Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Internal Medicine, Nephrology Division, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Open Heart. 2021 Dec;8(2). doi: 10.1136/openhrt-2021-001786.
It is unknown whether screen-detected atrial fibrillation (AF) carries cardiovascular risks similar to clinically detected AF. We aimed to compare clinical outcomes between individuals with screen-detected and clinically detected incident AF.
We studied 8265 participants (age 49 ± 13 years, 50% women) without prevalent AF from the community-based Prevention of Renal and Vascular End-stage Disease (PREVEND) study. By design of the PREVEND study, 70% of participants had a urinary albumin concentration >10 mg/L. Participants underwent 12-lead ECG screening at baseline and every 3 years. AF was considered screen-detected when first diagnosed during a study visit and clinically detected when first diagnosed during a hospital visit. We analysed data from the baseline visit (1997-1998) up to the third follow-up visit (2008). We used Cox regression with screen-detected and clinically detected AF as time-varying covariates to study the association of screen-detected and clinically detected AF with all-cause mortality, incident heart failure (HF) and vascular events.
During a follow-up of 9.8 ± 2.3 years, 265 participants (3.2%) developed incident AF, of whom 60 (23%) had screen-detected AF. The majority of baseline characteristics were comparable between individuals with screen-detected and clinically detected AF. Unadjusted, both screen-detected and clinically detected AF were strongly associated with mortality, incident HF, and vascular events. After multivariable adjustment, screen-detected and clinically detected AF remained significantly associated with mortality (HR 2.21 (95% CI 1.09 to 4.47) vs 2.95 (2.18 to 4.00), p for difference=0.447) and incident HF (4.90 (2.28 to 10.57) vs 3.98 (2.49 to 6.34), p for difference=0.635). After adjustment, screen-detected AF was not significantly associated with vascular events, whereas clinically detected AF was (1.12 (0.46 to 2.71) vs 1.92 (1.21 to 3.06), p for difference=0.283).
Screen-detected incident AF was associated with an increased risk of adverse outcomes, especially all-cause mortality and incident HF. The risk of outcomes was not significantly different between screen-detected AF and clinically detected AF.
目前尚不清楚经筛查发现的心房颤动（房颤）是否具有与临床发现的房颤相似的心血管风险。我们旨在比较经筛查和临床发现的偶发性房颤患者的临床结局。
我们研究了来自社区为基础的预防肾脏和血管终末期疾病（PREVEND）研究的 8265 名参与者（年龄 49±13 岁，50%为女性），他们均无现有房颤。根据 PREVEND 研究的设计，70%的参与者尿白蛋白浓度>10mg/L。参与者在基线和每 3 年进行 12 导联心电图筛查。当在研究就诊时首次诊断为房颤时，将房颤视为经筛查发现；当在医院就诊时首次诊断为房颤时，将房颤视为临床发现。我们分析了从基线访视（1997-1998 年）到第三次随访访视（2008 年）的数据。我们使用 Cox 回归，将经筛查和临床发现的房颤作为时变协变量，研究经筛查和临床发现的房颤与全因死亡率、新发心力衰竭（HF）和血管事件的相关性。
在 9.8±2.3 年的随访期间，265 名参与者（3.2%）发生了偶发性房颤，其中 60 名（23%）为经筛查发现的房颤。经筛查和临床发现的房颤患者的大多数基线特征在两组间无差异。未经调整时，经筛查和临床发现的房颤均与死亡率、新发 HF 和血管事件显著相关。多变量调整后，经筛查和临床发现的房颤与死亡率（HR 2.21（95%CI 1.09 至 4.47）与 2.95（2.18 至 4.00），p 值差异=0.447）和新发 HF（4.90（2.28 至 10.57）与 3.98（2.49 至 6.34），p 值差异=0.635）仍显著相关。调整后，经筛查发现的房颤与血管事件无显著相关性，而临床发现的房颤有相关性（1.12（0.46 至 2.71）与 1.92（1.21 至 3.06），p 值差异=0.283）。
经筛查发现的偶发性房颤与不良结局风险增加相关，尤其是全因死亡率和新发 HF。经筛查发现的房颤与临床发现的房颤的结局风险无显著差异。
