Atrial fibrillation in myocardial infarction patients: Impact on health care utilization.
Atrial fibrillation in myocardial infarction patients: Impact on health care utilization.
复制标题
心肌梗死患者的心房颤动：对医疗保健利用的影响。
DOI：
10.1016/j.ahj.2013.07.013
复制
发表时间：
2013
影响因子：
4.8
通讯作者：
Roger,VeroniqueL
中科院分区：
文献类型：
--
作者：
Chamberlain,AlannaM;Bielinski,SuzetteJ;Weston,SusanA;Klaskala,Winslow;Mills,RogerM;Gersh,BernardJ;Alonso,Alvaro;Roger,VeroniqueL
背景心房颤动（AF）经常并发心肌梗死（MI）。虽然AF对MI患者的生存率有不利影响，但AF对医疗保健利用率的影响尚未研究。（MI后<30天）和迟发性（MI后≥30天）AF在明尼苏达州Olmsted县社区的MI患者中进行评估。结果在1,502例MI患者中，237例既往有AF，163例新发房颤，113例晚发房颤，989例无房颤。平均随访3.9年，3,661例住院，5,559例艾德就诊，80,240例门诊就诊。调整后，与无AF的患者相比，既往和新发AF患者的住院风险分别增加了1.6倍和1.3倍。相比之下，晚发性房颤的住院风险增加2.2倍。既往、新发和迟发性AF的艾德访视的风险比分别为1.4、1.2和1.8，门诊访视的风险比分别为1.4、1.2和1.7。对时间依赖性复发性MI和心力衰竭的额外校正略微减弱了住院和艾德访视的结果;然而，迟发性房颤患者仍然表现出>50%的风险增加，这两个利用measures.ConclusionsIn心肌梗死患者，住院的风险，艾德访问，和门诊访问不同的房颤发作的时间，迟发性房颤的风险最大。房颤在MI后预后不良，强调了MI患者管理的重要性。
BackgroundAtrial fibrillation (AF) often complicates myocardial infarction (MI). While AF adversely impacts survival in MI patients, the impact of AF on health care utilization has not been studied.MethodsThe risk of hospitalizations, emergency department (ED) visits, and outpatient visits associated with prior, new-onset (<30 days post-MI), and late-onset (≥30 days post-MI) AF was assessed among incident MI patients from the Olmsted County, Minnesota, community.ResultsOf 1,502 MI patients, 237 had prior AF, 163 developed new-onset AF, 113 developed late-onset AF, and 989 had no AF. Over a mean follow-up of 3.9 years, 3,661 hospitalizations, 5,559 ED visits, and 80,240 outpatient visits occurred. After adjustment, compared with patients without AF, those with prior and new-onset AF exhibited a 1.6-fold and 1.3-fold increased risk of hospitalization, respectively. In contrast, late-onset AF carried a 2.2-fold increased risk of hospitalization. The hazard ratios were 1.4, 1.2, and 1.8 for ED visits and 1.4, 1.2, and 1.7 for outpatient visits for prior, new-onset, and late-onset AF. Additional adjustment for time-dependent recurrent MI and heart failure attenuated the results slightly for hospitalizations and ED visits; however, patients with late-onset AF still exhibited a >50% increased risk for both utilization measures.ConclusionsIn MI patients, the risk of hospitalizations, ED visits, and outpatient visits differed by the timing of AF onset, with the greatest risk conferred by late-onset AF. Atrial fibrillation imparts an adverse prognosis after MI, underscoring the importance of its management in MI patients.