在心房动患者中心力衰竭和严重出血
Nicholas R Jones1, Margaret Smith2,3, Sarah Lay-Flurrie2
1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK nicholas.jones2@phc.ox.ac.uk.
Open heart
|October 14, 2024
概括
患有心力衰竭 (HF) 和心房动 (AF) 的人面临较高的重大出血风险,与单独AF的人相比. 目前的出血风险得分可能低估了这种危险,需要仔细考虑预后.
科学领域:
- 心脏病学 心脏病学
- 临床流行病学 临床流行病学
- 药物监督 药物监督 药物监督
背景情况:
- 目前,心房动 (AF) 出血风险预测得分不包括心力衰竭 (HF).
- 关于HF作为AF患者大出血的危险因素的重要性存在不确定性.
- 这项研究评估了HF和AF患者与单独AF患者的大型出血的相对风险.
研究的目的:
- 量化心力衰竭和心房动患者大出血的风险.
- 为了将这种风险与仅有心房动的患者进行比较.
- 评估HF和AF患者当前出血风险预测得分的充分性.
主要方法:
- 一个大规模的英语初级保健队列研究,使用临床实践研究数据链接 (CPRD) 从2000-2018.
- 纳入标准:年龄≥45岁的患者.
- 利用传统的生存分析和竞争风险方法,考虑死亡率和抗凝血状态.
主要成果:
- 在7.56年的中位数随访期间,HF和AF患者的调整危险比率 (HR) 对重大出血 (2.52) 与仅AF (1.87) 相比较高.
- 竞争性风险分析表明,两组主要出血的HR相似 (HF+AF:1.71与AF仅1.82).
- 尽管出血风险增加,但HF和AF组的死亡率明显高 (60.0%),而非仅AF组 (27.2%).
结论:
- 与单独患有AF的患者相比,患有HF和AF的患者患大出血的风险增加.
- 现有的出血风险预测得分可能会低估HF和AF组合人群中的出血风险.
- 在预测HF和AF患者出血风险时,应仔细考虑预后,特别是死亡风险.
相关概念视频
01:23Rheumatic Heart Disease I: Introduction
3
Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
3
01:27Heart Failure I: Introduction
2
Heart failure refers to a clinical syndrome caused by structural or functional cardiac disorders that prevent the heart from pumping an adequate amount of blood to meet the body's metabolic needs. This condition often arises from myocardial infarction or ischemia, leading to decreased cardiac output, reduced tissue perfusion, impaired gas exchange, fluid volume imbalance, and decreased functional ability.Heart failure can result from disruptions in the mechanisms that regulate cardiac output...
2
01:26Heart Failure III: Clinical Manifestations
3
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...
3
01:26Imbalances in Cardiac Output
1.4K
The heart's primary function is to pump blood throughout the body, maintaining a balance between blood sent out (cardiac output) and blood returning (venous return). If this balance is disrupted, it can result in congestive heart failure (CHF), a severe condition where the heart becomes an inefficient pump, leading to inadequate blood circulation.
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
1.4K
01:17Pathophysiology of Heart Failure
1.5K
Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
1.5K
01:28Disturbances in Heart Rhythm
913
Arrhythmia or dysrhythmia refers to an abnormal heart rhythm caused by a defect in the heart's conduction system. It can cause the heart to beat irregularly, too quickly, or too slowly, leading to symptoms like chest pain, shortness of breath, and fainting. Factors such as stress, caffeine, alcohol, nicotine, cocaine, certain drugs, congenital defects, diseases, and electrolyte abnormalities can trigger arrhythmias.
Arrhythmias are categorized by their speed, rhythm, and origin. A slow...
Arrhythmias are categorized by their speed, rhythm, and origin. A slow...
913