From the Internal Medicine Residency Program, Morehouse School of Medicine, Atlanta, GA.
Department of Medicine, Morehouse School of Medicine, Atlanta, GA.
Crit Pathw Cardiol. 2021 Sep 1;20(3):168-172. doi: 10.1097/HPC.0000000000000257.
In this study, we investigated the temporal trends in the prevalence and prognostic implication of atrial fibrillation (AF) in patient with light-chain cardiac amyloidosis (AL-CA).
We identified 3030 patients with AL-CA from the 2015 to 2017 National Inpatient Sample, of which 1577 (52%) had AF. We used trend analysis to assess the temporal trends in the prevalence of AF by subtype from 2015 to 2017. We compared inhospital mortality, acute on chronic heart failure, stroke, length of stay (LOS), and total cost in patients with to those without AF, stratified by subtype of AF.
The prevalence of AF among patients with AL-CA was unchanged from 2015 to 2017 (50%-53%; adjusted odds ratio, 1.1 [0.9-1.5]; P = 0.3). The trend was unchanged in the stratified analysis by subtype of AF. Patients with AF were older and had more comorbidities. After propensity matching, acute on chronic heart failure was significantly higher in patients with AL-CA and AF, compared with those with AL-CA alone (55.6% vs. 48.3%; P < 0.0001). There was no difference in inhospital mortality (7.5% vs. 7.5%; P = 0.9), stroke (2.0% vs. 2.5%; P = 0.5), median LOS (5 [3-9] vs. 5 [3-8]; P = 0.3), and median total hospital cost $42,469 ([$21,309-$92,855] vs. $44,008 [$22,889-$94,200]; P = 0.6). In the stratified analysis, acute on chronic heart failure remained significant higher in patients with paroxysmal and nonparoxysmal AF, while LOS became significantly longer in patients with paroxysmal AF.
Among patients with AL-CA, AF is associated with a higher risk of acute on chronic heart failure.
在这项研究中，我们调查了轻链心脏淀粉样变性（AL-CA）患者中房颤（AF）的流行率及其预后意义的时间趋势。
我们从 2015 年至 2017 年的国家住院患者样本中确定了 3030 例 AL-CA 患者，其中 1577 例（52%）患有 AF。我们使用趋势分析评估了 2015 年至 2017 年 AF 亚组的流行率变化。我们比较了有和无 AF 的患者的院内死亡率、慢性心力衰竭急性加重、卒中和住院时间（LOS）以及总费用，并按 AF 亚组进行了分层。
AL-CA 患者中 AF 的患病率在 2015 年至 2017 年期间保持不变（50%-53%；调整后比值比，1.1 [0.9-1.5]；P=0.3）。AF 亚组的分层分析显示趋势不变。AF 患者年龄较大，合并症较多。经过倾向匹配后，与单纯 AL-CA 患者相比，AF 合并 AL-CA 患者的慢性心力衰竭急性加重更为显著（55.6% vs. 48.3%；P<0.0001）。院内死亡率无差异（7.5% vs. 7.5%；P=0.9）、卒中和中位 LOS（5[3-9] vs. 5[3-8]；P=0.3）以及中位总住院费用（$42469 [$21309-$92855] vs. $44008 [$22889-$94200]；P=0.6）。分层分析显示，阵发性和非阵发性 AF 患者的慢性心力衰竭急性加重风险更高，而阵发性 AF 患者的 LOS 显著延长。
在 AL-CA 患者中，AF 与慢性心力衰竭急性加重的风险增加相关。
