Atrial fibrillation and outcomes in heart failure with preserved versus reduced left ventricular ejection fraction.
Atrial fibrillation and outcomes in heart failure with preserved versus reduced left ventricular ejection fraction.
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DOI：
10.1161/jaha.112.005694
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发表时间：
2013-02-01
影响因子：
5.4
通讯作者：
Cardiovascular Research Network PRESERVE Study
中科院分区：
文献类型：
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作者：
McManus DD;Hsu G;Sung SH;Saczynski JS;Smith DH;Magid DJ;Gurwitz JH;Goldberg RJ;Go AS;Cardiovascular Research Network PRESERVE Study
心房颤动 (AF) 和心力衰竭 (HF) 是全国最常见的两种心血管疾病，并且 AF 常常使 HF 并发。我们在一个大型当代队列中研究了 AF 对 HF-PEF 与 HF-REF 不良结局的影响。我们根据 2005-2008 年心血管研究网络 4 个健康计划的出院和门诊诊断以及相关影像学结果，确定了所有诊断为 HF-PEF 或 HF-REF 的成年人。有关人口特征、诊断、手术、门诊药房使用和实验室结果的数据均来自健康计划数据库。因心力衰竭、中风和任何原因住院的情况是从出院和账单数据库中确定的。死亡人数是根据健康计划和州死亡档案确定的。在 23 644 名 HF 患者中，11 429 名 (48.3%) 记录有 AF（9081 名既往患者，2348 名患者）。与未患有 AF 的患者相比，AF 患者的调整后缺血性卒中发生率（发生 AF 的风险比 [HR] 2.47；既往 AF 的风险比 [HR 1.57]）、心衰住院率（发生 AF 的风险比 [HR]2.00；既往 AF 的 HR 1.22）、全因住院率（发生 AF 的风险比 [HR] 1.45；既往 AF 的 HR 1.15）更高。 AF）和死亡（事件 AF HR 1.67；先前存在的 AF HR 1.13）。对于 HF-PEF 和 HF-REF，AF 与这些结果的关联相似，但缺血性卒中除外。 AF 是 HF-PEF 或 HF-REF 患者不良结果的一个潜在危险因素。需要有效的干预措施来改善这些高危患者的预后。
Atrial fibrillation (AF) and heart failure (HF) are 2 of the most common cardiovascular conditions nationally and AF frequently complicates HF. We examined how AF has impacts on adverse outcomes in HF‐PEF versus HF‐REF within a large, contemporary cohort. We identified all adults diagnosed with HF‐PEF or HF‐REF based on hospital discharge and ambulatory visit diagnoses and relevant imaging results for 2005–2008 from 4 health plans in the Cardiovascular Research Network. Data on demographic features, diagnoses, procedures, outpatient pharmacy use, and laboratory results were ascertained from health plan databases. Hospitalizations for HF, stroke, and any reason were identified from hospital discharge and billing claims databases. Deaths were ascertained from health plan and state death files. Among 23 644 patients with HF, 11 429 (48.3%) had documented AF (9081 preexisting, 2348 incident). Compared with patients who did not have AF, patients with AF had higher adjusted rates of ischemic stroke (hazard ratio [HR] 2.47 for incident AF; HR 1.57 for preexisting AF), hospitalization for HF (HR 2.00 for incident AF; HR 1.22 for preexisting AF), all‐cause hospitalization (HR 1.45 for incident AF; HR 1.15 for preexisting AF), and death (incident AF HR 1.67; preexisting AF HR 1.13). The associations of AF with these outcomes were similar for HF‐PEF and HF‐REF, with the exception of ischemic stroke. AF is a potent risk factor for adverse outcomes in patients with HF‐PEF or HF‐REF. Effective interventions are needed to improve the prognosis of these high‐risk patients.