Department of Internal Medicine Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
Department of Medicine, Section of Cardiovascular medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
JACC Clin Electrophysiol. 2021 Nov;7(11):1366-1375. doi: 10.1016/j.jacep.2021.02.021. Epub 2021 Apr 28.
This study sought to investigate the mortality associated with atrial fibrillation (AF) in men and women with heart failure (HF) according to the sequence of presentation and rhythm versus rate control.
The sex-specific epidemiology of AF in HF is sparse.
Using the Danish nationwide registries, all first-time cases of HF were identified and followed for all-cause mortality from 1998 to 2018.
Among 252,988 patients with HF (mean age: 74 ± 13 years, 45% women), AF presented before HF in 54,064 (21%) and on the same day in 27,651 (11%) individuals, similar in women and men. Among patients without AF, the cumulative 10-year incidence of AF was 18.7% (95% confidence interval [CI]: 18.2% to 19.1%) in women and 21.3% (95% CI: 21.0% to 21.6%) in men. On follow-up (mean: 6.2 ± 5.8 years), adjusted mortality rate ratios were 3.33 (95% CI: 3.25 to 3.41) in women and 2.84 (95% CI: 2.78 to 2.90) in men if AF antedated HF, 3.45 (95% CI: 3.37 to 3.56) in women versus 2.76 (95% CI: 2.69 to 2.83) in men when AF and HF were diagnosed concomitantly, and 4.85 (95% CI: 4.73 to 4.97) in women versus 3.89 (95% CI: 3.80 to 3.98) in men when AF developed after HF. Compared with rate control for AF, a rhythm-controlling strategy was associated with lowered mortality in inverse probability-weighted models across all strata and in both sexes (hazard ratio: 0.75 to 0.83), except for women who developed AF after HF onset (hazard ratio: 1.03).
More than half of all men and women with HF will develop AF during their clinical course, with prognosis associated with AF being worse in women than men. Further studies are needed to understand the underlying mechanisms.
本研究旨在根据房颤（AF）的发生顺序、节律控制与心率控制，探讨 AF 与心力衰竭（HF）患者死亡率之间的关系。
HF 合并 AF 的性别特异性流行病学资料较为匮乏。
利用丹麦全国性注册数据库，我们确定了所有首次 HF 病例，并于 1998 年至 2018 年随访全因死亡率。
在 252988 例 HF 患者（平均年龄：74±13 岁，45%为女性）中，54064 例（21%）AF 先于 HF 发生，27651 例（11%）在同一天发生，女性与男性之间无差异。在无 AF 的患者中，女性 10 年累积 AF 发生率为 18.7%（95%置信区间[CI]：18.2%至 19.1%），男性为 21.3%（95%CI：21.0%至 21.6%）。在随访期间（平均：6.2±5.8 年），如果 AF 先于 HF 发生，女性的校正死亡率比值比为 3.33（95%CI：3.25 至 3.41），男性为 2.84（95%CI：2.78 至 2.90）；如果 AF 和 HF 同时诊断，女性为 3.45（95%CI：3.37 至 3.56），男性为 2.76（95%CI：2.69 至 2.83）；如果 AF 发生在 HF 之后，女性为 4.85（95%CI：4.73 至 4.97），男性为 3.89（95%CI：3.80 至 3.98）。与 AF 的心率控制策略相比，在所有亚组和两性中，采用节律控制策略的死亡率均较低（风险比：0.75 至 0.83），但 HF 后发生 AF 的女性除外（风险比：1.03）。
超过一半的 HF 男性和女性在其病程中会发生 AF，AF 预后女性比男性更差。需要进一步研究以了解潜在机制。
