General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
Europace. 2018 Nov 1;20(FI_3):f329-f336. doi: 10.1093/europace/eux322.
To examine the number and type of co-morbid long-term health conditions (LTCs) and their associations with all-cause mortality in an atrial fibrillation (AF) population.
Community cohort participants (UK Biobank n = 502 637) aged 37-73 years were recruited between 2006 and 2010. Self-reported LTCs (n = 42) identified in people with AF at baseline. All-cause mortality was available for a median follow-up of 7 years (interquartile range 76-93 months). Hazard ratios (HRs) examined associations between number and type of co-morbid LTC and all-cause mortality, adjusting for age, sex, socio-economic status, smoking, and anticoagulation status. Three thousand six hundred fifty-one participants (0.7% of the study population) reported AF; mean age was 61.9 years. The all-cause mortality rate was 6.7% (248 participants) at 7 years. Atrial fibrillation participants with ≥4 co-morbidities had a six-fold higher risk of mortality compared to participants without any LTC. Co-morbid heart failure was associated with higher risk of mortality [HR 2.96, 95% confidence interval (CI) 1.83-4.80], whereas the presence of co-morbid stroke did not have a significant association. Among non-cardiometabolic conditions, presence of chronic obstructive pulmonary disease (HR 3.31, 95% CI 2.14-5.11) and osteoporosis (HR 3.13, 95% CI 1.63-6.01) was associated with a higher risk of mortality.
Survival in middle-aged to older individuals with self-reported AF is strongly correlated with level of multimorbidity. This group should be targeted for interventions to optimize their management, which in turn may potentially reduce the impact of their co-morbidities on survival. Future AF clinical guidelines need to place greater emphasis on the issue of co-morbidity.
在房颤（AF）人群中，检查合并的长期健康状况（LTC）的数量和类型及其与全因死亡率的关系。
社区队列参与者（英国生物库 n = 502637）年龄在 37-73 岁之间，于 2006 年至 2010 年期间招募。在基线时患有 AF 的人群中自我报告了 LTC（n = 42）。在中位数为 7 年（四分位距 76-93 个月）的随访期间，可获得全因死亡率。风险比（HRs）检查了合并 LTC 的数量和类型与全因死亡率之间的关系，调整了年龄、性别、社会经济地位、吸烟和抗凝状态。3651 名参与者（研究人群的 0.7%）报告了 AF；平均年龄为 61.9 岁。7 年后，全因死亡率为 6.7%（248 名参与者）。与没有任何 LTC 的参与者相比，患有≥4 种合并症的 AF 参与者的死亡率高 6 倍。合并心力衰竭与更高的死亡率相关[HR 2.96，95%置信区间（CI）1.83-4.80]，而合并中风则没有显著相关性。在非心血管代谢疾病中，慢性阻塞性肺疾病（HR 3.31，95%CI 2.14-5.11）和骨质疏松症（HR 3.13，95%CI 1.63-6.01）的存在与更高的死亡率相关。
自我报告的 AF 中中年至老年个体的生存与合并症的严重程度密切相关。该人群应成为干预措施的目标，以优化其管理，从而可能降低其合并症对生存的影响。未来的 AF 临床指南需要更加重视合并症问题。
