高龄老年NVAF患者血栓栓塞和出血事件的长期随访结果及其出血事件的危险因素分析

Long-term follow-up results and risk factors of bleeding among very elderly patients with non-valvular atrial fibrillation

目的观察高龄老年非瓣膜性心房颤动(NVAF)患者长期随访过程中血栓栓塞和出血事件的发生情况,并探讨其出血事件的危险因素。方法该研究为回顾性队列研究,纳入2016年1月1日至7月30日在北京医院老年医学部住院的老年NVAF患者,根据入组时的年龄分为高龄老年组(年龄≥80岁)和低龄老年组(年龄≥65岁~<80岁),进一步根据是否发生出血事件将高龄老年组患者分为出血组和未出血组,进行亚组分析。收集入选者的基线临床资料。每半年对患者进行1次随访,记录血栓栓塞事件和出血事件的发生情况,随访结束日期为2021年12月31日或患者死亡日期。采用多因素logistic回归模型分析高龄老年NVAF患者出血事件的独立危险因素。结果研究纳入患者177例,其中高龄老年组107例,年龄(88.64±5.43)岁,低龄老年组70例,年龄(69.87±7.47)岁。高龄老年组随访(4.30±1.72)年,低龄老年组随访(4.80±1.63)年,期间两组患者发生血栓栓塞事件的比例差异无统计学意义[17例(15.9%)比10例(14.3%),P>0.05],而高龄老年组患者发生出血事件和严重出血事件的比例均高于低龄老年组[分别为49例(45.8%)比7例(10.0%),和15例(14.0%)比1例(1.4%),均P<0.05]。高龄NVAF患者随访期间发生出血事件者49例(出血组),未发生出血事件者58例(未出血组),与未出血组比较,出血组患者的年龄更大,合并慢性心功能不全、慢性肾脏病、恶性肿瘤的比例更高,有出血史的比例更高,出血风险评分——HAS-BLED评分更高(均P<0.05)。多因素logistic 回归模型分析结果显示,年龄大、HAS-BLED评分高、既往出血史、合并恶性肿瘤是高龄老年NVAF患者出血事件的独立危险因素(均P<0.05)。结论高龄老年NVAF患者长期随访过程中血栓栓塞事件的发生率与低龄老年患者相当,但出血事件的发生率较高,而年龄、HAS-BLED评分、既往出血史、合并恶性肿瘤是其发生出血事件的独立危险因素。

Objective To investigate the long-term follow-up results and the risk factors of bleeding among very elderly patients with non-valvular atrial fibrillation(NVAF).Methods A total of 177 patients with NVAF admitted in Beijing Hospital from January 2016 to July 2016 were enrolled in the study,including 107 very elderly patients(aged≥80 years)and 70 elderly patients(aged 65-80 years).The demographic information,comorbid diseases,lifestyles,antithrombotic therapy,thromboembolism risks,bleeding risks,and medical history were documented.Patients were followed up for 5 years and the events of death,thromboembolism,bleeding and major bleeding were recorded.Results There was no significant difference in the incidence of thromboembolic events between the two groups(15.9%(17/107)vs.14.3%(10/70),P>0.05).The proportions of bleeding events and severe bleeding events in the very elderly group were higher than those in the elderly group(45.8%(49/107)vs.10.0%(7/70),14.0%(15/107)vs.1.4%(1/70),both P<0.05).According to the bleeding events during follow-up,very elderly patients were divided into bleeding group(n=49)and non-bleeding group(n=58).Compared with the non-bleeding group,patients in the bleeding group had an older age,a higher proportion of chronic cardiac insufficiency,chronic kidney disease,malignant tumor,bleeding history and higher bleeding risk score(HAS-BLED score)(all P<0.05).Multivariate logistic regression model analysis showed that age,HAS-BLED score,history of bleeding,and complicated malignant tumor were independent risk factors for bleeding events in very elderly patients with NVAF(all P<0.05).Conclusions Very elderly patients with NVAF have a similar risk of thromboembolism compared with the younger elderly,but have significantly higher risk of the bleeding and major bleeding.Age,HAS-BLED score,bleeding history,and malignant tumor are independent risk factors for bleeding events in very elderly NVAF patients.