用心电图检查心房动:美国预防服务工作组的证据报告和系统审查
Daniel E Jonas1,2,3, Leila C Kahwati1,4, Jonathan D Y Yun3,5
1RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center.
JAMA
|August 9, 2018
概括
使用心电图 (ECG) 的心房动查检测出比没有查更多的病例,但不超过脉测试. 治疗降低了中风风险,但增加了出血风险,对查检测的病例的好处尚不清楚.
科学领域:
- 心脏病学
- 预防医学
- 公共卫生
背景情况:
- 前庭动是一种常见的心律失常,增加了中风风险.
- 查AF的目的是识别无症状的个体进行早期干预.
- 预防中风的治疗对于控制肌痛风险至关重要.
研究的目的:
- 通过心电图 (ECG) 检查非膜性心房动 (NVAF) 的证据.
- 评估65岁及以上无症状成年人的中风预防治疗方法.
- 为美国预防服务工作组 (USPSTF) 的建议提供信息.
主要方法:
- 随机临床试验 (RCT),队列研究和元分析的系统审查.
- 数据来源包括到2017年5月的MEDLINE,Cochrane图书馆和试验登记册,并通过2018年6月进行监测.
- 研究重点是AF检测,中风预防治疗 (华法林,阿司匹林,NOACs) 和相关的危害.
主要成果:
- 系统的心电图查发现了更多的新发动脉比没有查 (2.8% vs 0.6%),但不超过脉测试.
- 没有研究直接比较查与不查的健康结果.
- 华法林降低了缺血性中风和死亡率,但增加了出血风险;NOAC显示出类似的趋势,出血的置信区间更大.
结论:
- 电脑心电图查可以检测以前未被诊断的心脏病,但在检测率方面没有明显的优势.
- 虽然AF治疗降低了中风和死亡率,但与通常的护理或基于症状的检测相比,其对查检测的无症状老年人的益处仍未得到证实.
- 需要进行进一步的研究,以评估查和治疗查检测到的肌肉炎的健康结果.
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