Ninni Sandro, Lemesle Gilles, Meurice Thibaud, Tricot Olivier, Lamblin Nicolas, Bauters Christophe
Institut Cœur Poumon, University of Lille, CHU Lille, 59000 Lille, France.
Hôpital Privé Le Bois, 59003 Lille, France.
J Clin Med. 2021 Feb 28;10(5):923. doi: 10.3390/jcm10050923.
Incident heart failure (HF), ischemic stroke and systemic embolism (IS/SE), and major bleeding related to anticoagulation therapy are still the most frequent events occurring in patients with atrial fibrillation (AF). The aim of this study was to assess the 3-year incidence, predictors, and related mortality of IS/SE, major bleeding, and HF in a large cohort of AF outpatients.
We studied 4973 outpatients with prevalent AF included in the CARDIONOR registry. The mean age was 72.9 ± 11.2 years, 24.1% had diabetes mellitus and 78.9% had anticoagulant therapy at baseline. The mean CHADSVasc score was 3.4 ± 1.7. After a median follow-up of 3.2 years (IQR: 2.8 to 3.5), incident HF, IS/SE and major bleeding occurred in 10.5%, 3.3% and 2.1% of patients, respectively. When analyzed as time-dependent variables, IS/SE, major bleeding and hospitalization for decompensated HF were all strongly associated with mortality. The independent predictors of incident HF were age, women, hypertension, diabetes mellitus, coronary artery disease and a previous history of HF. A sensitivity analysis in patients without history of HF at inclusion revealed that incident HF remained the most frequent adverse event, occurring in 5.3% of patients, compared to IS/SE (1.7%) and major bleeding (2.5%).
HF is a common residual cardiovascular adverse event occurring in AF outpatients and is associated with a very high mortality. Since modifiable risk factors are associated with incident HF, upstream intensive management of these risk factors would be of interest.
新发心力衰竭（HF）、缺血性卒中和系统性栓塞（IS/SE）以及与抗凝治疗相关的大出血仍是心房颤动（AF）患者中最常见的事件。本研究的目的是评估一大群AF门诊患者中IS/SE、大出血和HF的3年发病率、预测因素及相关死亡率。
我们研究了纳入CARDIONOR注册研究的4973例AF门诊患者。平均年龄为72.9±11.2岁，24.1%患有糖尿病，78.9%在基线时接受抗凝治疗。平均CHADSVasc评分为3.4±1.7。中位随访3.2年（四分位间距：2.8至3.5年）后，分别有10.5%、3.3%和2.1%的患者发生新发HF、IS/SE和大出血。当作为时间依赖性变量进行分析时，IS/SE、大出血和失代偿性HF住院均与死亡率密切相关。新发HF的独立预测因素为年龄、女性、高血压、糖尿病、冠状动脉疾病和既往HF病史。对入组时无HF病史的患者进行的敏感性分析显示，新发HF仍然是最常见的不良事件，5.3%的患者发生，而IS/SE为1.7%，大出血为2.5%。
HF是AF门诊患者中常见的残留心血管不良事件，且与极高的死亡率相关。由于可改变的危险因素与新发HF相关，对这些危险因素进行上游强化管理将具有重要意义。
