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中华心脏与心律电子杂志 ›› 2022, Vol. 10 ›› Issue (03) : 133 -140. doi: 10.3877/cma.j.issn.2095-6568.2022.03.002

所属专题: 总编推荐

心血管急危重症

符合ABC管理路径对中国急诊心房颤动患者预后的影响
姜莉1, 王娟1, 杨艳敏1,(), 朱俊1, 张晗1, 邵兴慧1   
  1. 1. 100037 北京,中国医学科学院 北京协和医学院 国家心血管病中心 心血管疾病国家重点实验室 阜外医院急重症中心
  • 收稿日期:2022-08-10 出版日期:2022-09-25
  • 通信作者: 杨艳敏
  • 基金资助:
    首都临床诊疗技术研究及示范应用(Z191100006619121); 院所青年基金(2022FWQN18)

Influence of compliance with atrial fibrillation better care (ABC) management pathway on prognosis of Chinese emergency patients with atrial fibrillation

Li Jiang1, Juan Wang1, Yanmin Yang1,(), Jun Zhu1, Han Zhang1, Xinghui Shao1   

  1. 1. Emergency and Intensive Care Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, Beijing 100037, China
  • Received:2022-08-10 Published:2022-09-25
  • Corresponding author: Yanmin Yang
引用本文:

姜莉, 王娟, 杨艳敏, 朱俊, 张晗, 邵兴慧. 符合ABC管理路径对中国急诊心房颤动患者预后的影响[J/OL]. 中华心脏与心律电子杂志, 2022, 10(03): 133-140.

Li Jiang, Juan Wang, Yanmin Yang, Jun Zhu, Han Zhang, Xinghui Shao. Influence of compliance with atrial fibrillation better care (ABC) management pathway on prognosis of Chinese emergency patients with atrial fibrillation[J/OL]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2022, 10(03): 133-140.

目的

探讨符合心房颤动(房颤)更好的管理(atrial fibrillation better care,ABC)管理路径对中国急诊房颤患者预后的影响。

方法

纳入2008年11月至2011年10月在中国20家医院急诊就诊的房颤患者,并随访12个月。根据患者是否符合ABC管理路径分为2组:符合ABC路径组与不符合ABC路径组。主要临床结局事件为全因死亡,次要临床结局事件为心血管死亡、卒中和大出血事件。应用Cox回归模型分析上述事件的影响因素。

结果

共纳入2 015例房颤患者,年龄(68.5±13.3)岁,其中女1 104例(54.8%)。随访12个月,符合ABC路径组(126/2 015例,6.3%)患者死亡4例(3.2%,4/126),其中心血管死亡1例(0.8%,1/126);不符合ABC路径组(1 889/2 015例,93.7%)患者死亡275例(14.6%,275/1 889),其中心血管死亡163例(8.6%,163/1 889)。两组患者卒中和大出血发生率差异无统计学意义。多因素Cox模型分析显示,与不符合ABC路径组比,符合ABC路径组的全因死亡风险(HR 0.211,95% CI 0.078~0.572,P=0.002)和心血管死亡风险(HR 0.085,95%CI 0.012~0.612,P=0.014)均显著下降。

结论

在当代真实的中国急诊房颤患者队列中,符合ABC路径的临床综合管理与显著降低全因死亡、心血管死亡风险相关,采用ABC路径的综合管理可以改善房颤患者的预后。

Objective

To investigate the impact of atrial fibrillation better care (ABC) pathway on the prognosis of Chinese emergency patients with atrial fibrillation (AF).

Methods

This study included patients with AF who presented to the emergency department of 20 hospitals in China from November 2008 to October 2011, and every patient had a 12-months follow-up. Patients were divided into 2 groups according to whether they followed the ABC pathway: ABC adherent and Non-ABC adherent. The primary clinical outcome measure was all-cause death, and the secondary clinical outcome measure was cardiovascular death, stroke, and major bleeding. Univariate and multivariable Cox regression models were used to analyze the effects of the ABC adherence on the clinical outcomes.

