Shantsila Eduard, Choi Eue-Keun, Lane Deirdre A, Joung Boyoung, Lip Gregory Y H
Department of Primary Care and Mental Health, University of Liverpool, United Kingdom.
Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
Lancet Reg Health Eur. 2024 Feb 1;37:100784. doi: 10.1016/j.lanepe.2023.100784. eCollection 2024 Feb.
Modern anticoagulation therapy has dramatically reduced the risk of stroke and systemic thromboembolism in people with atrial fibrillation (AF). However, AF still impairs quality of life, increases the risk of stroke and heart failure, and is linked to cognitive impairment. There is also a recognition of the residual risk of thromboembolic complications despite anticoagulation. Hence, AF management is evolving towards a more comprehensive understanding of risk factors predisposing to the development of this arrhythmia, its' complications and interventions to mitigate the risk. This review summarises the recent advances in understanding of risk factors for incident AF and managing these risk factors. It includes a discussion of lifestyle, somatic, psychological, and socioeconomic risk factors. The available data call for a practice shift towards a more individualised approach considering an increasingly broader range of health and patient factors contributing to AF-related health burden. The review highlights the needs of people living with co-morbidities (especially with multimorbidity), polypharmacy and the role of the changing population demographics affecting the European region and globally.
现代抗凝治疗已显著降低心房颤动(AF)患者中风和全身性血栓栓塞的风险。然而,AF 仍会损害生活质量,增加中风和心力衰竭的风险,并与认知障碍有关。尽管进行了抗凝治疗,但人们也认识到血栓栓塞并发症的残余风险。因此,AF 的管理正在朝着更全面地了解导致这种心律失常发生的危险因素、其并发症以及降低风险的干预措施发展。本综述总结了对新发 AF 危险因素的认识以及对这些危险因素的管理方面的最新进展。它包括对生活方式、躯体、心理和社会经济危险因素的讨论。现有数据要求实践转向更个体化的方法,考虑到越来越多导致 AF 相关健康负担的健康和患者因素。该综述强调了患有合并症(尤其是多种合并症)、多重用药患者的需求,以及影响欧洲地区和全球的不断变化的人口结构的作用。