Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
Department of Arrhythmia, Ijinkai Takeda General Hospital, Kyoto, Japan.
Chest. 2016 Feb;149(2):401-412. doi: 10.1378/chest.15-1095. Epub 2016 Jan 12.
Atrial fibrillation (AF) is increasingly prevalent with age, and increasing age is an independent risk factor for ischemic stroke. Oral anticoagulant (OAC) therapy use in the extreme elderly (aged ≥ 85 years) is challenging.
The Fushimi AF Registry is a community-based prospective study of Japanese patients with AF (79 participating medical institutions in Fushimi-ku, Kyoto, Japan). Patient enrollment started in March 2011, and follow-up data were available for 3,304 patients as of July 2014. We compared clinical characteristics and outcomes between the extreme elderly group (n = 479 [14.5%]) and other age-groups.
The extreme elderly group had a higher prevalence of major comorbidities and risk scores for stroke but received fewer OACs. After a mean follow-up of 2.0 years, end points in the extreme elderly group were as follows: all-cause death, 17.6; stroke/systemic embolism, 5.1; and major bleeding, 2.0 per 100 person-years. Extreme age was associated with a higher incidence of combined stroke/systemic embolism and all-cause death (hazard ratio [HR], 3.20; 95% CI, 2.66-3.84; P < .01) and higher incidences of stroke/systemic embolism (HR, 2.57; 95% CI, 1.77-3.65; P < .01) and mortality (HR, 3.48; 95% CI, 2.84-4.25; P < .01) compared with other patients (aged ≤ 84 years). The incidence of major bleeding was not significantly different (HR, 1.40; 95% CI, 0.78-2.36; P = .25).
In the present community-based prospective cohort, Japanese extreme elderly patients with AF had a higher incidence of stroke but similar major bleeding risks compared with the younger AF population.
UMIN Clinical Trials Registry; No.: UMIN000005834; URL: http://www.umin.ac.jp/ctr/index.htm.
随着年龄的增长，心房颤动（AF）的发病率越来越高，年龄的增长是缺血性卒中的独立危险因素。高龄（≥ 85 岁）患者使用口服抗凝剂（OAC）治疗具有挑战性。
Fushimi AF 注册研究是一项针对日本 AF 患者的社区为基础的前瞻性研究（日本京都府伏见区的 79 家参与医疗机构）。患者于 2011 年 3 月开始入组，截至 2014 年 7 月，共有 3304 例患者获得随访数据。我们比较了超高龄组（n = 479 [14.5%]）和其他年龄组之间的临床特征和结局。
超高龄组主要合并症和卒中风险评分较高，但 OAC 使用率较低。平均随访 2.0 年后，超高龄组的终点事件如下：全因死亡 17.6%，卒中/全身性栓塞 5.1%，大出血 2.0%/100 人年。超高龄与联合卒中/全身性栓塞和全因死亡发生率升高相关（风险比[HR]，3.20；95%置信区间[CI]，2.66-3.84；P <.01），以及卒中/全身性栓塞（HR，2.57；95%CI，1.77-3.65；P <.01）和死亡率（HR，3.48；95%CI，2.84-4.25；P <.01）均高于其他患者（≤ 84 岁）。大出血发生率无显著差异（HR，1.40；95%CI，0.78-2.36；P =.25）。
在本次基于社区的前瞻性队列研究中，日本超高龄 AF 患者的卒中发生率较高，但与年轻 AF 人群相比，大出血风险相似。
UMIN 临床试验注册；编号：UMIN000005834；网址：http://www.umin.ac.jp/ctr/index.htm。
