CHA_(2)DS_(2)-VASc评分法筛查社区老年人群心房颤动与缺血性卒中患病情况的价值研究

New Value of CHA_(2)DS_(2)-VASc Scoring System:Screening for Atrial Fibrillation and Ischemic Stroke in Communityliving Elderly Population

背景老年人是心房颤动(简称房颤)的高危人群,提高社区老年人群房颤的精准筛查能力有助于降低房颤相关脑卒中的发生风险。目的探究CHA_(2)DS_(2)-VASc评分法能否用于社区老年人的房颤与缺血性卒中患病情况的筛查。方法2019年10月-2020年3月选取长期居住在北京市海淀区的某社区老年人为研究对象。通过病史采集和常规12导联心电图检查,收集社区老年人基本资料和常见疾病的患病情况,并计算缺血性卒中风险(CHA_(2)DS_(2)-VASc评分表评分)。结果328例社区老年人中房颤40例(12.2%),缺血性卒中60例(18.3%),平均CHA_(2)DS_(2)-VASc评分表评分(3.2±1.5)分。房颤老年人平均CHA_(2)DS_(2)-VASc评分表评分高于无房颤老年人(P<0.05);缺血性卒中老年人CHA_(2)DS_(2)-VASc评分表评分高于无缺血性卒中老年人(P<0.05)。CHA_(2)DS_(2)-VASc评分表评分为0~6分的老年人房颤发生率依次为0、4.8%(2/42)、3.7%(2/54)、14.6%(12/82)、15.8%(12/76)、8.3%(4/48)、40.0%(8/20),随着CHA_(2)DS_(2)-VASc评分表评分增加老年人房颤发生率逐渐增加(r_(s)=0.248,P<0.001)。CHA_(2)DS_(2)-VASc评分表评分为0~6分的老年人缺血性卒中发生率依次为0、4.8%(2/42)、11.1%(6/54)、12.2%(10/82)、18.4%(14/76)、45.8%(22/48)、30.0%(6/20),随着CHA_(2)DS_(2)-VASc评分表评分增加老年人缺血性卒中发生率逐渐增加(r_(s)=0.296,P=0.001)。结论CHA_(2)DS_(2)-VASc评分表可用于筛查社区老年人房颤与缺血性卒中患病情况,评分越高的老年人房颤与缺血性卒中发生率越高。

Background The elders are a high-risk population for atrial fibrillation(AF).Improving the level of accurately screening for AF among the elderly in the community can help to reduce the risk of AF-related stroke.Objective To examine whether the CHA_(2)DS_(2)-VASc scoring system is feasible for the screening of AF and ischemic stroke in the elderly in the community.Methods The long-term older residents in a community,Beijing's Haidian District,were enrolled from October 2019 to March 2020.Medical history(including basic characteristics,and morbidity of common diseases),and results of normal 12-lead electrocardiogram were collected.Ischemic stroke risk was estimated by using the CHA_(2)DS_(2)-VASc scoring system.Results A total of 328 olders were enrolled,including 40(12.2%)with AF and 60(18.3%)with ischemic stroke detected by the screen,with a mean CHA_(2)DS_(2)-VASc score of(3.2±1.5)points.Participants with AF had higher mean CHA_(2)DS_(2)-VASc score than those without(P<0.05).The mean CHA_(2)DS_(2)-VASc score of those with ischemic stroke was higher than that of those without(P<0.05).The AF prevalence in participants with CHA_(2)DS_(2)-VASc score from 0 to 6 was 0,4.8%(2/42),3.7%(2/54),14.6%(12/82),15.8%(12/76),8.3%(4/48),and 40.0%(8/20),respectively,showing a gradual increase with the CHA_(2)DS_(2)-VASc score(r_(s)=0.248,P<0.001).The ischemic stroke prevalence in participants with CHA_(2)DS_(2)-VASc score from 0 to 6 was 0,4.8%(2/42),11.1%(6/54),12.2%(10/82),18.4%(14/76),45.8%(22/48),and 30.0%(6/20),respectively,demonstrating a gradual increase with the CHA_(2)DS_(2)-VASc score(r_(s)=0.296,P=0.001).Conclusion The CHA_(2)DS_(2)-VASc scoring system could be used to screen for AF and ischemic stroke in community-living elderly population.The olders with a higher CHA_(2)DS_(2)-VASc score may have a higher AF or stroke prevalence.