老年人房颤患者的长期个体和人群功能结局。
Long-term individual and population functional outcomes in older adults with atrial fibrillation.
机构信息
Division of Hematology and Oncology, University of California, San Francisco, San Francisco, California, USA.
Division of Geriatrics, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, California, USA.
出版信息
J Am Geriatr Soc. 2021 Jun;69(6):1570-1578. doi: 10.1111/jgs.17087. Epub 2021 Mar 5.
BACKGROUND
Older adults with atrial fibrillation (AF) have multiple risk factors for disablement. Long-term function and the contribution of strokes to disability have not been previously characterized. Our objective was to determine long-term function among older adults with AF and the relative contribution of stroke.
METHODS
We used data from the nationally representative Health and Retirement Study (1992-2014) with participants ≥65 years with incident AF. We examined the association of incident stroke with three outcomes: independence with activities of daily living (ADL), instrumental activities of daily living (IADL), and residence outside a nursing home (community-dwelling). We fit logistic regression models with repeated measures adjusting for comorbidities and demographics to estimate the effect of stroke on function. We estimated the contribution of strokes to the overall population burden of disability using the method of recycled predictions.
RESULTS
Among 3530 participants (median age 79 years, 53% women), 262 had a stroke over 17,396 person-years. Independent of stroke and accounting for comorbidities, annually, ADL independence decreased by 4.4%, IADL independence decreased by 3.9%, and community dwelling decreased by 1.2% (p < 0.05 for all). Accounting for comorbidities, of those who experienced a stroke, 31.9% developed new ADL dependence, 26.5% developed new IADL dependence, and 8.6% newly moved to a nursing home (p < 0.05 for all). Considering all causes of function loss, 1.7% of ADL disability-years, 1.2% of IADL disability-years, and 7.3% of nursing home years could be attributed to stroke over 7.4 years.
CONCLUSION
Older adults lose substantial function over time following AF diagnosis, independent of stroke. Stroke was associated with a significant functional decline and increase in the likelihood of nursing home move, but stroke did not accelerate subsequent disability accrual. Because of the high background rate of disability, stroke was not the dominant determinant of population-level disability in older adults with AF.
背景
患有心房颤动（AF）的老年人存在多种残疾风险因素。长期功能以及中风对残疾的影响以前并未得到描述。我们的目的是确定患有 AF 的老年人的长期功能以及中风的相对影响。
方法
我们使用来自具有代表性的全国健康和退休研究（1992-2014 年）的数据，该研究的参与者年龄在 65 岁及以上，患有新发心房颤动。我们研究了新发中风与三种结局的关系：日常生活活动（ADL）独立性、工具性日常生活活动（IADL）独立性和居住在疗养院之外（社区居住）。我们使用具有重复测量的逻辑回归模型来调整合并症和人口统计学因素，以估计中风对功能的影响。我们使用循环预测方法来估计中风对整体人群残疾负担的贡献。
结果
在 3530 名参与者中（中位年龄为 79 岁，53%为女性），有 262 名参与者在 17396 人年中发生了中风。无论是否发生中风以及是否存在合并症，每年 ADL 独立性下降 4.4%，IADL 独立性下降 3.9%，社区居住下降 1.2%（所有 p<0.05）。考虑到合并症，发生中风的患者中有 31.9%出现新的 ADL 依赖，26.5%出现新的 IADL 依赖，8.6%新搬到疗养院（所有 p<0.05）。考虑到所有功能丧失的原因，在 7.4 年中，1.7%的 ADL 残疾年，1.2%的 IADL 残疾年和 7.3%的疗养院入住年可归因于中风。
结论
在诊断出心房颤动后，老年人的功能会随着时间的流逝而大大下降，而中风则与功能明显下降以及搬入疗养院的可能性增加有关，但中风并没有加速随后的残疾累积。由于残疾的背景发生率很高，中风并不是患有心房颤动的老年人中人群残疾的主要决定因素。
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