Jackson Sandra L, Tong Xin, Yin Xiaoping, George Mary G, Ritchey Matthew D
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia.
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia.
Am J Cardiol. 2017 Dec 1;120(11):1966-1973. doi: 10.1016/j.amjcard.2017.08.017. Epub 2017 Aug 30.
The prevalence of atrial fibrillation (AF) is increasing in the United States as the population ages, but national surveillance is lacking. This cross-sectional study (2006 to 2014) analyzed data from the Healthcare Cost and Utilization Project's Nationwide Emergency Department Sample, the National (Nationwide) Inpatient Sample, and the National Vital Statistics System. Event totals were estimated independently for emergency department (ED) visits, hospitalizations, and mortality, and then collectively after applying criteria to identify mutually exclusive events. Rates were calculated for AF as primary diagnosis or underlying cause of death (primary AF), as well as secondary diagnosis or contributing cause of death (co-morbid AF), and standardized by age to the 2010 US population. From 2006 to 2014, event rates increased for primary AF (249 to 268 per 100,000) and co-morbid AF (1,473 to 1,835 per 100,000). In 2014, an estimated 599,790 ED visits, 453,060 hospitalizations, and 21,712 deaths listed AF as primary. A total of 684,470 mutually exclusive primary AF and 4,695,997 mutually exclusive co-morbid AF events occurred. Among ED visits and hospitalizations with primary AF, the most common secondary diagnoses were hypertension, heart failure, ischemic heart disease, and diabetes. The mean cost per hospitalization with primary AF was $8,819. Mean costs were higher for those with co-morbid AF versus those without co-morbid AF among hospitalizations with a primary diagnosis of ischemic heart disease, heart failure, stroke, hypertension, or diabetes (all p ≤0.01). In conclusion, with the substantial health and economic impact of AF and an aging US population, improved diagnosis, prevention, management, and surveillance of AF are increasingly important.
随着美国人口老龄化,心房颤动(AF)的患病率正在上升,但缺乏全国性监测。这项横断面研究(2006年至2014年)分析了医疗成本与利用项目的全国急诊科样本、全国(全美国)住院患者样本以及国家生命统计系统的数据。分别独立估计急诊科就诊、住院和死亡事件总数,然后在应用标准识别互斥事件后汇总。计算AF作为主要诊断或死亡根本原因(原发性AF)以及次要诊断或死亡促成原因(合并症AF)的发生率,并按年龄标准化至2010年美国人口。2006年至2014年,原发性AF(每10万人中从249例增至268例)和合并症AF(每10万人中从1473例增至1835例)的事件发生率均有所上升。2014年,估计有599,790次急诊科就诊、453,060次住院以及21,712例死亡将AF列为主要病因。共发生了684,470例互斥的原发性AF事件和4,695,997例互斥的合并症AF事件。在原发性AF的急诊科就诊和住院病例中,最常见的次要诊断为高血压、心力衰竭、缺血性心脏病和糖尿病。原发性AF住院的平均费用为8,819美元。在原发性诊断为缺血性心脏病、心力衰竭、中风、高血压或糖尿病的住院病例中,合并症AF患者的平均费用高于无合并症AF的患者(所有p≤0.01)。总之,鉴于AF对健康和经济有重大影响且美国人口老龄化,改善AF的诊断、预防、管理和监测愈发重要。