患有心房的老年患者的临床结果:来自加菲尔德-AF注册表的见解
Samuel Z Goldhaber1, Jean-Pierre Bassand2, A John Camm3
1Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
The American journal of medicine
|November 2, 2023
概括
口服抗凝剂 (OAC) 降低了老年心房患者的死亡率和中风风险. 非维生素K口服抗凝剂 (NOACs) 显示出比维生素K抗剂 (VKAs) 更好的结果.
科学领域:
- 心脏病学 心脏病学
- 老年病的医生 老年病的医生
- 药理学 药理学是指药理学的学科.
背景情况:
- 口服抗凝剂 (OACs) 在老年心房 (AF) 患者中未得到充分利用,尽管有证实的益处.
- 调查OAC使用和结果的年龄相关差异对于优化治疗至关重要.
研究的目的:
- 检查基线特征,治疗模式和OAC对AF患者不同年龄组临床结果的影响.
- 根据年龄,比较OACs与没有OACs和非维生素K口服抗凝剂 (NOACs) 与维生素K对抗剂 (VKAs) 的有效性.
主要方法:
- 一项前性观察性研究 (GARFIELD-AF),对52,018名新诊断的AF患者进行了24个月的随访.
- 使用权重的Cox比例风险模型和倾向性得分重叠权重来分析与年龄相关的结果和治疗比较.
主要成果:
- 在85岁以上的患者中,OAC使用显著降低了全因死亡率,并在65-74岁和85岁以上的患者中显著降低了中风风险.
- 在接受OAC治疗的老年患者 (≥85岁) 中没有观察到增加的重大出血风险.
- 与VKAs相比,NOACs在所有年龄组都显示出全因死亡率的降低,特别是在年轻人群中.
结论:
- 在老年AF患者中,OAC是安全有效的,可降低死亡率和中风风险.
- 在老年AF人群中,NOAC提供了一个潜在的更安全,更有效的替代VKA.
相关概念视频
01:26Heart Failure III: Clinical Manifestations
20
Heart failure (HF) manifests primarily as dyspnea, fatigue, and fluid retention, resulting in peripheral and pulmonary edema. Symptoms may vary depending on which ventricle is more affected, left or right.Left-Sided Heart FailureAlso known as left ventricular failure, this condition results from the left ventricle's inability to fill or eject sufficient blood into the systemic circulation. It leads to pulmonary congestion, which occurs when the left ventricle fails to eject blood effectively...
20
01:25Aortic Regurgitation III: Medical Management
24
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
24
01:26Atherosclerosis III: Management
11
Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
11
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
14
Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
14
01:30Acute Coronary Syndrome III: Diagnostic Studies
9
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
9
01:26Peripheral Artery Disease IV: Nursing Management
11
The nursing management of a patient with peripheral artery disease (PAD) begins with a thorough assessment of the patient’s health history and clinical manifestations.AssessmentHealth History: Evaluate the patient’s history of hypertension, hyperlipidemia, family history of cardiovascular issues, and lifestyle factors such as dietary patterns, smoking, and physical activity.Physical Examination:Assess the affected extremity for decreased or absent peripheral pulses,...
11