老年人的认知障碍、年龄、生活质量和房颤治疗策略：SAGE-AF 研究。
Cognitive impairment, age, quality of life, and treatment strategy for atrial fibrillation in older adults: The SAGE-AF study.
机构信息
Evans Department of Medicine, Cardiovascular Medicine Section, Arrhythmia Service, Boston University School of Medicine, Boston, Massachusetts, USA.
Bouvé College of Health Sciences, Department of Pharmacy and Health System Sciences, Northeastern University, Boston, Massachusetts, USA.
出版信息
J Am Geriatr Soc. 2022 Oct;70(10):2818-2826. doi: 10.1111/jgs.17886. Epub 2022 Jun 23.
BACKGROUND
Atrial fibrillation (AF) treatment includes anticoagulation for high stroke risk individuals and either rate or rhythm control strategies. We aimed to investigate the impact of age, geriatric factors, and medical comorbidities on choice of rhythm versus rate control strategy in older adults.
METHODS
Patients with AF aged ≥65 years with CHA DS VASc score ≥2 and eligible for anticoagulation were recruited for the Systematic Assessment of Geriatric Elements-AF (SAGE-AF) prospective cohort study. An interview that included measures of HRQoL, cognitive function, vision, hearing, and frailty was performed. The association between these elements and AF treatment strategy was examined by multivariable logistic regression models.
RESULTS
One thousand two hundred forty-four participants (mean age 76 years; 49% female; 85% non-Hispanic white) were enrolled. Rate and rhythm control were used in 534 and 710 participants, respectively. Compared to participants <75 years, those ≥75 were more likely to be treated with a rate control strategy (age 75-84 adjusted odds ratio [aOR] 1.37 [95% CI 0.99, 1.88]; age 85+ aOR = 2.05, 95% CI 1.30, 3.21). Those treated with a rate control strategy were more likely to have cognitive impairment (aOR = 1.50, 95% CI 1.13, 1.99), and peripheral vascular disease (PVD) (aOR = 1.82, 95% CI 1.22, 2.72) but less likely to have visual impairment (aOR 0.73 [0.55, 0.98]), congestive heart failure (CHF; aOR 0.68 [0.49, 0.94]) or receive anticoagulation (aOR 0.53, 95% CI 0.36, 0.78).
CONCLUSION
Older age, cognitive impairment, and PVD were associated with use of rate control strategy. Visual impairment, CHF, and anticoagulation use were associated with a rhythm control strategy. There was no difference in HRQoL between the rate and rhythm control groups. This study suggests that certain geriatric elements may be associated with AF treatment strategies. Further study is needed to evaluate how these decisions affect outcomes.
背景
心房颤动（AF）的治疗包括对高卒中风险人群进行抗凝治疗，以及采用控制心率或节律的策略。我们旨在研究年龄、老年因素和合并症对老年患者选择节律或心率控制策略的影响。
方法
入选了年龄≥65 岁且 CHA2DS2-VASc 评分≥2 分且适合抗凝治疗的 AF 患者，进行系统性评估老年因素-AF（SAGE-AF）前瞻性队列研究。进行了一项包括生活质量、认知功能、视力、听力和虚弱评估的访谈。采用多变量逻辑回归模型来研究这些因素与 AF 治疗策略之间的关系。
结果
共纳入 1244 名参与者（平均年龄 76 岁；49%为女性；85%为非西班牙裔白人）。534 名参与者采用了心率控制策略，710 名参与者采用了节律控制策略。与<75 岁的参与者相比，≥75 岁的参与者更有可能采用心率控制策略（年龄 75-84 岁的调整比值比[aOR]为 1.37[95%可信区间 0.99,1.88]；年龄 85 岁以上 aOR=2.05，95%可信区间 1.30,3.21）。采用心率控制策略的患者更有可能存在认知障碍（aOR=1.50，95%可信区间 1.13,1.99）和外周血管疾病（PVD；aOR=1.82，95%可信区间 1.22,2.72），但不太可能存在视力障碍（aOR 0.73[0.55,0.98]）、充血性心力衰竭（CHF；aOR 0.68[0.49,0.94]）或接受抗凝治疗（aOR 0.53，95%可信区间 0.36,0.78）。
结论
年龄较大、认知障碍和 PVD 与采用心率控制策略相关。视力障碍、CHF 和抗凝治疗与节律控制策略相关。心率和节律控制组之间的生活质量没有差异。本研究表明，某些老年因素可能与 AF 治疗策略相关。需要进一步研究来评估这些决策如何影响结局。
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