Atrial fibrillation(AF)is the most common cardiac arrhythmia affecting millions of people worldwide with increasing incidence and prevalence.Radiofrequency catheter ablation has evolved as the treatment of choice for ...Atrial fibrillation(AF)is the most common cardiac arrhythmia affecting millions of people worldwide with increasing incidence and prevalence.Radiofrequency catheter ablation has evolved as the treatment of choice for both paroxysmal and persistent AF.Several studies have been reported on catheter ablation as the first-line treatment for paroxysmal AF and different strategies for persistent AF.New technologies such as contact-force sensing catheters and cryoballoon have been recently used and the procedure carries the risk of complications like hematoma,arteriovenous fistula,cardiac tamponade,pulmonary vein stenosis,atrio-esophageal fistula and death.展开更多
Background:Elderly adults with atrial fi brillation(AF)are at increased risk of frailty and thromboembolic complications.However,studies on the prevalence of frailty in AF patients and data on the relationship between...Background:Elderly adults with atrial fi brillation(AF)are at increased risk of frailty and thromboembolic complications.However,studies on the prevalence of frailty in AF patients and data on the relationship between frailty and the use of anticoagulants are limited.Methods:We conducted a cross-sectional study involving 500 participants.Patients aged 65 years or older were consecutively selected from the Chinese Atrial Fibrillation Registry study.The patient’s frailty status was assessed with use of the Canadian Study of Health and Aging Clinical Frailty Scale.We assessed the prevalence of and factors associated with frailty,and how frailty affects anticoagulant therapy.Results:In 500 elderly adults with AF(age 75.2±6.7 years;51.6%female),201 patients(40.2%)were frail.The prevalence of frailty was higher in females(P=0.002)and increased with age and CHA 2 DS 2-VASc score(P for trend less than 0.001 for both).The factors associated with frailty were a history of heart failure(odds ratio[OR]2.40,95%confi dence interval[CI]1.39–4.14),female sex(OR 2.09,95%CI 1.27–3.43),and advanced age(OR 1.13,95%CI 1.09–1.17).Frail patients were signifi cantly less likely to have ever been prescribed anticoagulants compared with nonfrail patients(81.7 vs.54.9%,P<0.001).Conclusions:Frailty is prevalent in elderly adults with AF,especially in females,those of advanced age,and those with heart failure.Frailty status has a signifi cant impact on prescription of anticoagulants for high-risk AF patients.展开更多
目的通过充血性心力衰竭、高血压、年龄≥75岁（双倍）、糖尿病、卒中（双倍）、血管病变、年龄65-74岁、女性（Congestive heart failure,Hypertension,Age≥75（doubled）,Diabetes Mellitus,Stroke（doubled）,vascular disease,age ...目的通过充血性心力衰竭、高血压、年龄≥75岁（双倍）、糖尿病、卒中（双倍）、血管病变、年龄65-74岁、女性（Congestive heart failure,Hypertension,Age≥75（doubled）,Diabetes Mellitus,Stroke（doubled）,vascular disease,age 65-74 and sex category（female）,CHA2DS2-VASc）评分观察心房颤动合并脑栓塞患者的抗栓治疗现状,分析高血压、异常的肝肾功能、卒中、出血、国际标准化比值（international normalized ratio,INR）不稳定、年龄、药物治疗或者饮酒（Hypertension,Abnormal renal and liver function,Stroke,Bleeding,Labile international normalized ratio,Elderly,Drugs and alcohol intake,HAS-BLED）评分及其他相关临床危险因素与心房颤动合并脑栓塞出血转化的关系。方法回顾性分析2012年5月至2014年12月在北京博爱医院神经康复科住院的心房颤动合并脑栓塞患者的临床资料。根据CHA_2DS_2-VASc评分观察低危组（0分）、中危组（1分）、高危组（≥2分）的抗栓治疗情况。