Department of Internal medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin.
Division of Internal medicine, Huntsville hospital, Huntsville, Alabama.
Am J Cardiol. 2021 Aug 1;152:94-98. doi: 10.1016/j.amjcard.2021.04.016. Epub 2021 Jun 2.
The impact of atrial fibrillation (AF) on the hospitalization outcomes in patients ≥ 60 years of age with implantable cardioverter defibrillators (ICD) is not well studied. We queried the National Inpatient Sample database for all patients aged ≥ 60 who had a history of ICD placement, and were admitted with a primary diagnosis of heart failure (HF) during the years 2016-2017. Patients were stratified into 2 groups based on their history of AF. The primary outcome of the study was all-cause in-hospital mortality. Secondary outcomes included cardiogenic shock, myocardial infarction (MI), ventricular fibrillation (VF), stroke and acute kidney injury (AKI). The association between different age strata and outcomes was investigated. The hospitalization outcomes were modeled using logistic regression. A total of 178,045 patients were included, of whom 56.2% had AF. AF correlated with increased mortality (A-OR 1.22 (95% CI: 1.06-1.4), p=0.005), cardiogenic shock (A-OR 1.21 (95%CI: 1.08-1.36), p<0.001), AKI (A-OR 1.12 (95%CI: 1.06-1.17), p<0.001 and lower risk for MI (A-OR 0.79 (95% CI: 0.68-0.9), p<0.001. There was no correlation between AF and risk for VF or stroke. A significant correlation between AF and higher risk for mortality, cardiogenic shock and AKI was demonstrated in ages ≤ 75, ≤ 75, and ≤ 80 years, respectively. In contrast, a significant correlation between AF and lower risk for MI is only demonstrated at age > 70 years. We conclude that AF is an independent predictor for increased all-cause in-hospital mortality and cardiogenic shock. Such risk is influenced by age.
心房颤动（AF）对植入式心脏复律除颤器（ICD）≥60 岁患者住院结局的影响尚未得到充分研究。我们从 2016 年至 2017 年国家住院患者样本数据库中查询了所有有 ICD 植入史且因心力衰竭（HF）初次诊断而入院的≥60 岁患者。根据 AF 病史将患者分为 2 组。研究的主要结局是全因住院死亡率。次要结局包括心源性休克、心肌梗死（MI）、心室颤动（VF）、中风和急性肾损伤（AKI）。研究了不同年龄组与结局之间的关系。使用逻辑回归模型来模拟住院结局。共纳入 178045 例患者，其中 56.2%有 AF。AF 与死亡率增加相关（调整优势比 1.22[95%CI：1.06-1.4]，p=0.005）、心源性休克（调整优势比 1.21[95%CI：1.08-1.36]，p<0.001）、AKI（调整优势比 1.12[95%CI：1.06-1.17]，p<0.001）和 MI 风险降低（调整优势比 0.79[95%CI：0.68-0.9]，p<0.001）。AF 与 VF 或中风风险之间无相关性。在年龄≤75 岁、≤75 岁和≤80 岁的患者中，AF 与更高的死亡率、心源性休克和 AKI 风险之间存在显著相关性。相反，仅在年龄>70 岁的患者中，AF 与 MI 风险降低之间存在显著相关性。我们得出结论，AF 是全因住院死亡率和心源性休克增加的独立预测因子。这种风险受年龄影响。
