In-hospital therapies and determinants of treatment strategy selection in patients with atrial fibrillation and left ventricular systolic dysfunction in China: a retrospective study based on the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) project, 2015-2019.
In-hospital therapies and determinants of treatment strategy selection in patients with atrial fibrillation and left ventricular systolic dysfunction in China: a retrospective study based on the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) project, 2015-2019.
复制标题
DOI：
10.1136/bmjopen-2022-070070
复制
发表时间：
2023-06-05
期刊：
影响因子：
2.9
通讯作者：
Huo, Yong
中科院分区：
文献类型：
--
作者：
He, Pengkang;Pan, Yannan;Jiang, Jie;Fan, Fangfang;Zhou, Jing;Xia, Yulong;Liu, Jun;Yang, Na;Hao, Yongchen;Li, Jianping;Liu, Jing;Zhao, Dong;Huo, Yong
房颤（AF）合并心力衰竭患者的最佳治疗策略仍存在争议。我们的目的是总结住院治疗，并确定与治疗策略选择相关的因素。一项回顾性研究，分析了2015年至2019年中国改善心血管疾病护理-房颤（CCC-AF）项目。CCC-AF项目包括来自中国30个省的151家三级医院和85家二级医院的患者。研究样本包括房颤和左心室收缩功能障碍（LVSD，定义为左心室射血分数<50%）患者，共5560例。按治疗策略对患者进行分类。分析了住院治疗情况及治疗趋势。多元逻辑回归模型被用来寻找治疗策略的决定因素。16.9%的患者使用了节律控制治疗，无显著趋势（p趋势=0.175）。5.5%的患者使用了导管消融术，从2015年的3.3%增加到2019年的6.6%（p趋势<0.001）。与节律控制负相关的因素包括年龄增加（OR 0.973，95% CI 0.967 - 0.980），瓣膜性房颤（OR 0.618，95% CI 0.419至0.911），AF类型（持续性：OR 0.546，95% CI 0.462至0.645;长期持续性：OR 0.298，95% CI 0.240至0.368），左心房直径较大（OR 0.966，95%CI 0.957至0.976）和较高的Charlson合并症指数评分（CCI 1-2：OR 0.630，95% CI 0.529至0.750; CCI≥3：OR 0.551，95% CI 0.390至0.778）。较高的血小板计数（OR 1.025，95% CI 1.013 - 1.037）和既往心律控制尝试（电击复律：OR 4.483，95% CI 2.369 - 8.483;导管消融：OR 4.957，95% CI 3.072 - 7.997）与心律控制策略呈正相关。在中国，非节律控制策略仍然是AF和LVSD患者的主要选择。年龄、AF类型、既往治疗、左心房直径、血小板计数和合并症是治疗策略的主要决定因素。应进一步推广遵循指南的治疗。 NCT02309398。
The optimal treatment strategy remains debatable in patients with atrial fibrillation (AF) and heart failure. Our objectives were to summarise in-hospital therapies and determine factors associated with treatment strategy selections. A retrospective study analysing the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) project from 2015 to 2019. The CCC-AF project included patients from 151 tertiary and 85 secondary hospitals across 30 provinces in China. Patients with AF and left ventricular systolic dysfunction (LVSD, defined as left ventricular ejection fraction<50%) were included, with 5560 patients in the study sample. Patients were classified by treatment strategies. In-hospital treatments and trends of therapies were analysed. Multiple logistic regression models were used to find determinants of treatment strategies. Rhythm control therapies were used in 16.9% of patients with no significant trends (p trend=0.175). Catheter ablation was used in 5.5% of patients, increasing from 3.3% in 2015 to 6.6% in 2019 (p trend<0.001). Factors negatively associated with rhythm control included increased age (OR 0.973, 95% CI 0.967 to 0.980), valvular AF (OR 0.618, 95% CI 0.419 to 0.911), AF types (persistent: OR 0.546, 95% CI 0.462 to 0.645; long-standing persistent: OR 0.298, 95% CI 0.240 to 0.368), larger left atrial diameters (OR 0.966, 95% CI 0.957 to 0.976) and higher Charlson Comorbidity Index scores (CCI 1–2: OR 0.630, 95% CI 0.529 to 0.750; CCI≥3: OR 0.551, 95% CI 0.390 to 0.778). Higher platelet counts (OR 1.025, 95% CI 1.013 to 1.037) and prior rhythm control attempts (electrical cardioversion: OR 4.483, 95% CI 2.369 to 8.483; catheter ablation: OR 4.957, 95% CI 3.072 to 7.997) were positively associated with rhythm control strategies. In China, non-rhythm control strategy remained the dominant choice in patients with AF and LVSD. Age, AF types, prior treatments, left atrial diameters, platelet counts and comorbidities were major determinants of treatment strategies. Guideline-adherent therapies should be further promoted. NCT02309398.
登录
查看更多内容
影响因子：
37.8
作者：
Packer DL;Piccini JP;Monahan KH;Al-Khalidi HR;Silverstein AP;Noseworthy PA;Poole JE;Bahnson TD;Lee KL;Mark DB;CABANA Investigators
通讯作者：
CABANA Investigators
影响因子：
4.8
作者：
Gehi, Anil K.;Doros, Gheorghe;Maddox, Thomas M.
通讯作者：
Maddox, Thomas M.
影响因子：
9.7
作者：
Li, Shi-Jun;Sartipy, Ulrik;Fu, Michael
通讯作者：
Fu, Michael
影响因子：
8.4
作者：
Kuck, Karl-Heinz;Merkely, Bela;Hindricks, Gerhard
通讯作者：
Hindricks, Gerhard
影响因子：
4.8
作者：
Steinberg, Benjamin A.;Holmes, DaJuanicia N.;Ezekowitz, Michael D.;Fonarow, Gregg C.;Kowey, Peter R.;Mahaffey, Kenneth W.;Naccarelli, Gerald;Reiffel, James;Chang, Paul;Peterson, Eric D.;Piccini, Jonathan P.
通讯作者：
Piccini, Jonathan P.