Factors that influence awareness and treatment of atrial fibrillation in older adults
Factors that influence awareness and treatment of atrial fibrillation in older adults
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影响老年人房颤认知和治疗的因素
DOI：
10.1093/qjmed/hct060
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发表时间：
2013-05-01
影响因子：
13.3
通讯作者：
Kenny, R. A.
中科院分区：
文献类型：
--
作者：
Frewen, J.;Finucane, C.;Kenny, R. A.
目的：本研究的目的是调查房颤（AF）的患病率，治疗率的AF和潜在的认识和治疗的因素，在一个大型的全国代表性study.Methods：人口样本的人年龄在50岁以上，生活在共和国的爱尔兰，被招募的一部分，爱尔兰纵向研究老龄化。获得10分钟心电图记录（n = 4890），并进行分析以检测AF。还记录了自我报告的心律失常、主观和客观健康指标（心血管疾病、CHA（2）DS（2）-VASc变量和血压）和药物治疗。结果：房颤的总患病率为3%（95%CI：2.4-3.7%），有明显的年龄梯度和性别差异[4.8%（男性）vs.1.4%（女性）; P < 0.0001]。总的来说，67.8%的人处于中风的高风险中（CHA（2）DS（2）-VASc >= 2），其中59.3%的人治疗不足。高比例的38.1%不知道患有AF。CHA（2）DS（2）-VASc和HAS-BLED评分影响知晓或治疗。缺乏认识与受教育程度较低有关（P = 0.01），认知功能低下（P = 0.04），农村地区（OR = 3.67; P = 0.02）和全科医生就诊次数（P = 0.01），而未经治疗的AF受虚弱状态的影响结论：在未来30年内，不列颠群岛80岁以上的人口数量预计将翻一番，房颤的检测和管理迫在眉睫。三分之二的中风高危成年人没有得到充分的治疗。建议更定期地筛查房颤，应用卒中和出血风险标准，并了解影响诊断和治疗的因素。
Aim: The aims of this study were to investigate the prevalence of atrial fibrillation (AF), treatment rates of AF and the factors underlying awareness and treatment, in a large nationally representative study.Methods: A population sample of people aged 50+, living in the Republic of Ireland, were recruited as part of The Irish longitudinal study on ageing. Ten-minute electrocardiogram recordings were obtained (n = 4890), and analysed to detect AF. Self-reported arrhythmias, subjective and objective health measures (cardiovascular diseases, CHA(2)DS(2)-VASc variables and blood pressure) and medications were also recorded. Logistic regressions were used to determine associations with outcomes of presence of AF, lack of awareness and untreated AF.Results: Overall prevalence of AF was 3% (95% CI: 2.4-3.7%), with a marked age gradient and sex difference [4.8% (men) vs. 1.4% (women); P < 0.0001]. In total, 67.8% were at high risk of stroke (CHA(2)DS(2)-VASc >= 2), of whom 59.3% were inadequately treated. A high proportion of 38.1% were unaware of having AF. CHA(2)DS(2)-VASc nor HAS-BLED score influenced awareness or treatment. Lack of awareness was associated with lower education (P = 0.01), lower cognition (P = 0.04), rural location (OR = 3.67; P = 0.02) and number of general practitioner visits (P = 0.01), whereas untreated AF was influenced by frailty status (P = 0.04).Conclusions: With projected doubling of numbers of persons over 80 in the next 30 years in the British Isles, detection and management of AF is pressing. Two-thirds of adults at high risk of stroke were inadequately treated. More regular screening for AF, application of criteria for stroke and bleeding risk and awareness of factors influencing diagnosis and treatment is recommended.