University of Western Australia, Perth, WA.
Western Australia Centre for Rural Health, University of Western Australia, Geraldton, WA.
Med J Aust. 2020 Mar;212(5):215-221. doi: 10.5694/mja2.50496. Epub 2020 Feb 6.
To assess the risks of stroke and cardiovascular mortality for Aboriginal and non-Aboriginal Australians with atrial fibrillation.
Retrospective data linkage cohort study.
SETTING, PARTICIPANTS: All people aged 20-84 years hospitalised with atrial fibrillation in Western Australia during 2000-2012.
Stroke incidence rates and mortality after hospitalisation for atrial fibrillation, and 10-year risks of stroke and of cardiovascular and all-cause mortality.
Among 55 482 index admissions with atrial fibrillation, 7.7% of 20-59-year-old patients and 1.3% of 60-84-year-old patients were Aboriginal Australians. A larger proportion of Aboriginal patients aged 20-59 years had CHA DS -VASc scores of 2 or more (59.8% v 21.8%). In 20-59-year-old Aboriginal patients, the incidence during follow-up (maximum, 10 years; median, 7.1 years) of stroke (incidence rate ratio [IRR], 3.2; 95% CI, 2.5-4.1) and fatal stroke (IRR, 5.7; 95% CI, 3.9-8.9) were markedly higher than for non-Aboriginal patients. Stroke incidence was higher for 60-84-year-old patients, but the difference between Aboriginal and non-Aboriginal patients was smaller (IRR, 1.6; 95% CI, 1.3-2.0). Cardiovascular mortality during follow-up was also higher for 20-59-year-old Aboriginal patients (IRR, 4.4; 95% CI, 4.3-5.9). The hazards of stroke (adjusted HR [aHR], 1.67; 95% CI, 1.22-2.28) and cardiovascular mortality (aHR, 1.47; 95% CI, 1.18-1.83) in younger Aboriginal patients remained significantly higher after multivariable adjustment; age/sex, principal diagnosis of atrial fibrillation, and CHA DS -VASc score were the most influential factors.
Stroke risk and cardiovascular mortality are markedly higher for Aboriginal than non-Aboriginal patients with atrial fibrillation, particularly for patients under 60. Strategies for providing evidence-based therapies and cardiovascular prevention to Aboriginal people with atrial fibrillation must be improved.
评估澳大利亚原住民和非原住民房颤患者发生卒中及心血管死亡的风险。
回顾性数据链接队列研究。
地点、参与者：2000 年至 2012 年期间，在西澳大利亚州因房颤住院的所有 20-84 岁患者。
房颤住院后卒中发生率和死亡率，以及 10 年卒中风险、心血管死亡风险和全因死亡风险。
在 55482 例房颤指数入院患者中，20-59 岁患者中有 7.7%和 60-84 岁患者中有 1.3%为原住民澳大利亚人。在年龄 20-59 岁的原住民患者中，CHA2DS2-VASc 评分≥2 的比例更大（59.8%比 21.8%）。在年龄 20-59 岁的原住民患者中，随访期间（最长 10 年；中位数 7.1 年）卒中（发生率比 [IRR]，3.2；95%CI，2.5-4.1）和致命性卒中（IRR，5.7；95%CI，3.9-8.9）的发生率明显高于非原住民患者。在年龄 60-84 岁的患者中，卒中发生率更高，但原住民与非原住民患者之间的差异较小（IRR，1.6；95%CI，1.3-2.0）。在年龄 20-59 岁的原住民患者中，心血管死亡率也更高（IRR，4.4；95%CI，4.3-5.9）。经多变量调整后，年轻原住民患者的卒中（调整后的 HR [aHR]，1.67；95%CI，1.22-2.28）和心血管死亡（aHR，1.47；95%CI，1.18-1.83）风险仍然显著升高；年龄/性别、房颤的主要诊断和 CHA2DS2-VASc 评分是最具影响力的因素。
房颤患者中，原住民患者发生卒中风险和心血管死亡风险明显高于非原住民患者，尤其是 60 岁以下的患者。必须改善为房颤原住民患者提供循证治疗和心血管预防的策略。
