Incidence of chronic atrial fibrillation in general practice and its treatment pattern
Incidence of chronic atrial fibrillation in general practice and its treatment pattern
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DOI：
10.1016/s0895-4356(01)00478-4
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发表时间：
2002-04-01
影响因子：
7.2
通讯作者：
Rodríguez, LAG
中科院分区：
文献类型：
--
作者：
Ruigómez, A;Johansson, S;Rodríguez, LAG
本文的目的是估计慢性心房颤动（AF）的发病率在一般的做法设置，以确定其发生的诱发因素，并描述在诊断后的一年的治疗模式。使用的方法是一项基于人群的队列研究，使用英国的全科医学研究数据库（GPRD）。我们确定了年龄在40-89岁之间的患者，首次记录诊断为AF。通过向全科医生发送问卷来验证诊断。使用1，035例确诊的慢性AF事件病例和来自原始来源人群的5，000例对照随机样本进行巢式病例对照分析，以评估AF的风险因素。慢性房颤的发病率为1.7/1000人-年，并随年龄增长而显著增加。男性的年龄校正率比为1.4（95% CI 1.2-1.6）。主要风险因素包括年龄、高BMI、过度饮酒和既往心血管合并症，特别是瓣膜性心脏病和心力衰竭。近70%的患者使用地高辛，近15%的患者未接受任何抗肿瘤治疗。接近40%的患者在确诊后的3个月内没有接受华法林或阿司匹林治疗。在潜在的抗凝候选人中，70岁或以上的患者中只有22%的人服用华法林，而40-69岁的患者中有49%服用华法林。慢性房颤是一种老年疾病，女性发病率低于男性，特别是在年轻时。年龄、体重、过度饮酒和心血管疾病是房颤的主要独立危险因素。不到一半的慢性房颤患者和无抗凝禁忌症的患者在诊断后的前三个月内接受华法林治疗。(C)2002年爱思唯尔科技有限公司All rights reserved.
The object of this article was to estimate the incidence rate of chronic atrial fibrillation (AF) in a general practice setting, to identify factors predisposing to its occurrence, and to describe treatment patterns in the year following the diagnosis. The method used was a population-based cohort study using the General Practice Research Database (GPRD) in the UK. We identified patients aged 40-89 years with a first ever recorded diagnosis of AF. The diagnosis was validated through a questionnaire sent to the general practitioners. A nested case-control analysis was performed to assess risk factors for AF using 1,035 confirmed incident cases of chronic AF and a random sample of 5,000 controls from the original source population. The incidence rate of chronic AF was 1.7 per 1,000 person-years, and increased markedly with age. The age adjusted rate ratio among males was 1.4 (95% CI 1.2-1.6). The major risk factors were age, high BMI, excessive alcohol consumption, and prior cardiovascular comorbidity, in particular, valvular heart disease and heart failure. Digoxin was used in close to 70% of the patients, and close to 15% did not receive any antiarrhythmic treatment. Close to 40% did not receive either warfarin or aspirin in the 3 months period after the diagnosis. Among the potential candidates for anticoagulation only 22% of those aged 70 years or older were prescribed warfarin in comparison to 49% among patients aged 40-69 years. Chronic AF is a disease of the elderly, with women presenting a lower incidence rate than men specially in young age. Age, weight, excessive alcohol consumption, and cardiovascular morbidity were the main independent risk factors for AF. Less than half of patients with chronic AF and no contraindications for anticoagulation received warfarin within the first trimester after the diagnosis. (C) 2002 Elsevier Science Inc. All rights reserved.