《房颤负荷在COPD住院期间增加》

  • 来源专题:重大慢性病
  • 编译者: 李永洁
  • 发布时间:2024-11-21
  • 研究结果表明,在慢性阻塞性肺疾病(COPD)严重恶化时,需对房颤(AF)保持高度警惕。团队开展了一项研究,旨在描述因急性COPD加重而住院的伴或不伴HF患者的AF负担,并确定AF与住院之间的时间关系。他们收集了2007年至2021年间植入心脏复律除颤器的患者的数据,心脏再同步治疗以及植入式心脏监测器,利用与美敦力CareLink数据库相连接的Optum去标识化电子健康记录数据集进行回顾性分析。他们研究了COPD患者的入院情况,这些患者的COPD入院前30天至入院后60天内的设备诊断参数可用。共识别出20,056例患有心力衰竭(HF)的COPD患者住院病例,以及3877例无HF的COPD患者住院病例。在患有心力衰竭的患者中,43%的患者每日房颤负荷至少为6分钟,22%的患者至少有1小时的不规则心律。而在未患心力衰竭的患者中,40%的患者每日至少有6分钟的不规则心律,18%的患者至少有1小时。在心衰患者中,平均每日房颤负荷从入院前30天的基线值158分钟/天增加到入院时的170分钟/天,并在住院后20天恢复至基线水平。对于未患心力衰竭的患者,其房颤负担从基线的107分钟/天增加到住院期间的113分钟/天,并在住院后20天恢复至基线水平。



  • 原文来源:https://www.medscape.com/viewarticle/af-burden-increases-around-time-copd-hospitalizations-2024a1000izc
相关报告
  • 《持续性房颤会增加心力衰竭患者抗凝相关的出血风险》

    • 来源专题:心血管疾病防治
    • 编译者:jiafw
    • 发布时间:2018-12-18
    • 背景:心房颤动患者的口服抗凝治疗可降低血栓栓塞事件的风险,但会增加出血风险,本研究探讨了阵发性和持续性房颤患者接受抗凝治疗后的相关临床结局是否不同。 方法:在前瞻性多中心队列研究分析中,根据患者的房颤分型分析了抗凝相关不良事件的发生率,相关结局的信息在3年内集中记录,通过医疗记录验证并由独立审查小组裁定。 结果:总体而言,该样本包括1089个房颤患者,其中阵发性房颤患者398,持续房颤患者691例。在调整潜在混杂因素的Cox回归分析中,与阵发性房颤相比,持续房颤的临床相关出血风险升高[风险比1.40(1.02; 1.93); P = 0.038]。对于临床相关的出血,检测到房颤分型与伴随的心力衰竭存在显著相互作用:伴有心衰的风险比为2.45(1.51,3.98)VS. 不伴心衰的风险比为0.85(0.55,1.34); P = 0.003。在心衰患者中,持续性房颤也表明大出血的风险升高[风险比 2.25(1.26,4.20); P = 0.006]。 结论:在接受口服抗凝治疗的心衰患者中,持续性房颤的出血风险显著升高。
  • 《心房颤动患者的地高辛水平和死亡率》

    • 来源专题:心血管疾病防治
    • 编译者:张燕舞
    • 发布时间:2018-05-22
    • 地高辛在心房颤动(AF)房率控制中的作用多年来基于对死亡率增加的担忧而受到质疑。 ARISTOTLE试验(比较大约18,000例房颤患者的抗凝治疗)的一项表现良好的事后亚组分析显示,地高辛的使用与≥1.2ng / mL水平的死亡风险显着相关。 我们几乎从不使用地高辛作为第一个控制率的药物,很少将其添加到其他控制率的药物中。 BACKGROUND Digoxin is widely used in patients with atrial fibrillation (AF). OBJECTIVES The goal of this paper was to explore whether digoxin use was independently associated with increased mortality in patients with AF and if the association was modified by heart failure and/or serum digoxin concentration. METHODS The association between digoxin use and mortality was assessed in 17,897 patients by using a propensity score-adjusted analysis and in new digoxin users during the trial versus propensity score-matched control participants. The authors investigated the independent association between serum digoxin concentration and mortality after multivariable adjustment. RESULTS At baseline, 5,824 (32.5%) patients were receiving digoxin. Baseline digoxin use was not associated with an increased risk of death (adjusted hazard ratio [HR]: 1.09; 95% confidence interval [CI]: 0.96 to 1.23; p = 0.19). However, patients with a serum digoxin concentration ≥1.2 ng/ml had a 56% increased hazard of mortality (adjusted HR: 1.56; 95% CI: 1.20 to 2.04) compared with those not on digoxin. When analyzed as a continuous variable, serum digoxin concentration was associated with a 19% higher adjusted hazard of death for each 0.5-ng/ml increase (p = 0.0010); these results were similar for patients with and without heart failure. Compared with propensity score-matched control participants, the risk of death (adjusted HR: 1.78; 95% CI: 1.37 to 2.31) and sudden death (adjusted HR: 2.14; 95% CI: 1.11 to 4.12) was significantly higher in new digoxin users. CONCLUSIONS In patients with AF taking digoxin, the risk of death was independently related to serum digoxin concentration and was highest in patients with concentrations ≥1.2 ng/ml. Initiating digoxin was independently associated with higher mortality in patients with AF, regardless of heart failure.