急诊就诊伴症状性心房颤动患者的抗心律失常药物治疗 - 一项前瞻性全国队列研究。

Antiarrhythmic drug therapy among patients presenting to emergency department with symptomatic atrial fibrillation - a prospective nationwide cohort.

机构信息

Heart Center Co. Tampere University Hospital, P.O. Box 2000, -33521, Tampere, FI, Finland.

Heart Center, Kuopio University Hospital, Kuopio, Finland.

出版信息

Scand J Trauma Resusc Emerg Med. 2017 Aug 15;25(1):81. doi: 10.1186/s13049-017-0424-7.

DOI:10.1186/s13049-017-0424-7

PMID:28810904

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5558694/

Abstract

BACKGROUND

Atrial fibrillation (AF) is a common arrhythmia that causes numerous visits to emergency departments (ED). The aim of the FinFib2 study was to evaluate whether treatment of patients with AF in ED is consistent with the contemporary European Society of Cardiology (ESC) management guidelines. Here we report the results of antiarrhythmic drug therapy (AAD) in ED.

METHODS

All patients within the two-week study period whose primary reason for the ED visit was symptomatic AF were included into this prospective multicentre study. Comprehensive data on factors contributing to the treatment of AF were collected, including a data of previous use of ADDs, and changes made for them during a visit in ED.

RESULTS

The study population consisted of 1013 consecutive patients (mean age 70 ± 13 years, 47.6% female). The mean European Heart Rhythm Association (EHRA) symptom score was 2.2 ± 0.8. Rhythm control strategy was opt for 498 (63.8%) and 140 (64.5%) patients with previously and newly diagnosed AF, respectively. In patients with previously diagnosed AF the most frequently used AAD was a beta blocker (80.9%). Prior use of class I (11.4%) and III (9.1%) AADs as well as start or adjustment of their dosage (7.4%) were uncommon. Most of the patients with newly diagnosed AF were prescribed a beta blocker (71.0%) or a calcium channel antagonist (24.0%), and only two of them received class I or class III AADs.

CONCLUSIONS

Our data demonstrated that in patients presenting to the ED with recurrent symptomatic AF and aimed for rhythm control strategy, the use of class I and class III AADs was rare despite ESC guideline recommendations. It is possible that early adaptation of a more aggressive rhythm control strategy might improve a quality of life for symptomatic patients and alleviate the ED burden associated with AF. Beta blockers were used by majority of patients as rate control therapy both in rate and rhythm control groups.

TRIAL REGISTRATION

NCT01990105 . Registered 15 November 2013.

摘要

背景

心房颤动（AF）是一种常见的心律失常，会导致许多人前往急诊科（ED）就诊。FinFib2 研究的目的是评估 ED 中 AF 患者的治疗是否符合当代欧洲心脏病学会（ESC）管理指南。这里我们报告 ED 中抗心律失常药物治疗（AAD）的结果。

方法

在为期两周的研究期间，因症状性 AF 而就诊 ED 的所有患者均被纳入这项前瞻性多中心研究。收集了导致 AF 治疗的各种因素的综合数据，包括之前使用 ADD 的数据，以及在 ED 就诊期间对其进行的更改。

结果

研究人群由 1013 例连续患者组成（平均年龄 70±13 岁，47.6%为女性）。平均欧洲心律协会（EHRA）症状评分 2.2±0.8。节律控制策略适用于 498（63.8%）例和 140（64.5%）例分别为既往和新诊断的 AF 患者。在既往诊断为 AF 的患者中，最常使用的 AAD 是β受体阻滞剂（80.9%）。既往使用 I 类（11.4%）和 III 类（9.1%）AAD 以及开始或调整其剂量（7.4%）并不常见。大多数新诊断为 AF 的患者被开了β受体阻滞剂（71.0%）或钙通道拮抗剂（24.0%），仅有两人接受了 I 类或 III 类 AAD。

结论

我们的数据表明，在因反复发作症状性 AF 而就诊 ED 并旨在采用节律控制策略的患者中，尽管 ESC 指南有建议，但 I 类和 III 类 AAD 的使用仍然很少见。早期采用更积极的节律控制策略可能会改善有症状患者的生活质量，并减轻与 AF 相关的 ED 负担。β受体阻滞剂被大多数患者用作节律和心率控制组的心率控制治疗。