肯尼亚瓣膜性和非瓣膜性心房颤动患者的临床特征及12个月结局
Clinical characteristics and 12-month outcomes of patients with valvular and non-valvular atrial fibrillation in Kenya.
作者信息
Temu Tecla M, Lane Kathleen A, Shen Changyu, Ng'ang'a Loise, Akwanalo Constantine O, Chen Peng-Sheng, Emonyi Wilfred, Heckbert Susan R, Koech Myra M, Manji Imran, Vatta Matteo, Velazquez Eric J, Wessel Jennifer, Kimaiyo Sylvester, Inui Thomas S, Bloomfield Gerald S
机构信息
Department of Medical Microbiology, University of Nairobi College of Health Sciences, Nairobi, Kenya.
Department of Biostatistics, Indiana University School of Medicine, Indiana University, Indianapolis, IN, United States of America.
出版信息
PLoS One. 2017 Sep 21;12(9):e0185204. doi: 10.1371/journal.pone.0185204. eCollection 2017.
BACKGROUND
Atrial fibrillation (AF) is a major contributor to the global cardiovascular disease burden. The clinical profile and outcomes of AF patients with valvular heart diseases in sub-Saharan Africa (SSA) have not been adequately described. We assessed clinical features and 12-month outcomes of patients with valvular AF (vAF) in comparison to AF patients without valvular heart disease (nvAF) in western Kenya.
METHODS
We performed a cohort study with retrospective data gathering to characterize risk factors and prospective data collection to characterize their hospitalization, stroke and mortality rates.
RESULTS
The AF patients included 77 with vAF and 69 with nvAF. The mean (SD) age of vAF and nvAF patients were 37.9(14.5) and 69.4(12.3) years, respectively. There were significant differences (p<0.001) between vAF and nvAF patients with respect to female sex (78% vs. 55%), rates of hypertension (29% vs. 73%) and heart failure (10% vs. 49%). vAF patients were more likely to be taking anticoagulation therapy compared to those with nvAF (97% vs. 76%; p<0.01). After 12-months of follow-up, the overall mortality, hospitalization and stroke rates for vAF patients were high, at 10%, 34% and 5% respectively, and were similar to the rates in the nvAF patients (15%, 36%, and 5%, respectively).
CONCLUSION
Despite younger age and few comorbid conditions, patients with vAF in this developing country setting are at high risk for nonfatal and fatal outcomes, and are in need of interventions to improve short and long-term outcomes.
背景
心房颤动（AF）是全球心血管疾病负担的主要促成因素。撒哈拉以南非洲（SSA）地区患有心脏瓣膜病的房颤患者的临床特征和预后尚未得到充分描述。我们评估了肯尼亚西部患有瓣膜性房颤（vAF）的患者与无心脏瓣膜病的房颤患者（nvAF）的临床特征和12个月的预后情况。
方法
我们进行了一项队列研究，通过回顾性数据收集来确定危险因素，并通过前瞻性数据收集来确定其住院率、中风率和死亡率。
结果
房颤患者包括77例vAF患者和69例nvAF患者。vAF患者和nvAF患者的平均（标准差）年龄分别为37.9（14.5）岁和69.4（12.3）岁。vAF患者和nvAF患者在女性比例（78%对55%）、高血压发病率（29%对73%）和心力衰竭发病率（10%对49%）方面存在显著差异（p<0.001）。与nvAF患者相比，vAF患者更有可能接受抗凝治疗（97%对76%；p<0.01）。经过12个月的随访，vAF患者的总体死亡率、住院率和中风率较高，分别为10%、34%和5%，与nvAF患者的比率相似（分别为15%、36%和5%）。
结论
尽管在这个发展中国家环境中，vAF患者年龄较轻且合并症较少，但他们面临非致命和致命结局的高风险，需要采取干预措施来改善短期和长期结局。
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