School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia.
School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, The University of Western Australia, Crawley, Western Australia, Australia.
Int J Cardiol. 2019 Feb 1;276:273-277. doi: 10.1016/j.ijcard.2018.09.047. Epub 2018 Sep 13.
To determine if increasing hospitalisations for non-valvular atrial fibrillation (NVAF) in Western Australia (WA) was due to incident (first-ever) or repeat hospitalisations, an ageing population structure, changing procedural practice or a combination of these factors.
We conducted a longitudinal retrospective population study on all WA residents aged 25-94 years between 2000 and 2013, with a principal hospital discharge diagnosis of NVAF. Person-linked hospital morbidity and mortality records were used to measure annual rate ratios (RRs) and 95% confidence intervals (CIs) in the total and incident NVAF (25-94 years) hospitalisations, further stratified by sex and by age-specific standardised groups (25-44, 45-64, 65-75, 75-84, 85-94 years).
There were 55,532 total hospitalisations for NVAF between 2000 and 2013, patient mean age 68.3 years, and 58% male. Annual age- and sex- standardised rates for total NVAF hospitalisation increased by 3.0%/year (RR 1.030; 95%CI; 1.028, 1.038), and in both men and women. The largest absolute increase in hospitalisation rate occurred in those aged 85-94 years (∆613/100,000 men and women combined). Incident NVAF hospitalisations showed a borderline decline of 0.5%/year (RR 0.99; 95%CI; 0.99, 1.0) with a statistically significant trend in women but not men. The rate of AF admissions associated with a catheter ablation increased by 13%/year (95%CI; 13.1%, 15.3%).
The increasing rates of total hospitalisation for NVAF is driven more by repeat than incident admissions, escalating hospitalisations in the very elderly, and more frequent interventional procedures. These drivers have major economic and healthcare planning implications.
确定西澳大利亚州（WA）非瓣膜性心房颤动（NVAF）住院人数的增加是由于首发（首次）还是重复住院、人口结构老龄化、手术操作改变还是这些因素的综合影响。
我们对 2000 年至 2013 年间所有 25-94 岁的 WA 居民进行了一项纵向回顾性人群研究，主要的住院诊断为 NVAF。利用人员链接的住院发病率和死亡率记录，测量了 NVAF（25-94 岁）总住院率和首发 NVAF 住院率的年比率（RR）和 95%置信区间（CI），进一步按性别和特定年龄标准化组（25-44、45-64、65-75、75-84、85-94 岁）分层。
2000 年至 2013 年间，共发生 55532 例 NVAF 住院治疗，患者平均年龄为 68.3 岁，男性占 58%。NVAF 总住院率的年年龄和性别标准化率增加了 3.0%/年（RR 1.030；95%CI；1.028，1.038），男性和女性均如此。住院率绝对增加最大的是 85-94 岁的人群（∆613/100000 名男女患者）。首发 NVAF 住院率呈每年下降 0.5%（RR 0.99；95%CI；0.99，1.0），女性呈下降趋势，但男性无此趋势。接受导管消融治疗的房颤入院率每年增加 13%（95%CI；13.1%，15.3%）。
NVAF 总住院率的增加主要是由于重复住院而不是首发住院、高龄患者住院率上升以及介入治疗频率增加所致。这些驱动因素对经济和医疗保健规划具有重大影响。