Results

A total of 2 015 patients with AF were included in this study.The average age was (68.5±13.3) years, 1 104 (54.8%) were female, and the patients in the ABC/Non-ABC adherent were 126 (6.3%,126/2 015) and 1 889 (93.7%,1 889/2 015), respectively. During the 12-month follow-up, all-cause death and cardiovascular death occurred in 4 (3.2%, 4/126) patients and 1 (0.8%,1/126) in the ABC adherent group, and 275 (14.6%, 275/1 889) and 163 (8.6%, 163/1 889) in the Non-ABC adherent group. Multivariable Cox model analysis showed that the risk of all-cause mortality (HR 0.211, 95% CI 0.078~0.572, P=0.002) and cardiovascular mortality (HR 0.085, 95% CI 0.012~0.612, P=0.014) were significantly decreased in the ABC adherent group compared with the Non-ABC adherent group. The incidence of stroke and major bleeding was not statistically different between the two groups.

Conclusion

In a contemporary cohort of Chinese emergency patients with AF, comprehensive clinical management with the ABC pathway was associated with a significant decrease in the risk of all-cause death and cardiovascular death, and integrated management using the ABC pathway could improve the prognosis of patients with AF.

表1 符合ABC路径组与不符合ABC路径组房颤患者的基线特征
符合ABC路径组 不符合ABC路径组 P
例数 126 1 889
年龄(岁,
x¯±s
65.3±12.0 68.7±13.3 0.006
女性[例(%)] 73(57.9) 1031(54.6) 0.463
体重指数(kg/m2
x¯±s
24.1±3.3 23.5±3.6 0.058
收缩压(mmHg,
x¯±s
134.8±20.4 131.7±23.5 0.143
舒张压(mmHg,
x¯±s
81.3±13.7 79.8±14.8 0.266
心率(次/min,
x¯±s
88.9±23.2 102.6±29.5 <0.001
CHA2DS2-VASc评分(
x¯±s
3.7±1.8 3.5±2.1 0.205
吸烟史[例(%)] 26(20.6) 407(21.5) 0.810
饮酒史[例(%)] 3(2.4) 108(5.7) 0.112
房颤类型[例(%)] 0.003
阵发性房颤 24(19.0) 594(31.4)
持续性房颤 25(19.8) 424(22.4)
永久性房颤 77(61.1) 871(46.1)
合并疾病[例(%)]
冠心病 41(32.5) 802(42.5) 0.029
高血压 98(77.8) 1020(54.0) <0.001
心力衰竭 54(42.9) 700(37.1) 0.193
心脏瓣膜病 49(38.9) 358(19.0) <0.001
先天性心脏病 2(1.6) 41(2.2) 0.661
糖尿病 31(24.6) 280(14.8) 0.003
卒中/TIA史 35(27.8) 344(18.2) 0.008
大出血史 3(2.4) 45(2.4) 0.999
COPD 9(7.1) 227(12.0) 0.099
痴呆/认知障碍 0(0.0) 44(2.3) 0.083
睡眠呼吸暂停 2(1.6) 68(3.6) 0.232
甲亢 2(1.6) 64(3.4) 0.272
药物治疗[例(%)]
华法林 126(100%) 249(13.2) <0.001
抗血小板药 45(35.7) 1 236(65.4) <0.001
β受体阻滞剂 91(72.2) 924(48.9) <0.001
非二氢吡啶类钙通道阻滞剂 43(34.1) 530(28.1) 0.144
地高辛 72(57.1) 646(34.2) <0.001
胺碘酮 23(18.3) 224(11.9) 0.034
普罗帕酮 9(7.1) 81(4.3) 0.133
索他洛尔 2(1.6) 11(0.6) 0.172
利尿剂 76(60.3) 781(41.3) <0.001
ACEI/ARB 84(66.7) 766(40.6) <0.001
他汀类 33(26.2) 491(26.0) 0.961
图1 符合ABC路径组与不符合ABC路径组患者12个月随访的临床结局事件发生率比较(1A为全因死亡,1B为心血管死亡,1C为卒中,1D为大出血)
图2 符合ABC路径组与不符合ABC路径组随访临床结局事件的Kaplan-Meier曲线(2A为全因死亡,2B为心血管死亡,2C为卒中,2D为大出血)
图3 房颤患者多因素Cox回归模型分析全因死亡的独立危险因素 房颤为心房颤动,ACEI为血管紧张素转换酶抑制剂,ARB为血管紧张素受体拮抗剂,COPD为慢性阻塞性肺疾病,BMI为体重指数
图4 房颤患者多因素Cox回归模型分析心血管死亡的独立危险因素 房颤为心房颤动,BMI为体重指数
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