心力衰竭和心房动中风发生率:基于人口的回顾性队列研究
Nicholas R Jones1, Margaret Smith2, Sarah Lay-Flurrie1
1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
概括
心力衰竭 (HF) 在心房动 (AF) 患者中增加了中风风险,但高死亡率使风险评估复杂化. 由于预后不佳,现有的评分可能会高估HF患者中风风险.
科学领域:
- 心脏病学 心脏病学
- 神经学 神经学
- 公共卫生 公共卫生
背景情况:
- 心力衰竭 (HF) 是患有心房动 (AF) 的患者中风的已知危险因素.
- 现有的中风风险评分不能充分解释与HF相关的不良预后.
- 这项研究涉及AF患者中风风险的HF预后意义.
研究的目的:
- 为了研究HF和AF的个体中风的发病率,与单独AF的人相比.
- 为了在分析中风发病率时考虑死亡的竞争风险.
- 评估HF对AF患者中风风险预测的影响.
主要方法:
- 一项以人口为基础的回顾性队列研究,利用英语初级保健和二级保健数据 (医院情节统计).
- 包括2000年至2018年年龄≥45岁的2,381,941名个人,分析HF和AF作为时间变化的共变量.
- 采用Cox和Fine-Gray模型计算第一次中风的危险比率 (HRs),考虑竞争的风险.
主要成果:
- 在平均6.62年的随访期间,中风发生在3.9%的队列中,死亡发生在13.2%的队列中.
- 虽然单独AF在考克斯模型中显示了最高的相对中风风险 (HR2.43),但在细灰模型中,HF和AF的风险降低了 (HR1.48),这表明在考虑死亡率后风险减弱.
- 死亡率很高,在患有HF的个体中超过51.3%.
结论:
- 心力衰竭是中风的病因风险因素,但其预后影响因高死亡率而减少.
- CHA2DS2-VASc得分可能会高估一些HF患者的中风发病率,特别是那些预后较差的患者.
- 精确的中风风险评估在HF的AF患者需要考虑竞争死亡风险.
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