Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality - The Framingham Heart Study
Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality - The Framingham Heart Study
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DOI：
10.1161/01.cir.0000072767.89944.6e
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发表时间：
2003-06-17
期刊：
影响因子：
37.8
通讯作者：
Benjamin, EJ
中科院分区：
文献类型：
--
作者：
Wang, TJ;Larson, MG;Benjamin, EJ
背景-心房颤动（AF）和充血性心力衰竭（CHF）经常一起发生，但关于它们的时间关系和这些条件对mortality.Methods和Results-We的联合影响的信息是有限的，我们研究了Fracket研究中新发AF或CHF的参与者。采用多变量考克斯比例风险模型（含时间依赖变量）评估AF或CHF后的死亡率是否受其他疾病的发生和时间的影响。根据时间段和心血管风险因素调整风险比（HR）。在研究期间，1470名参与者发生了AF、CHF或两者兼而有之。在382名同时患有这两种疾病的患者中，38%首先患有AF，41%首先患有CHF，21%在同一天被诊断出来。AF受试者中CHF的发生率为33/1000人-年，CHF受试者中AF的发生率为54/1000人-年。在AF受试者中，随后发生CHF与死亡率增加相关（男性：HR 2.7; 95% CI，1.9 - 3.7;女性：HR 3.1; 95% CI，2.2 - 4.2）。同样，在CHF受试者中，AF的晚期发展与死亡率增加相关（男性：HR 1.6; 95% CI，1.2 - 2.1;女性：HR 2.7，95% CI，2.0 - 3.6）。先前存在的CHF对AF患者的生存率有不利影响，但先前存在的AF与CHF患者的不良生存率无关。进一步研究AF和CHF联合发生的发病机制、预防和最佳管理似乎是必要的。
Background-Atrial fibrillation (AF) and congestive heart failure (CHF) frequently occur together, but there is limited information regarding their temporal relations and the combined influence of these conditions on mortality.Methods and Results-We studied participants in the Framingham Study with new-onset AF or CHF. Multivariable Cox proportional hazards models with time-dependent variables were used to evaluate whether mortality after AF or CHF was affected by the occurrence and timing of the other condition. Hazard ratios (HRs) were adjusted for time period and cardiovascular risk factors. During the study period, 1470 participants developed AF, CHF, or both. Among 382 individuals with both conditions, 38% had AF first, 41% had CHF first, and 21% had both diagnosed on the same day. The incidence of CHF among AF subjects was 33 per 1000 person-years, and the incidence of AF among CHF subjects was 54 per 1000 person-years. In AF subjects, the subsequent development of CHF was associated with increased mortality (men: HR 2.7; 95% CI, 1.9 to 3.7; women: HR 3.1; 95% CI, 2.2 to 4.2). Similarly, in CHF subjects, later development of AF was associated with increased mortality (men: HR 1.6; 95% CI, 1.2 to 2.1; women: HR 2.7, 95% CI, 2.0 to 3.6). Preexisting CHF adversely affected survival in individuals with AF, but preexisting AF was not associated with adverse survival in those with CHF.Conclusions-Individuals with AF or CHF who subsequently develop the other condition have a poor prognosis. Additional studies addressing the pathogenesis, prevention, and optimal management of the joint occurrence of AF and CHF appear warranted.