《房颤负荷在COPD住院期间增加》

  • 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。



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  • 《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.
  • 《血清纤维蛋白原/白蛋白比值预测急性心肌梗死患者经皮冠状动脉介入治疗后住院期间新发房颤的风险:一项回顾性研究》

    • 来源专题:重大慢性病
    • 编译者:黄雅兰
    • 发布时间:2023-09-12
    • 背景:新发心房颤动(NOAF)是急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)的常见不良后果,并与住院时间和预后密切相关。近年来,血清纤维蛋白原/白蛋白比(FAR)作为炎症和血栓形成的新生物标志物,已被用于预测冠状动脉疾病的严重程度和预后。我们的研究旨在调查AMI患者PCI术后住院期间FAR和NOAF的关系。 方法:回顾性分析670例急性心肌梗死患者PCI术后住院期间和随访期间NOAF的发生率。收集的数据包括患者年龄、性别、体重指数、病史、当前药物治疗、心力衰竭、实验室检查、罪犯血管、超声心动图特征和AMI类型。入选患者被分为NOAF组和非NOAF组。比较两组患者的基线特征,并使用logistic回归分析和受试者工作特征曲线评估FAR和NOAF之间的预测相关性。 结果:53名(7.9%)患者在住院期间发生NOAF。除了年龄较大、中性粒细胞计数较高、左心房较大、入院时Killip分级较差、体重指数较低、血小板计数较低、左心室射血分数较低和目标性左旋支动脉疾病外,NOAF的发生与FAR较高独立相关。FAR对住院期间NOAF的发生表现出更好的预测值(曲线下面积,0.732;95%置信区间,0.659-0.808)。 结论:FAR是预测急性心肌梗死患者PCI术后住院期间NOAF风险的可靠工具,比单独使用血清纤维蛋白和血清白蛋白水平具有更好的预测价值。