Incidence of and risk factors for atrial fibrillation in older adults.
Incidence of and risk factors for atrial fibrillation in older adults.
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DOI：
10.1161/01.cir.96.7.2455
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发表时间：
1997-10
期刊：
影响因子：
37.8
通讯作者：
B. Psaty;T. Manolio;L. Kuller;R. Kronmal;M. Cushman;L. Fried;R. White;C. Furberg;P. Rautaharju
中科院分区：
文献类型：
--
作者：
B. Psaty;T. Manolio;L. Kuller;R. Kronmal;M. Cushman;L. Fried;R. White;C. Furberg;P. Rautaharju
本研究旨在描述3年随访期间老年人房颤（AF）的发生率。方法和结果在这项队列研究中，5201名≥ 65岁的成年人在1989年6月至1993年5月期间每年进行四次检查。在基线时，参与者回答问卷，并进行详细的检查，包括颈动脉超声，肺功能测试，心电图和超声心动图。排除了基线时有起搏器或AF的受试者（n=357）。新发AF病例从三个来源确定：（1）年度自我报告，（2）年度ECG和（3）出院诊断。考克斯比例风险模型被用来评估基线风险因素作为事件AF的预测因子。在4844名参与者中，304名在平均3.28年的随访期间发生了首次AF发作，发病率为19.2/1000人-年。发病与年龄、男性和临床心血管疾病密切相关。对于65至74岁和75至84岁的男性，发生率分别为17.6和42.7，女性为10.1和21.6起事件/1000人年。在逐步模型中，利尿剂的使用、心脏瓣膜病史、冠心病、高龄、较高水平的收缩压、身高、血糖和左心房大小都与AF风险增加相关。1秒用力呼气量与AF风险降低相关。结论老年人AF的发病率可能高于先前人群研究的估计。左心房大小似乎是一个重要的危险因素，控制血压和血糖可能对预防AF的发展很重要。
BACKGROUND This study aimed to describe the incidence of atrial fibrillation (AF) among older adults during 3 years of follow-up. METHODS AND RESULTS In this cohort study, 5201 adults > or = 65 years old were examined annually on four occasions between June 1989 and May 1993. At baseline, participants answered questionnaires and underwent a detailed examination that included carotid ultrasound, pulmonary function tests, ECG, and echocardiography. Subjects with a pacemaker or AF at baseline (n=357) were excluded. New cases of AF were identified from three sources: (1) annual self-reports, (2) annual ECGs, and (3) hospital discharge diagnoses. Cox proportional-hazards models were used to assess baseline risk factors as predictors of incident AF. Among 4844 participants, 304 developed a first episode of AF during an average follow-up of 3.28 years, for an incidence of 19.2 per 1000 person-years. The onset was strongly associated with age, male sex, and the presence of clinical cardiovascular disease. For men 65 to 74 and 75 to 84 years old, the incidences were 17.6 and 42.7, respectively, and for women, 10.1 and 21.6 events per 1000 person-years. In stepwise models, the use of diuretics, a history of valvular heart disease, coronary disease, advancing age, higher levels of systolic blood pressure, height, glucose, and left atrial size were all associated with an increased risk of AF. The use of beta-blockers and high levels of alcohol use, cholesterol, and forced expiratory volume in 1 second were associated with a reduced risk of AF. CONCLUSIONS The incidence of AF in older adults may be higher than estimated by previous population studies. Left atrial size appears to be an important risk factor, and the control of blood pressure and glucose may be important in preventing the development of AF.