Care Patterns and Outcomes in Atrial Fibrillation Patients With and Without Diabetes ORBIT-AF Registry
Care Patterns and Outcomes in Atrial Fibrillation Patients With and Without Diabetes ORBIT-AF Registry
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DOI：
10.1016/j.jacc.2017.07.755
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发表时间：
2017-09-12
影响因子：
24
通讯作者：
Fonarow, Gregg C.
中科院分区：
文献类型：
--
作者：
Echouffo-Tcheugui, Justin B.;Shrader, Peter;Fonarow, Gregg C.
研究背景糖尿病是房颤患者血栓栓塞症的危险因素，但糖尿病对房颤患者预后的影响却知之甚少。目的本研究评估了患有和不患有糖尿病的房颤患者的症状、健康状况、护理和预后是否存在差异。方法队列研究包括9,749名患者，这些患者来自更好地了解房颤治疗情况的结果登记处(Orbit-AF)，该登记处是一家全国性的前瞻性门诊登记处，记录有房颤事件和房颤流行的患者。结果糖尿病患者(29.5%)更年轻，更有可能患有高血压、慢性肾脏疾病、心力衰竭和中风。与非糖尿病患者相比，糖尿病患者的房颤对生活质量评分的影响也较低，分别为80分(四分位数范围：62.5至92.6)和82.4分(四分位数范围：67.6至93.5p=0.025)，并且更有可能接受抗凝治疗(p<；0.001)。糖尿病与更高的死亡风险相关，包括总体(70岁与AHR的调整危险比[AHR]：1.63；95%可信区间[CI]：1.04至2.56；70岁与AHR：1.25；95%CI：1.09至1.44，70岁与70岁)和心血管(CV)死亡率(AHR：2.20；95%CI：1.22至3.98，70岁与1.24；95%CI：1.02至1.51；=70岁)。糖尿病患者非心血管疾病死亡、心源性猝死、住院、心血管疾病住院、非心血管事件和非出血相关住院的风险较高，但血栓栓子事件、出血相关住院、新发心力衰竭和房颤进展的风险没有增加。结论在房颤患者中，糖尿病与房颤症状加重、生活质量降低、死亡和住院风险增加有关，但与血栓栓子或出血事件无关。(J am Coll心脏ol 2017；70：第1325-35)(C)2017年，由美国心脏病学会基金会主办。
BACKGROUND Diabetes is a well-established risk factor for thromboembolism in patients with atrial fibrillation (AF), but less is known about how diabetes influences outcomes among AF patients.OBJECTIVES This study assessed whether symptoms, health status, care, and outcomes differ between AF patients with and without diabetes.METHODS The cohort study included 9,749 patients from the ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry, a prospective, nationwide, outpatient registry of patients with incident and prevalent AF. Outcomes included symptoms, health status, and AF treatment, as well as 2-year risk of death, hospitalization, thromboembolic events, heart failure (HF), and AF progression.RESULTS Patients with diabetes (29.5%) were younger, more likely to have hypertension, chronic kidney disease, HF, coronary heart disease, and stroke. Compared to patients without diabetes, patients with diabetes also had a lower Atrial Fibrillation Effects on Quality of Life score of 80 (interquartile range [IQR]: 62.5 to 92.6) versus 82.4 (IQR: 67.6 to 93.5; p = 0.025) and were more likely to receive anticoagulation (p < 0.001). Diabetes was associated with higher mortality risk, including overall (adjusted hazard ratio [aHR]: 1.63; 95% confidence interval [CI]: 1.04 to 2.56, for age < 70 years vs. aHR: 1.25; 95% CI: 1.09 to 1.44, for age >= 70 years) and cardiovascular (CV) mortality (aHR: 2.20; 95% CI: 1.22 to 3.98, for age < 70 years vs. 1.24; 95% CI: 1.02 to 1.51 for age >= 70 years). Diabetes conferred a higher risk of non-CV death, sudden cardiac death, hospitalization, CV hospitalization, and non-CV and nonbleeding-related hospitalization, but no increase in risks of thromboembolic events, bleeding-related hospitalization, new-onset HF, and AF progression.CONCLUSIONS Among AF patients, diabetes was associated with worse AF symptoms and lower quality of life, and increased risk of death and hospitalizations, but not thromboembolic or bleeding events. (J Am Coll Cardiol 2017; 70: 1325-35) (C) 2017 by the American College of Cardiology Foundation.