对心房的查:美国预防服务工作组的最新证据报告和系统审查
Leila C Kahwati1,2, Gary N Asher1,3, Zachary O Kadro1,4
1RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center.
JAMA
|January 25, 2022
概括
查心房动可以发现更多未被诊断的病例. 虽然抗凝剂降低了中风和死亡风险,但它增加了出血风险,对整体健康结果的证据有限.
科学领域:
- 心脏病学
- 预防医学
- 公共卫生
背景情况:
- 心房动是最常见的心律失常,也是中风的重要危险因素.
- 在预防中风方面, 早期发现和治疗AF至关重要.
研究的目的:
- 对未曾发生中风的无症状成年人进行查的有效性和危害情况进行审查.
- 为美国预防服务工作组提供指导方针.
主要方法:
- 随机临床试验 (RCT),测试准确性研究和观察性研究的系统审查和元分析.
- 包括的研究重点是查方法,AF患者的抗凝治疗,以及报告的危害.
主要成果:
- 查发现更多未诊断的AF病例. 一个RCT建议使用心电图查可能减少复合终点,但有局限性.
- 抗凝药 (华法林,DOACs) 显著降低了AF患者中风风险和全因死亡率.
- 抗凝药增加了严重出血的风险,尽管估计不准确,并且在某些分析中不排除无效.
结论:
- 查AF可以增加病例的检测,但对其对健康结果的影响的强有力的证据有限.
- 抗凝药在脑筋梗塞和死率降低方面是有效的,但会增加出血的风险.
- 需要进一步的研究来评估抗凝血在查检测到的AF群体中的益处和危害.
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