根据HAS-BLED评分,分析心房颤动脑栓塞出血转化（hemorrhagic transformation,HT）率在出血转化低危组（0-2分）和出血转化高危组（≥3分）之间的差异,同时对多个临床变量进行多因素分析,寻找与HT相关的临床危险因素。结果研究共入组101例患者,患者在发生脑栓塞之前,根据CHA_2DS_2-VASc评分,低危组抗凝率66.7%（2/3）,无抗血小板治疗;中危组抗凝、抗血小板率均为16.7%（2/12）;高危组抗凝率19.8%（17/86）,抗血小板率14.0%（12/86）。脑栓塞前1个月内停用抗凝治疗而发病的占所有抗凝患者42.8%（9/21）。发生脑栓塞之后,所有患者均为高危组,抗凝治疗率68.3%（69/101）,抗血小板治疗率25.7%（26/101）。根据HAS-BLED评分,心房颤动合并脑栓塞后,出血转化高危组HT 58.5%（31/53）,与低危组HT 37.5%（18/48）比较,差异有显著性（χ-2=4.443,P=0.035）。对HT组与非HT组的多个临床变量分析发现,两组美国国立卫生研究院（National Institutes of Health Stroke Scale,NIHSS）评分差异有显著性（14.860±4.486 vs 11.940±5.648,P=0.006）;HAS-BLED评分差异有显著性（2.76±0.80 vs 2.21±0.96,P=0.003）;病灶范围大的梗死灶HT为57.9%（44/76）,小的梗死灶为HT 20%（5/25）,两组有显著差异（P=0.001）。多因素Logistic回归分析发现NIHSS（OR 1.106,95%CI 1.106-1.216,P=0.036）、病灶范围大小（OR 5.083,95%CI 1.826-14.148,P=0.002）和HASBLED评分（OR 2.353,95%CI 1.326-4.175,P=0.003）均是心房颤动患者脑栓塞后HT的危险因素。结论心房颤动合并脑栓塞的患者抗栓治疗率不理想,HAS-BLED评分能很好地预测心房颤动合并脑栓塞后的HT风险,另外,神经功能缺损较重、病灶范围大也是心房颤动合并脑栓塞患者发生HT的危险因素。展开更多
文摘Atrial fibrillation(AF)is the most common cardiac arrhythmia affecting millions of people worldwide with increasing incidence and prevalence.Radiofrequency catheter ablation has evolved as the treatment of choice for both paroxysmal and persistent AF.Several studies have been reported on catheter ablation as the first-line treatment for paroxysmal AF and different strategies for persistent AF.New technologies such as contact-force sensing catheters and cryoballoon have been recently used and the procedure carries the risk of complications like hematoma,arteriovenous fistula,cardiac tamponade,pulmonary vein stenosis,atrio-esophageal fistula and death.
基金This work was supported by the National Key Research and Development Program of China(2016YFC0900901,2016YFC1301002,2017YFC0908803,2018YFC1312501)a grant from the National Natural Science Foundation of China(81530016).
文摘Background:Elderly adults with atrial fi brillation(AF)are at increased risk of frailty and thromboembolic complications.However,studies on the prevalence of frailty in AF patients and data on the relationship between frailty and the use of anticoagulants are limited.Methods:We conducted a cross-sectional study involving 500 participants.Patients aged 65 years or older were consecutively selected from the Chinese Atrial Fibrillation Registry study.The patient’s frailty status was assessed with use of the Canadian Study of Health and Aging Clinical Frailty Scale.We assessed the prevalence of and factors associated with frailty,and how frailty affects anticoagulant therapy.Results:In 500 elderly adults with AF(age 75.2±6.7 years;51.6%female),201 patients(40.2%)were frail.The prevalence of frailty was higher in females(P=0.002)and increased with age and CHA 2 DS 2-VASc score(P for trend less than 0.001 for both).The factors associated with frailty were a history of heart failure(odds ratio[OR]2.40,95%confi dence interval[CI]1.39–4.14),female sex(OR 2.09,95%CI 1.27–3.43),and advanced age(OR 1.13,95%CI 1.09–1.17).Frail patients were signifi cantly less likely to have ever been prescribed anticoagulants compared with nonfrail patients(81.7 vs.54.9%,P<0.001).Conclusions:Frailty is prevalent in elderly adults with AF,especially in females,those of advanced age,and those with heart failure.Frailty status has a signifi cant impact on prescription of anticoagulants for high-risk AF patients.
