Ball Jocasta, Løchen Maja-Lisa, Carrington Melinda J, Wiley Joshua F, Stewart Simon
1 Pre-Clinical Disease and Prevention, Baker Heart and Diabetes Institute, Australia.
2 School of Public Health and Preventive Medicine, Monash University, Australia.
Eur J Cardiovasc Nurs. 2018 Oct;17(7):627-636. doi: 10.1177/1474515118772446. Epub 2018 Apr 17.
Atrial fibrillation represents a substantial clinical and public health issue. The definitive impact of body mass index on prognosis of patients with chronic (persistent or permanent) atrial fibrillation remains undetermined.
The purpose of this study was to investigate the association of body mass index with health outcomes (mortality and re-hospitalisation) of patients with chronic atrial fibrillation.
Using data from the Standard versus Atrial Fibrillation spEcific managemenT strategY (SAFETY) trial (a randomised controlled trial of home-based, atrial fibrillation-specific disease management), we performed post-hoc analyses of mortality and re-hospitalisation outcomes during minimum 24-month follow-up according to baseline body mass index profile.
Of 297 participants (mean age 71±11 years, 47% female, mean body mass index 29.6±6.7 kg/m), 35.0% of participants were overweight (body mass index 25.0-29.9 kg/m) and 43.1% were obese (body mass index≥30 kg/m). During follow-up, n=42 died including 16/65 (24.6%) classified as normal body mass index, 16/104 (15.4%) classified as overweight and 10/128 (7.8%) classified as obese. Increasing body mass index was not associated with increased mortality but was associated with re-hospitalisation due to cardiovascular disease with greater length-of-stay (odds ratio 1.05; 95% confidence interval 1.00-1.09, p=0.032). Obese individuals experienced increased unplanned admissions compared to overweight individuals (incidence rate ratio 0.71; 95% confidence interval 0.53-0.96, p=0.028), and increased cardiovascular-related (incidence rate ratio 0.58; 95% confidence interval 0.39-0.86, p=0.007) and all-cause admissions (incidence rate ratio 0.63; 95% confidence interval 0.45-0.89, p=0.008) compared to those classified as normal body mass index.
Overweight and obesity were not associated with survival in patients with chronic atrial fibrillation but were associated with more frequent hospital care and prolonged stay.
心房颤动是一个重大的临床和公共卫生问题。体重指数对慢性（持续性或永久性）心房颤动患者预后的决定性影响仍未确定。
本研究旨在调查体重指数与慢性心房颤动患者健康结局（死亡率和再次住院）之间的关联。
利用标准与心房颤动特异性管理策略（SAFETY）试验（一项基于家庭的心房颤动特异性疾病管理随机对照试验）的数据，我们根据基线体重指数概况对至少24个月随访期间的死亡率和再次住院结局进行了事后分析。
在297名参与者中（平均年龄71±11岁，47%为女性，平均体重指数29.6±6.7kg/m），35.0%的参与者超重（体重指数25.0 - 29.9kg/m），43.1%的参与者肥胖（体重指数≥30kg/m）。在随访期间，n = 42人死亡，其中体重指数分类为正常的16/65人（24.6%）、超重的16/104人（15.4%）和肥胖的10/128人（7.8%）。体重指数增加与死亡率增加无关，但与因心血管疾病再次住院及住院时间延长有关（比值比1.05；95%置信区间1.00 - 1.09，p = 0.032）。与超重个体相比，肥胖个体的计划外入院增加（发病率比0.71；95%置信区间0.53 - 0.96，p = 0.028），与体重指数分类为正常的个体相比，心血管相关（发病率比0.58；95%置信区间0.39 - 0.86，p = 0.007）和全因入院（发病率比0.63；95%置信区间0.45 - 0.89，p = 0.008）增加。
超重和肥胖与慢性心房颤动患者的生存无关，但与更频繁的住院治疗和更长的住院时间有关。
