Haimovich Julian S, Di Achille Paolo, Nauffal Victor, Singh Pulkit, Reeder Christopher, Wang Xin, Sarma Gopal, Kornej Jelena, Benjamin Emelia J, Philippakis Anthony, Batra Puneet, Ellinor Patrick T, Lubitz Steven A, Khurshid Shaan
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
JACC Adv. 2024 May 24;3(7):101004. doi: 10.1016/j.jacadv.2024.101004. eCollection 2024 Jul.
Disorders affecting cardiac conduction are associated with substantial morbidity. Understanding the epidemiology and risk factors for conduction disorders may enable earlier diagnosis and preventive efforts.
The purpose of this study was to quantify contemporary frequency and risk factors for electrocardiogram (ECG)-defined cardiac conduction disorders in a large multi-institutional primary care sample.
We quantified prevalence and incidence of conduction disorders among adults receiving longitudinal primary care between 2001 and 2019, each with at least one 12-lead ECG performed prior to the start of follow-up and at least one ECG during follow-up. We defined conduction disorders using curated terms extracted from ECG diagnostic statements by cardiologists. We grouped conduction disorders by inferred anatomic location of abnormal conduction. We tested associations between clinical factors and incident conduction disease using multivariable proportional hazards regression.
We analyzed 189,163 individuals (median age 55 years; 58% female). The overall prevalence of conduction disorders was 27% among men and 15% among women. Among 119,926 individuals (median age 55 years; 51% female), 6,802 developed an incident conduction system abnormality over a median of 10 years (Q1, Q3: 6, 15 years) of follow-up. Incident conduction disorders were more common in men (8.78 events/1,000 person-years) vs women (4.34 events/1,000 person-years, < 0.05). In multivariable models, clinical factors including older age (HR: 1.25 per 5-year increase [95% CI: 1.24-1.26]) and myocardial infarction (HR: 1.39 [95% CI: 1.26-1.54]) were associated with incident conduction disorders.
Cardiac conduction disorders are common in a primary care population, especially among older individuals with cardiovascular risk factors.
影响心脏传导的疾病与较高的发病率相关。了解传导障碍的流行病学和危险因素可能有助于早期诊断和预防。
本研究的目的是在一个大型多机构初级保健样本中，量化心电图（ECG）定义的心脏传导障碍的当代频率和危险因素。
我们对2001年至2019年期间接受纵向初级保健的成年人中传导障碍的患病率和发病率进行了量化，每位成年人在随访开始前至少进行了一次12导联心电图检查，随访期间至少进行了一次心电图检查。我们使用心脏病专家从心电图诊断陈述中提取的经过整理的术语来定义传导障碍。我们根据异常传导的推断解剖位置对传导障碍进行分组。我们使用多变量比例风险回归测试临床因素与新发传导疾病之间的关联。
我们分析了189,163人（中位年龄55岁；58%为女性）。传导障碍的总体患病率在男性中为27%，在女性中为15%。在119,926人（中位年龄55岁；51%为女性）中，6,802人在中位10年（四分位间距：6, 15年）的随访中出现了新发的传导系统异常。新发传导障碍在男性中更常见（8.78例/1000人年），而在女性中为（4.34例/1000人年，<0.05）。在多变量模型中，包括年龄较大（每增加5岁风险比：1.25 [95%置信区间：1.24 - 1.26]）和心肌梗死（风险比：1.39 [95%置信区间：1.26 - 1.54]）在内的临床因素与新发传导障碍相关。
心脏传导障碍在初级保健人群中很常见，尤其是在有心血管危险因素的老年人中。
