非瓣膜性心房颤动患者不同类型心力衰竭的患病率、特征和治疗策略。
Prevalence, Characteristics, and Treatment Strategy of Different Types of Heart Failure in Patients With Nonvalvular Atrial Fibrillation.
机构信息
Department of Cardiovascular Disease Peking University First Hospital Beijing China.
Institute of Cardiovascular Disease Peking University First Hospital Beijing China.
出版信息
J Am Heart Assoc. 2024 Oct;13(19):e033941. doi: 10.1161/JAHA.123.033941. Epub 2024 Sep 30.
BACKGROUND
Atrial fibrillation (AF) is the most common arrhythmia in patients with heart failure (HF). Epidemiological data regarding HF in patients with AF are lacking. We describe the epidemiology, clinical features, treatment strategies, and in-hospital outcomes in patients with AF and HF.
METHODS AND RESULTS
Patients with HF and nonvalvular AF in the Improving Care for Cardiovascular Disease in China-AF cohort from February 2015 to December 2019 were included. Patients were stratified by left ventricular ejection fraction into HF with reduced EF, HF with mildly reduced EF, and HF with preserved EF groups. The primary outcome was the occurrence of hospitalization for major adverse cardiovascular events, including death, cardiogenic shock, cardiac arrest, and stroke. Overall, 16 562 patients with AF and HF were included (mean age: 72.35±11.07 years; 46.1% female). HF with preserved EF (63.1%) accounted for the largest proportion, followed by HF with mildly reduced EF (19.0%) and HF with reduced EF (17.9%). Different HF subtypes in patients with AF had unique baseline demographic and clinical characteristics after multinomial logistic regression analysis. Compared with the HF with preserved EF group, hospitalization for major adverse cardiovascular events was increased in the HF with mildly reduced EF group (odds ratio=1.55 [95% CI, 1.18-2.03]) and HF with reduced EF group (odds ratio 1.60 [95% CI, 1.21-2.13]) after adjusting for confounders.
CONCLUSIONS
In this large Chinese AF registry, the distribution of HF differed from the non-AF population. Patients with AF with different types of HF have unique demographic and clinical characteristics. Occurrence rates of in-hospital outcomes were higher in patients with HF with mildly reduced EF and patients with HF with reduced EF compared with the HF with preserved EF group.
REGISTRATION
URL: http://www.clinicaltrials.gov; Unique identifier: NCT02309398.
背景
心房颤动（AF）是心力衰竭（HF）患者中最常见的心律失常。关于 AF 患者 HF 的流行病学数据尚缺乏。我们描述了 AF 和 HF 患者的流行病学、临床特征、治疗策略和住院结局。
方法和结果
纳入 2015 年 2 月至 2019 年 12 月期间来自中国改善心血管疾病的心血管疾病-房颤队列的 HF 合并非瓣膜性房颤患者。根据左心室射血分数将患者分为射血分数降低的心衰（HFrEF）、射血分数轻度降低的心衰（HFmrEF）和射血分数保留的心衰（HFpEF）组。主要结局为主要不良心血管事件住院，包括死亡、心源性休克、心脏骤停和卒中。共有 16562 例 AF 合并 HF 患者入选（平均年龄 72.35±11.07 岁；46.1%为女性）。HFpEF（63.1%）占比最大，其次是 HFmrEF（19.0%）和 HFrEF（17.9%）。多变量逻辑回归分析后，AF 合并 HF 患者不同 HF 亚型具有独特的基线人口统计学和临床特征。与 HFpEF 组相比，HFmrEF 组（比值比=1.55[95%置信区间，1.18-2.03]）和 HFrEF 组（比值比 1.60[95%置信区间，1.21-2.13]）住院主要不良心血管事件的发生率增加。
结论
在这项大型中国 AF 注册研究中，HF 的分布与非 AF 人群不同。不同类型 HF 的 AF 患者具有独特的人口统计学和临床特征。与 HFpEF 组相比，HFmrEF 和 HFrEF 患者的住院结局发生率更高。
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