急性肺栓塞患者心房颤动的患病率和发病率
The Prevalence and Incidence of Atrial Fibrillation in Patients with Acute Pulmonary Embolism.
作者信息
Ng Austin Chin Chwan, Adikari Dona, Yuan David, Lau Jerrett K, Yong Andy Sze Chiang, Chow Vincent, Kritharides Leonard
机构信息
Cardiology Department, The University of Sydney, Concord, New South Wales, Australia.
出版信息
PLoS One. 2016 Mar 1;11(3):e0150448. doi: 10.1371/journal.pone.0150448. eCollection 2016.
BACKGROUND
Symptomatic pulmonary embolism (PE) is a major cause of cardiovascular death and morbidity. Estimated prevalence and incidence of atrial fibrillation (AF) in developed countries are between 388-661 per 100,000, and 90-123 per 100,000 person-years respectively. However, the prevalence and incidence of AF in patients presenting with an acute PE and its predictors are not clear.
METHODS
Individual patient clinical details were retrieved from a database containing all confirmed acute PE presentations to a tertiary institution from 2001-2012. Prevalence and incidence of AF was tracked from a population registry by systematically searching for AF during any hospital admission (2000-2013) based on International Classification of Disease (ICD-10) code.
RESULTS
Of the 1,142 patients included in this study, 935 (81.9%) had no AF during index PE admission whilst 207 patients had documented baseline AF (prevalence rate 18,126 per 100,000; age-adjusted 4,672 per 100,000). Of the 935 patients without AF, 126 developed AF post-PE (incidence rate 2,778 per 100,000 person-years; age-adjusted 984 per 100,000 person-years). Mean time from PE to subsequent AF was 3.4 ± 2.9 years. Total mortality (mean follow-up 5.0 ± 3.7 years) was 42% (n = 478): 35% (n = 283), 59% (n = 119) and 60% (n = 76) in the no AF, baseline AF and subsequent AF cohorts respectively. Independent predictors for subsequent AF after acute PE include age (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.04-1.08, p<0.001), history of congestive cardiac failure (HR 1.88, 95% CI 1.12-3.16, p = 0.02), diabetes (HR 1.72, 95% CI 1.07-2.77, p = 0.02), obstructive sleep apnea (HR 4.83, 1.48-15.8, p = 0.009) and day-1 serum sodium level during index PE admission (HR 0.94, 95% CI 0.90-0.98, p = 0.002).
CONCLUSIONS
Patients presenting with acute PE have a markedly increased age-adjusted prevalence and subsequent incidence of AF. Screening for AF may be of importance post-PE.
背景
有症状的肺栓塞（PE）是心血管疾病死亡和发病的主要原因。发达国家心房颤动（AF）的估计患病率和发病率分别为每10万人388 - 661例和每10万人年90 - 123例。然而，急性PE患者中AF的患病率、发病率及其预测因素尚不清楚。
方法
从一个包含2001年至2012年三级医疗机构所有确诊急性PE病例的数据库中检索个体患者的临床详细信息。通过根据国际疾病分类（ICD - 10）编码系统搜索任何住院期间（2000年至2013年）的AF，从人群登记处追踪AF的患病率和发病率。
结果
本研究纳入的1142例患者中，935例（81.9%）在首次PE住院期间无AF，而207例患者有记录的基线AF（患病率为每10万人18,126例；年龄调整后为每10万人4,672例）。在935例无AF的患者中，126例在PE后发生AF（发病率为每10万人年2,778例；年龄调整后为每10万人年984例）。从PE到随后发生AF的平均时间为3.4±2.9年。总死亡率（平均随访5.0±
3.7年）为42%（n = 478）：无AF组为35%（n = 283），基线AF组为59%（n = 119），随后发生AF组为60%（n = 76）。急性PE后随后发生AF的独立预测因素包括年龄（风险比[HR] 1.06，95%置信区间[CI] 1.04 - 1.08，p<0.001）、充血性心力衰竭病史（HR 1.88，95% CI 1.12 - 3.16，p = 0.02）、糖尿病（HR 1.72，95% CI 1.07 - 2.77，p = 0.02）、阻塞性睡眠呼吸暂停（HR 4.83，1.48 - 15.8，p = 0.009）以及首次PE住院期间第1天的血清钠水平（HR 0.94，95% CI 0.90 - 0.98，p = 0.002）。
结论
急性PE患者年龄调整后的AF患病率和随后的发病率显著增加。PE后筛查AF可能很重要。
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