Department of Geriatric Medicine, Hôpital de Jolimont Groupe, La Louvière, Belgium; Department of Geriatric Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Department of Internal Medicine, CHU Charleroi, Belgium.
Am J Cardiol. 2022 Aug 15;177:40-47. doi: 10.1016/j.amjcard.2022.04.050. Epub 2022 Jun 18.
It is unclear whether the association between atrial fibrillation (AF) and intra-hospital mortality in patients aged 75 years and older is causal or not. This study aims (1) to describe the prevalence and clinical characteristics of AF in ≥75-year-old inpatients and (2) to study the association between AF and length of stay (LOS) and intra-hospital mortality. This retrospective cohort study includes consecutive patients aged ≥75 years admitted between January 2017 and December 2019 to a Belgian secondary hospital. Survival analysis was conducted on the whole dataset and a propensity score-matched dataset separately. Propensity score matching (PSM) was performed to account for the individual probability of having AF given a set of covariates. In 9,105 patients, 3,137 (34%) had a diagnosis of AF upon hospital admission. AF prevalence increased with age strata (from 29% to 38%), and Charlson Co-morbidity Index (from 28% to 57%). Intra-hospital mortality (20%) was higher in the AF group than in the AF-free group (25% vs 17%, p <0.001). The median LOS was 11 days and was shorter in those without AF (10 [4, 17] days) compared with those with AF (11 [5, 19], p <0.001). After PSM, AF was not associated with increased odds of LOS >10 days (odds ratio 1.08, confidence interval: 0.98 to 1.20, p = 0.13). The risk of intra-hospital death for patients with AF remained higher compared with those without AF (log-rank p = 0.0015 and hazard ratio 1.17; confidence interval: 1.04 to 1.32, p = 0.008). In conclusion, the prevalence of AF was high (34%) in inpatients aged ≥75 years and increased with age and co-morbidity burden. After PSM, patients with AF had a 17% higher risk of intra-hospital mortality than patients without AF.
在 75 岁及以上的患者中，心房颤动 (AF) 与院内死亡率之间的关联是否具有因果关系尚不清楚。本研究旨在：(1)描述≥75 岁住院患者中 AF 的患病率和临床特征；(2)研究 AF 与住院时间 (LOS) 和院内死亡率之间的关系。这项回顾性队列研究纳入了 2017 年 1 月至 2019 年 12 月期间在比利时一家二级医院连续收治的≥75 岁患者。对整个数据集和倾向评分匹配数据集分别进行生存分析。倾向评分匹配 (PSM) 用于根据一组协变量计算个体发生 AF 的概率。在 9105 名患者中，有 3137 名 (34%)入院时被诊断为 AF。AF 的患病率随年龄分层而增加 (从 29%增加到 38%)，Charlson 合并症指数 (从 28%增加到 57%)。AF 组的院内死亡率 (20%)高于无 AF 组 (25%比 17%，p<0.001)。中位 LOS 为 11 天，无 AF 组 (10[4，17]天) 短于 AF 组 (11[5，19]天，p<0.001)。PSM 后，AF 与 LOS>10 天的几率增加无关 (比值比 1.08，95%置信区间：0.98 至 1.20，p=0.13)。与无 AF 组相比，AF 患者的院内死亡风险仍然较高 (对数秩检验 p=0.0015，风险比 1.17；95%置信区间：1.04 至 1.32，p=0.008)。总之，≥75 岁住院患者中 AF 的患病率较高 (34%)，且随年龄和合并症负担增加而增加。PSM 后，AF 患者的院内死亡率比无 AF 患者高 17%。
