Lamblin Nicolas, Ninni Sandro, Tricot Olivier, Meurice Thibaud, Lemesle Gilles, Bauters Christophe
Department of Cardiology, Université de Lille, Lille, France.
Department of Cardiology, Centre Hospitalier de Dunkerque, Dunkerque, France.
Open Heart. 2020 Apr 21;7(1):e001165. doi: 10.1136/openhrt-2019-001165. eCollection 2020.
To assess secondary prevention and outcomes in patients with chronic coronary artery disease (CAD), atrial fibrillation (AF) and heart failure (HF), focusing on disease overlap.
We analysed the data of 10 517 outpatients with a diagnosis of CAD, AF and/or HF included in a prospective cohort study. Follow-up (median 3.2 years) was achieved in 10 478 (99.6%) patients. Seven mutually exclusive patient groups were formed: CAD alone (n=4303), AF alone (n=2604), CAD+AF (n=700), HF alone (n=513), HF+CAD (n=728), HF+AF (n=1087) and HF+CAD+AF (n=582).
Patients with disease overlaps represented 29.4% of the total population. The level of secondary prevention was high in all subgroups and in accordance with European class I - level A guidelines. Among patients with CAD, 99% received an antithrombotic and 91% received a statin. Among patients with AF, 81.7% were treated with an anticoagulant if indicated. Among HF patients with left ventricular ejection fraction <40%, 90.9% received a renin-angiotensin system antagonist and 91% a beta-blocker. Three-year all cause/cardiovascular mortality rates were: 6.4%/2%, 9.7%/3.3%, 15.6%/6.7%, 19.2%/9.4%, 24.3%/13.6%, 28%/15.7% and 35.4%/24.8%, for patients with CAD alone, AF alone, CAD+AF, HF alone, HF+CAD, HF+AF and HF+CAD+AF, respectively. In all groups with HF, observed all-cause mortality was higher (p<0.0001) than expected mortality for age-matched, gender-matched and geography-matched persons. In contrast, observed mortality was lower than expected for patients with CAD alone and AF alone (p<0.0001).
In a context of adequate secondary prevention, overlap between diseases is a frequent and high-risk situation with incremental increases in mortality. These patients deserve specific attention.
评估慢性冠状动脉疾病（CAD）、心房颤动（AF）和心力衰竭（HF）患者的二级预防及预后情况，重点关注疾病重叠情况。
我们分析了一项前瞻性队列研究中10517例诊断为CAD、AF和/或HF的门诊患者的数据。10478例（99.6%）患者完成随访（中位随访时间3.2年）。形成了7个相互排斥的患者组：单纯CAD组（n = 4303）、单纯AF组（n = 2604）、CAD + AF组（n = 700）、单纯HF组（n = 513）、HF + CAD组（n = 728）、HF + AF组（n = 1087）和HF + CAD + AF组（n = 582）。
疾病重叠患者占总人口的29.4%。所有亚组的二级预防水平都很高，且符合欧洲I级A类指南。在CAD患者中，99%接受了抗血栓治疗，91%接受了他汀类药物治疗。在AF患者中，81.7%在有指征时接受了抗凝治疗。在左心室射血分数<40%的HF患者中，90.9%接受了肾素 - 血管紧张素系统拮抗剂治疗，91%接受了β受体阻滞剂治疗。单纯CAD、单纯AF、CAD + AF、单纯HF、HF + CAD、HF + AF和HF + CAD + AF患者的三年全因/心血管死亡率分别为：6.4%/2%、9.7%/3.3%、15.6%/6.7%、19.2%/9.4%、24.3%/13.6%、28%/15.7%和35.4%/24.8%。在所有合并HF的组中，观察到的全因死亡率高于年龄匹配、性别匹配和地理位置匹配人群的预期死亡率（p < 0.0001）。相比之下，单纯CAD和单纯AF患者的观察到的死亡率低于预期（p < 0.0001）。
在二级预防充分开展的情况下，疾病重叠是一种常见且高危的情况，死亡率会逐渐增加。这些患者值得特别关注。
