Risk of stroke and transient ischaemic attack in patients with a diagnosis of resolved atrial fibrillation: retrospective cohort studies.
Risk of stroke and transient ischaemic attack in patients with a diagnosis of resolved atrial fibrillation: retrospective cohort studies.
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DOI：
10.1136/bmj.k1717
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发表时间：
2018-05-09
期刊：
影响因子：
--
通讯作者：
Marshall T
中科院分区：
文献类型：
--
作者：
Adderley NJ;Nirantharakumar K;Marshall T
测定诊断为“解决性”房颤的患者与未解决性房颤和无房颤的患者相比，卒中或短暂性缺血发作（TIA）的发生率和全因死亡率。两项回顾性队列研究。促进健康改善网络的一般做法，2000年1月1日至2016年5月15日。18岁及以上，既往无卒中或TIA的成年人：11 159例房颤消退，15 059例房颤对照，22 266例无房颤对照。主要结局是卒中或TIA的发生率。次要终点为全因死亡率。缓解房颤患者卒中或TIA的调整发生率比为房颤对照组0.76(95%可信区间0.67 ~ 0.85，P<0.001)，非房颤对照组1.63 （1.46 ~ 1.83，P<0.001）。缓解房颤患者的调整死亡率与房颤对照组相比为0.60 (0.56 ~ 0.65，P<0.001)，与非房颤对照组相比为1.13 （1.06 ~ 1.21，P<0.001）。当排除房颤缓解和复发性房颤的患者时，卒中或TIA的调整发生率比为1.45（1.26至1.67，P<0.001）。房颤缓解的患者比没有房颤的患者卒中或TIA的风险更高。即使在那些复发性心房颤动没有记录的人，风险也会增加。指南应更新，以提倡对已缓解的房颤患者继续使用抗凝剂。
To determine rates of stroke or transient ischaemic attack (TIA) and all cause mortality in patients with a diagnosis of “resolved” atrial fibrillation compared to patients with unresolved atrial fibrillation and without atrial fibrillation. Two retrospective cohort studies. General practices contributing to The Health Improvement Network, 1 January 2000 to 15 May 2016. Adults aged 18 years or more with no previous stroke or TIA: 11 159 with resolved atrial fibrillation, 15 059 controls with atrial fibrillation, and 22 266 controls without atrial fibrillation. Primary outcome was incidence of stroke or TIA. Secondary outcome was all cause mortality. Adjusted incidence rate ratios for stroke or TIA in patients with resolved atrial fibrillation were 0.76 (95% confidence interval 0.67 to 0.85, P<0.001) versus controls with atrial fibrillation and 1.63 (1.46 to 1.83, P<0.001) versus controls without atrial fibrillation. Adjusted incidence rate ratios for mortality in patients with resolved atrial fibrillation were 0.60 (0.56 to 0.65, P<0.001) versus controls with atrial fibrillation and 1.13 (1.06 to 1.21, P<0.001) versus controls without atrial fibrillation. When patients with resolved atrial fibrillation and documented recurrent atrial fibrillation were excluded the adjusted incidence rate ratio for stroke or TIA was 1.45 (1.26 to 1.67, P<0.001) versus controls without atrial fibrillation. Patients with resolved atrial fibrillation remain at higher risk of stroke or TIA than patients without atrial fibrillation. The risk is increased even in those in whom recurrent atrial fibrillation is not documented. Guidelines should be updated to advocate continued use of anticoagulants in patients with resolved atrial fibrillation.
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