Shteinshnaider Miriam, Almoznino-Sarafian Dorit, Alon Irena, Tzur Irma, Berman Sylvia, Cohen Natan, Gorelik Oleg
Department of Internal Medicine "F".
Research & Development Division and Department of Nephrology, Assaf Harofeh Medical Center (affiliated to Sackler School of Medicine, Tel Aviv University), Zerifin, Israel.
J Atr Fibrillation. 2012 Jun 15;5(1):343. doi: 10.4022/jafib.343. eCollection 2012 Jun-Jul.
Little is known about atrial fibrillation (AF) appearing during hospitalization in an Internal Medicine ward. We aimed to investigate characteristics and prognostic significance of in-hospital onset AF. We studied 249 consecutive unselected patients admitted to this medical department with paroxysmal or persistent AF (out-of-hospital group) or AF developed during hospitalization (in-hospital group). Demographic, clinical, laboratory, electrocardiographic and echocardiographic data and all-cause mortality following discharge were recorded and compared between the groups Diabetes mellitus (p=0.05), renal dysfunction (p<0.001), chronic lung disease (p=0.03) and history of stroke (p=0.01) were found more common in the in-hospital group (56 patients), compared to the out-of-hospital group (193 patients). Patients from the in-hospital group were more likely to have recurrent episodes of AF during hospitalization (p=0.002), were more frequently treated with amiodarone (p<0.001), discharged in sinus rhythm (p=0.04) and with medications for rhythm control (p=0.04). Time from onset to termination of AF (p<0.001) and hospital stay (p<0.001) were longer in the in-hospital group. On a median of 39-months follow-up, survival rate was lower in the in-hospital vs. out-of-hospital group (69.6% vs. 81.3%, p=0.025). Older age was significantly associated with shorter survival in the in-hospital group [odds ratio (OR)=1.87, 95% confidence interval (CI) 1.15-3.03, p=0.009]. In the out-of-hospital group, advanced age (OR=2.17, 95%CI 1.51-3.10, p<0.001), no prior AF episode (OR=3.41, 95%CI 1.56-7.46, p=0.002), diabetes mellitus (OR=2.22, 95%CI 1.12-4.39, p=0.006) and renal dysfunction (OR=2.44, 95%CI 1.10-5.38, p=0.049) were significantly associated with shorter survival. Patients developing in-hospital AF differed from subjects hospitalized for AF with respect to the severity of the clinical profile and prognosis.
关于在内科病房住院期间出现的心房颤动（AF），人们了解甚少。我们旨在调查住院期间发生的房颤的特征及其预后意义。我们研究了连续249例未经挑选的患者，这些患者因阵发性或持续性房颤入院（院外组）或在住院期间发生房颤（院内组）。记录并比较了两组患者的人口统计学、临床、实验室、心电图和超声心动图数据以及出院后的全因死亡率。与院外组（193例患者）相比，糖尿病（p=0.05）、肾功能不全（p<0.001）、慢性肺病（p=0.03）和卒中史（p=0.01）在院内组（56例患者）中更为常见。院内组患者在住院期间更易出现房颤复发（p=0.002），更常接受胺碘酮治疗（p<0.001），出院时窦性心律的比例更高（p=0.04）且使用了控制心律的药物（p=0.04）。院内组房颤发作至终止的时间（p<0.001）和住院时间（p<0.001）更长。在中位39个月的随访中，院内组的生存率低于院外组（69.6%对81.3%，p=0.025）。年龄较大与院内组患者较短的生存期显著相关[比值比（OR）=1.87，95%置信区间（CI）1.15 - 3.03，p=0.009]。在院外组中，高龄（OR=2.17，95%CI 1.51 - 3.10，p<0.001）、既往无房颤发作（OR=3.41，95%CI 1.56 - 7.46，p=0.002）、糖尿病（OR=2.22，95%CI 1.12 - 4.39，p=0.006）和肾功能不全（OR=2.44，95%CI 1.10 - 5.38，p=0.049）与较短的生存期显著相关。发生院内房颤的患者在临床特征的严重程度和预后方面与因房颤住院的患者不同。
