析了 AF 患者和不同程度 CI 的临床特征。多变量逻辑分析用于探索变量与死亡率之间的关系。
在纳入的 1384 名患者中，321 名患有 AF。患有 AF 的患者年龄较大，CI 和残疾程度较差，中风、高血压、心力衰竭和 CKD 的发生率较高，且不到 50%的患者接受抗凝治疗。在 AF 患者中，CI 较差和估算肾小球滤过率（eGFR）较低的患者死亡率较高（比值比 1.13，p=0.006）。较高的残疾程度、较高的年龄、较高的收缩压和较高的 eGFR 与口服抗凝剂处方的可能性较低相关。接受口服抗凝治疗的患者死亡率较低。
患有 AF 的老年住院患者更可能受到 CI 和 CKD 的影响，这两种情况使他们面临更高的死亡率风险。口服抗凝治疗仍未得到充分应用且未得到优化，可能有助于预防血栓栓塞事件的发生，这些事件可能与高死亡率有关。
