无症状心房动的远程查:AMALFI随机临床试验
Rohan Wijesurendra1, Guilherme Pessoa-Amorim1, Georgina Buck1
1Clinical Trial Service Unit and Epidemiological Studies Unit, Oxford Population Health, University of Oxford, Oxford, United Kingdom.
JAMA
|August 29, 2025
概括
使用心电图贴片对高风险的老年人进行查,在2.5年内轻微增加了心房动 (AF) 的检测. 与通常治疗相比,这种AF查也导致了更多的口服抗凝药使用.
科学领域:
- 心脏病学
- 公共卫生
- 临床试验
背景情况:
- 心房动是中风的主要原因.
- 早期检测和抗凝药可以减轻中风风险.
- 查策略对于在风险群体中识别无症状肌肉功能关键.
研究的目的:
- 在中度至高风险的老年人中使用14天的基于贴片的门诊心电图监测来评估AF查的长期有效性.
- 为了确定查是否增加了AF检测和抗凝剂的使用,而不是通常的护理.
主要方法:
- 一项远程随机临床试验,涉及5040名65岁以上的参与者,CHA2DS2VASc得分显示中度至高风险.
- 参与者被随机分配为接受ECG贴片监测器进行14天的监测或通常的护理.
- 主要结局是随机化后在2.5年内被诊断为AF的参与者比例.
主要成果:
- 通过心电图贴片检测到4. 2%的参与者.
- 随机化后的AF诊断发生在干预组的6. 8%,对照组的5. 4% (比例比,1.26;P=. 03).
- 与对照组相比,干预组的口服抗凝剂平均暴露时间 (1.63个月;P<.001).
结论:
- 在高风险的老年人中,以电脑电图贴片进行基于邮件的AF查,导致AF诊断在2.5年内略有增加,但在统计学上显著.
- 查策略还加强了口服抗凝药的使用.
- 这些发现支持基于贴片的心电图监测在初级护理环境中用于长期AF检测.
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