Vinter Nicklas, Cordsen Pia, Lip Gregory Y H, Benjamin Emelia J, Johnsen Søren Paaske, Frost Lars, Trinquart Ludovic
Diagnostic Centre, University Clinic for Development of Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Clin Epidemiol. 2022 May 31;14:711-720. doi: 10.2147/CLEP.S365706. eCollection 2022.
Prior work estimated excess death rates associated with atrial fibrillation (AF) in heart failure (HF) with hazard ratios (HR). The aim was to estimate the life-years lost after newly diagnosed AF in HF patients.
Among patients diagnosed with HF in 2008-2018 in the nationwide Danish Heart Failure Registry, we compared patients with incident AF to referents matched on age, sex, and time since HF. We estimated the marginal hazard ratio (HR) for death and marginal difference in restricted mean survival times (RMST) between AF cases and referents at 10 years after AF diagnosis. We adjusted for sex, age at AF diagnosis, clinical and lifestyle risk factors, and medications.
Among 4463 AF cases and 17,792 referents (mean age 73.7 years, 29% women), the HR was 1.41 (95% CI 1.38; 1.44) but there was evidence of non-proportional hazards. The difference in RMST was -18.2 months (95% CI -16.8; -19.6) at 10 years after AF diagnosis. There were differences in life-years lost between patients diagnosed with AF >1 year and ≤1 year after HF (-25.7 months, 95% CI -23.7; -27.7 vs -10.4 months, 95% CI -8.2; -12.5, p < 0.001), women and men (-20.3 months, 95% CI -17.7; -21.9 vs -17.2 months, 95% CI -15.5; -19.0, p = 0.05), patients with low, medium, and high CHADS-VASc (10.3 months, 95% CI -4.6; -16.1 vs -18.5 months, 95% CI -16.7; -20.4 vs 22.1, 95% CI -18.8; -22.3, p = 0.002).
HF patients with incident AF lost on average 1.5 life-years over 10 years after AF. Life-years lost were larger among patients diagnosed with AF >1 year after HF, women, and patients with higher CHADS-VASc.
既往研究通过风险比（HR）估计了心力衰竭（HF）患者中与心房颤动（AF）相关的超额死亡率。本研究旨在估计HF患者新诊断AF后的生命年损失。
在丹麦全国心力衰竭登记处2008 - 2018年诊断为HF的患者中，我们将新发AF患者与年龄、性别和HF病程相匹配的对照者进行比较。我们估计了AF诊断后10年时AF病例与对照者之间的死亡边际风险比（HR）和受限平均生存时间（RMST）的边际差异。我们对性别、AF诊断时的年龄、临床和生活方式风险因素以及药物进行了调整。
在4463例AF病例和17792例对照者（平均年龄73.7岁，29%为女性）中，HR为1.41（95%CI 1.38；1.44），但存在风险非比例性的证据。AF诊断后10年时RMST的差异为-18.2个月（95%CI -16.8；-19.6）。HF后诊断AF>1年和≤1年的患者之间的生命年损失存在差异（-25.7个月，95%CI -23.7；-27.7 vs -10.4个月，95%CI -8.2；-12.5，p<0.001），女性和男性之间也存在差异（-20.3个月，95%CI -17.7；-21.9 vs -17.2个月，95%CI -15.5；-19.0，p = 0.05），CHADS-VASc评分低、中、高的患者之间也存在差异（10.3个月，95%CI -4.6；-16.1 vs -18.5个月，95%CI -16.7；-20.4 vs 22.1，95%CI -18.8；-22.3，p = 0.002）。
新发AF的HF患者在AF后10年平均损失1.5个生命年。HF后诊断AF>1年的患者、女性以及CHADS-VASc评分较高的患者生命年损失更大。
