Yuan Z, Bowlin S, Einstadter D, Cebul R D, Conners A R, Rimm A A
Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio 44106-4945, USA.
Am J Public Health. 1998 Mar;88(3):395-400. doi: 10.2105/ajph.88.3.395.
This study examined the relationship between atrial fibrillation and (1) stroke and (2) all-cause mortality.
All eligible Medicare patients older than 65 years of age hospitalized in 1985 were followed up for 4 years. Kaplan-Meier and Cox proportional hazards models were used for assessment of risk of stroke and mortality.
A total of 4,282,607 eligible Medicare patients were hospitalized in 1985. The mean age was 76.1 (+/- 7.7) years; 58.7% were female; 7.2% were Black; and 8.4% had a diagnosis of atrial fibrillation. During the follow-up period, 66,063 patients (32.6/1000 person-years) developed nonembolic stroke and 7285 (3.6/1000 person-years) developed embolic stroke. After adjustment for age, race, sex, and comorbid conditions, atrial fibrillation remained a significant risk factor for both nonembolic stroke (relative risk [RR] = 1.56) and embolic stroke (RR = 5.80) and for mortality (RR = 1.31). Approximately 4.5% of nonembolic and 28.7% of embolic strokes among hospitalized Medicare patients aged 65 years and older were attributable to atrial fibrillation.
This study demonstrates that atrial fibrillation is associated with an appreciable increase in the risk of stroke (both embolic and nonembolic) and in the risk of mortality from all causes.
本研究探讨心房颤动与（1）中风和（2）全因死亡率之间的关系。
对1985年住院的所有65岁以上符合条件的医疗保险患者进行了4年的随访。采用Kaplan-Meier和Cox比例风险模型评估中风和死亡风险。
1985年共有4282607名符合条件的医疗保险患者住院。平均年龄为76.1（±7.7）岁；58.7%为女性；7.2%为黑人；8.4%被诊断为心房颤动。在随访期间，66063名患者（32.6/1000人年）发生了非栓塞性中风，7285名患者（3.6/1000人年）发生了栓塞性中风。在对年龄、种族、性别和合并症进行调整后，心房颤动仍然是发生非栓塞性中风（相对风险[RR]=1.56）和栓塞性中风（RR=5.80）以及死亡（RR=1.31）的重要风险因素。在65岁及以上住院医疗保险患者中，约4.5%的非栓塞性中风和28.7%的栓塞性中风可归因于心房颤动。
本研究表明，心房颤动与中风（包括栓塞性和非栓塞性）风险以及全因死亡风险的显著增加有关。
