Chung Sheng-Chia, Schmit Amand F, Lip Gregory Y H, Providencia Rui
Institute of Health Informatics, University College London, London, United Kingdom.
Institute of Cardiovascular Science, University College London, London, United Kingdom.
Front Cardiovasc Med. 2023 Sep 28;10:1204892. doi: 10.3389/fcvm.2023.1204892. eCollection 2023.
Atrial fibrillation (AF) confers a major healthcare burden from hospitalisations and AF-related complications, such as stroke and heart failure. We performed an electronic health records-wide association study to identify the most frequent reasons for healthcare utilization, pre and post new-onset AF.
Prospective cohort study with the linked electronic health records of 5.6 million patients in the United Kingdom Clinical Practice Research Datalink (1998-2016). A cohort study with AF patients and their age-and sex matched controls was implemented to compare the top 100 reasons of frequent hospitalisation and primary consultation.
Of the 199,433 patients who developed AF, we found the most frequent healthcare interactions to be cardiac, cerebrovascular and peripheral-vascular conditions, both prior to AF diagnosis (41/100 conditions in secondary care, such as cerebral infarction and valve diseases; and 33/100 conditions in primary care), and subsequently (47/100 conditions hospital care and 48 conditions in primary care). There was a high representation of repeated visits for cancer and infection affecting multiple organ systems. We identified 10 novel conditions which have not yet been associated with AF: folic acid deficiency, pancytopenia, idiopathic thrombocytopenic purpura, seborrheic dermatitis, lymphoedema, angioedema, laryngopharyngeal reflux, rib fracture, haemorrhagic gastritis, inflammatory polyneuropathies.
Our nationwide data provide knowledge and better understanding of the clinical needs of AF patients suggesting: (i) groups at higher risk of AF, where screening may be more cost-effective, and (ii) potential complications developing following new-onset AF that can be prevented through implementation of comprehensive integrated care management and more personalised, tailored treatment.
NCT04786366.
心房颤动（AF）因住院治疗及AF相关并发症（如中风和心力衰竭）带来了重大的医疗负担。我们开展了一项全电子健康记录关联研究，以确定新发AF前后医疗保健利用的最常见原因。
对英国临床实践研究数据链（1998 - 2016年）中560万患者的关联电子健康记录进行前瞻性队列研究。实施一项针对AF患者及其年龄和性别匹配对照的队列研究，以比较前100位频繁住院和初级会诊的原因。
在199433例发生AF的患者中，我们发现，在AF诊断之前（二级医疗中41/100种疾病，如脑梗死和瓣膜疾病；初级医疗中33/100种疾病）以及之后（住院治疗中47/100种疾病，初级医疗中48种疾病），最常见的医疗交互涉及心脏、脑血管和外周血管疾病。影响多个器官系统的癌症和感染的重复就诊情况很常见。我们确定了10种尚未与AF相关联的新疾病：叶酸缺乏、全血细胞减少、特发性血小板减少性紫癜、脂溢性皮炎、淋巴水肿、血管性水肿、喉咽反流、肋骨骨折、出血性胃炎、炎性多发性神经病。
我们的全国性数据提供了对AF患者临床需求的认识和更好理解，表明：（i）AF风险较高的群体，在这些群体中筛查可能更具成本效益；（ii）新发AF后可能出现的潜在并发症，可通过实施全面综合护理管理和更个性化、量身定制的治疗来预防。
NCT04786366。
