老年综合征与心房颤动：全美老年人群队列研究中的患病率及与抗凝治疗的相关性。
Geriatric Syndromes and Atrial Fibrillation: Prevalence and Association with Anticoagulant Use in a National Cohort of Older Americans.
机构信息
Division of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA.
Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.
出版信息
J Am Geriatr Soc. 2021 Feb;69(2):349-356. doi: 10.1111/jgs.16822. Epub 2020 Sep 28.
BACKGROUND
Although guidelines recommend focusing primarily on stroke risk to recommend anticoagulants in atrial fibrillation (AF), physicians report that geriatric syndromes (e.g., falls and disability) are important when considering anticoagulants. Little is known about the prevalence of geriatric syndromes in older adults with AF or the association with anticoagulant use.
METHODS
We performed a cross-sectional analysis of the 2014 Health and Retirement Study, a nationally representative study of older Americans. Participants were asked questions to assess domains of aging, including function, cognition, and medical conditions. We included participants 65 years and older with 2 years of continuous Medicare enrollment who met AF diagnosis criteria by claims codes. We examined five geriatric syndromes: one or more falls within the last 2 years, receiving help with activities of daily living (ADLs) or instrumental ADLs (IADL), experienced incontinence, and cognitive impairment. We determined the prevalence of geriatric syndromes and their association with anticoagulant use, adjusting for ischemic stroke risk (i.e., CHA DS -VASc score [congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease, and sex]).
RESULTS
In this study of 779 participants with AF (median age = 80 years; median CHA DS -VASc score = 4), 82% had one or more geriatric syndromes. Geriatric syndromes were common: 49% reported falls, 38% had ADL impairments, 42% had IADL impairments, 37% had cognitive impairments, and 43% reported incontinence. Overall, 65% reported anticoagulant use; guidelines recommend anticoagulant use for 97% of participants. Anticoagulant use rate decreased for each additional geriatric syndrome (average marginal effect = -3.7%; 95% confidence interval = -1.4% to -5.9%). Lower rates of anticoagulant use were reported in participants with ADL dependency, IADL dependency, and dementia.
CONCLUSION
Most older adults with AF had at least one geriatric syndrome, and geriatric syndromes were associated with reduced anticoagulant use. The high prevalence of geriatric syndromes may explain the lower than expected anticoagulant use in older adults.
背景
尽管指南建议主要关注中风风险以推荐房颤（AF）患者使用抗凝剂，但医生报告称，老年综合征（如跌倒和残疾）在考虑使用抗凝剂时很重要。对于患有 AF 的老年人中老年综合征的流行程度以及与抗凝剂使用的关联知之甚少。
方法
我们对美国老年人的全国代表性研究 2014 年健康与退休研究进行了横断面分析。参与者被问及评估衰老领域的问题，包括功能、认知和医疗状况。我们纳入了符合 AF 诊断标准的年龄在 65 岁及以上且连续两年参加医疗保险的参与者。我们检查了五种老年综合征：在过去 2 年内有一次或多次跌倒、需要帮助进行日常生活活动（ADL）或辅助日常生活活动（IADL）、出现尿失禁和认知障碍。我们确定了老年综合征的流行程度及其与抗凝剂使用的关联，同时调整了缺血性中风风险（即 CHA DS -VASc 评分[充血性心力衰竭、高血压、年龄、糖尿病、中风、血管疾病和性别]）。
结果
在这项对 779 名 AF 患者（中位年龄=80 岁；中位 CHA DS -VASc 评分为 4）的研究中，82%的患者有一个或多个老年综合征。老年综合征很常见：49%的患者报告跌倒，38%的患者 ADL 受损，42%的患者 IADL 受损，37%的患者认知障碍，43%的患者尿失禁。总体而言，65%的患者报告使用了抗凝剂；指南建议 97%的患者使用抗凝剂。随着老年综合征的增加，抗凝剂使用率降低（平均边际效应=-3.7%；95%置信区间=-1.4%至-5.9%）。在依赖 ADL、IADL 和痴呆的患者中，抗凝剂使用率较低。
结论
大多数患有 AF 的老年人至少有一种老年综合征，老年综合征与抗凝剂使用率降低有关。老年综合征的高患病率可能解释了老年人抗凝剂使用率低于预期的原因。
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