Balsam Paweł, Gawałko Monika, Peller Michał, Tymińska Agata, Ozierański Krzysztof, Zaleska Martyna, Żukowska Katarzyna, Szepietowska Katarzyna, Maciejewski Kacper, Grabowski Marcin, Borkowski Mariusz, Kołtowski Łukasz, Praska-Oginska Anna, Zaboyska Inna, Opolski Grzegorz, Bednarski Janusz
1st Chair and Department of Cardiology, Medical University of Warsaw.
Cardiology Unit, John Paul II Western Hospital, Grodzisk Mazowiecki.
Medicine (Baltimore). 2018 Nov;97(45):e13074. doi: 10.1097/MD.0000000000013074.
Congestive heart failure (CHF) and atrial fibrillation (AF) frequently coexist and are associated with increased risk of cardiovascular events.To compare baseline characteristics, comorbidities and pharmacotherapy in AF patients with concomitant CHF to those without CHF.The study included 3506 real-life AF patients with (37.1%) and without CHF - participants of the multicentre, retrospective MultiCenter expeRience in AFib patients Treated with OAC (CRAFT) trial (NCT02987062).All patients were treated with non-vitamin K antagonist oral anticoagulants (NOAC) or vitamin K antagonists (VKA). The frequency of NOAC among patients with and without CHF was 45.6% and 43.2%, respectively (P = .17). Patients with CHF were older (73.3 vs 64.7 years, P <.001), less likely to be women (37.4% vs 42%, P = .007), had higher CHA2DS2-VASc score (3.8 ± 1.7 vs 2.6 ± 1.8, P <.001), more often had permanent AF (53.0% vs 13.4%, P <.001), chronic obstructive pulmonary disease (16.7% vs 4.9%, P <.001), coronary artery disease (64.3% vs 29.8%, P <.001), peripheral vascular disease (65.3% vs 31.4%, P <.001), chronic kidney disease (43.1% vs 10.0%, P <.001), liver fibrosis (5.7% vs 2.6%, P <.001), neoplasm (9.6% vs 7.3%, P = .05), history of composite of stroke, transient ischemic attack or systemic embolization (16.2% vs 10.7%, P <.001), pacemaker (27.4% vs 22.1%, P = .004), implantable cardioverter-defibrillator (22.7% vs 0.8%, P <.001) or transaortic valve implantation (4.0% vs 0.8%, P <.001), cardiac resynchronization therapy (8.7% vs 0.3%, P <.001), composite of kidney transplantation, hemodialysis or creatinine level > 2.26 mg/dL (3.6% vs 0.8%, P <.001) and had less often hypertension (69.4% vs 72.5%, P = .05).Patients with AF and CHF had a higher thromboembolic risk and had more concomitant diseases.
充血性心力衰竭（CHF）和心房颤动（AF）常同时存在，并与心血管事件风险增加相关。为比较合并CHF的AF患者与未合并CHF的AF患者的基线特征、合并症及药物治疗情况。该研究纳入了3506例来自多中心回顾性房颤患者口服抗凝剂治疗多中心经验（CRAFT）试验（NCT02987062）的真实世界AF患者，其中合并CHF的患者占37.1%，未合并CHF的患者占62.9%。所有患者均接受非维生素K拮抗剂口服抗凝剂（NOAC）或维生素K拮抗剂（VKA）治疗。合并CHF和未合并CHF的患者中，NOAC的使用频率分别为45.6%和43.2%（P = 0.17）。合并CHF的患者年龄更大（73.3岁 vs 64.7岁，P < 0.001），女性比例更低（37.4% vs 42%，P = 0.007），CHA2DS2-VASc评分更高（3.8 ± 1.7 vs 2.6 ± 1.8，P < 0.001），永久性房颤更为常见（53.0% vs 13.4%，P < 0.001），慢性阻塞性肺疾病更为常见（16.7% vs 4.9%，P < 0.001），冠状动脉疾病更为常见（64.3% vs 29.8%，P < 0.001），外周血管疾病更为常见（65.3% vs 31.4%，P < 0.001），慢性肾脏疾病更为常见（43.1% vs 10.0%，P < 0.001），肝纤维化更为常见（5.7% vs 2.6%，P < 0.001），肿瘤更为常见（9.6% vs 7.3%，P = 0.05），有卒中、短暂性脑缺血发作或系统性栓塞病史的比例更高（16.2% vs 10.7%，P < 0.001）,有起搏器植入史的比例更高（27.4% vs 22.1%，P = 0.004），有植入式心脏复律除颤器植入史的比例更高（22.7% vs 0.8%，P < 0.001），有经主动脉瓣植入史的比例更高（4.0% vs 0.8%，P < 0.001），有心脏再同步治疗史的比例更高（8.7% vs 0.3%，P < 0.001），有肾移植、血液透析或肌酐水平>2.26 mg/dL病史的比例更高（3.6% vs 0.8%，P < 0.001），而高血压的比例更低（69.4% vs 72.5%，P = 0.05）。合并AF和CHF的患者血栓栓塞风险更高，且合并的疾病更多。
