Chen Mu, Li Cheng, Liao Peng, Cui Xin, Tian Wenqi, Wang Qunshan, Sun Jian, Yang Mei, Luo Li, Wu Hong, Li Yi-Gang
Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
School of Public Health, Fudan University, Shanghai, China.
Lancet Reg Health West Pac. 2022 May 3;23:100470. doi: 10.1016/j.lanwpc.2022.100470. eCollection 2022 Jun.
Atrial fibrillation(AF) has become a significant public health concern in China, with population aging and urbanization.
Data screening was performed for 30,244,930 subjects with medical insurance in the Shanghai Municipal Health Commission database between 2015 and 2020. Patients diagnosed with AF were identified and further assessed for treatment information and clinical outcomes, as well as sex differences and impact of COVID-19 pandemic on AF managment.
AF prevalence was 0.88% in Shanghai, which increased with age and reached 6.70% at subjects 80 years and over. AF was more prevalent in women compared with men (0.89% vs. 0.88%, p<0.0001), which could be attributed to higher AF burden in women over 80 years. Driven by increased prescription of non-vitamin K antagonist oral anticoagulants, anticoagulant use increased from 19.46% in 2015 to 56.57% in 2020. The number of left atrial appendage closure increased from 0.16% in 2015 to 1.23% in 2020. Rhythm control strategy was increasingly adopted, as the use of antiarrhythmic drugs doubled and ablation increased by 21% in 2020 compared to 2015. Compared with men, women were less prone to receive rhythm control treatments, including antiarrhythmics, ablation and cardioversion, but more likely to adopt rate control drugs. During the 5.5 years follow-up, the incidences of stroke, transient ischemic attack, systemic embolism, bleeding, myocardial infarction, and in-hospital death were 6.09%, 5.74%, 1.44%, 5.11%, 8.41%, and 12.84% in patients with index diagnosis of AF in 2015, respectively.
The burdens of AF and AF-related outcomes in Shanghai are high. Management of AF is markedly improved in recent years, and was not or only slightly impeded by the COVID-19 pandemic. There are sex differences in the prevalence, management, and outcomes of AF.
Shanghai Hospital Development Center, National Natural Science Foundation of China and Shanghai Municipal Science and Technology Commission.
随着人口老龄化和城市化进程，心房颤动（AF）已成为中国一个重大的公共卫生问题。
对上海市卫生健康委员会数据库中2015年至2020年期间30,244,930名参加医疗保险的受试者进行数据筛查。确定诊断为AF的患者，并进一步评估其治疗信息、临床结局，以及性别差异和新冠疫情对AF管理的影响。
上海AF患病率为0.88%，随年龄增长而升高，80岁及以上受试者中患病率达6.70%。女性AF患病率高于男性（0.89%对0.88%，p<0.0001），这可能归因于80岁以上女性的AF负担更高。在非维生素K拮抗剂口服抗凝药处方增加的推动下，抗凝药使用率从2015年的19.46%增至2020年的56.57%。左心耳封堵术的实施例数从2015年的0.16%增至2020年的1.23%。节律控制策略的采用越来越多，与2015年相比，2020年抗心律失常药物的使用量翻倍，导管消融术增加了21%。与男性相比，女性较少接受节律控制治疗，包括抗心律失常药物治疗、导管消融术和心脏复律，但更可能采用心率控制药物。在5.5年的随访期间，2015年索引诊断为AF的患者中，中风、短暂性脑缺血发作、全身性栓塞、出血、心肌梗死和住院死亡的发生率分别为6.09%、5.74%、1.44%、5.11%、8.41%和12.84%。
上海AF及其相关结局的负担较高。近年来AF管理有显著改善，且未受新冠疫情或仅受到轻微影响。AF的患病率、管理及结局存在性别差异。
上海医院发展中心、国家自然科学基金和上海市科学技术委员会。