文摘目的通过充血性心力衰竭、高血压、年龄≥75岁（双倍）、糖尿病、卒中（双倍）、血管病变、年龄65-74岁、女性（Congestive heart failure,Hypertension,Age≥75（doubled）,Diabetes Mellitus,Stroke（doubled）,vascular disease,age 65-74 and sex category（female）,CHA2DS2-VASc）评分观察心房颤动合并脑栓塞患者的抗栓治疗现状,分析高血压、异常的肝肾功能、卒中、出血、国际标准化比值（international normalized ratio,INR）不稳定、年龄、药物治疗或者饮酒（Hypertension,Abnormal renal and liver function,Stroke,Bleeding,Labile international normalized ratio,Elderly,Drugs and alcohol intake,HAS-BLED）评分及其他相关临床危险因素与心房颤动合并脑栓塞出血转化的关系。方法回顾性分析2012年5月至2014年12月在北京博爱医院神经康复科住院的心房颤动合并脑栓塞患者的临床资料。根据CHA_2DS_2-VASc评分观察低危组（0分）、中危组（1分）、高危组（≥2分）的抗栓治疗情况。根据HAS-BLED评分,分析心房颤动脑栓塞出血转化（hemorrhagic transformation,HT）率在出血转化低危组（0-2分）和出血转化高危组（≥3分）之间的差异,同时对多个临床变量进行多因素分析,寻找与HT相关的临床危险因素。结果研究共入组101例患者,患者在发生脑栓塞之前,根据CHA_2DS_2-VASc评分,低危组抗凝率66.7%（2/3）,无抗血小板治疗;中危组抗凝、抗血小板率均为16.7%（2/12）;高危组抗凝率19.8%（17/86）,抗血小板率14.0%（12/86）。脑栓塞前1个月内停用抗凝治疗而发病的占所有抗凝患者42.8%（9/21）。发生脑栓塞之后,所有患者均为高危组,抗凝治疗率68.3%（69/101）,抗血小板治疗率25.7%（26/101）。根据HAS-BLED评分,心房颤动合并脑栓塞后,出血转化高危组HT 58.5%（31/53）,与低危组HT 37.5%（18/48）比较,差异有显著性（χ-2=4.443,P=0.035）。对HT组与非HT组的多个临床变量分析发现,两组美国国立卫生研究院（National Institutes of Health Stroke Scale,NIHSS）评分差异有显著性（14.860±4.486 vs 11.940±5.648,P=0.006）;HAS-BLED评分差异有显著性（2.76±0.80 vs 2.21±0.96,P=0.003）;病灶范围大的梗死灶HT为57.9%（44/76）,小的梗死灶为HT 20%（5/25）,两组有显著差异（P=0.001）。多因素Logistic回归分析发现NIHSS（OR 1.106,95%CI 1.106-1.216,P=0.036）、病灶范围大小（OR 5.083,95%CI 1.826-14.148,P=0.002）和HASBLED评分（OR 2.353,95%CI 1.326-4.175,P=0.003）均是心房颤动患者脑栓塞后HT的危险因素。结论心房颤动合并脑栓塞的患者抗栓治疗率不理想,HAS-BLED评分能很好地预测心房颤动合并脑栓塞后的HT风险,另外,神经功能缺损较重、病灶范围大也是心房颤动合并脑栓塞患者发生HT的危险因素。
