Treatment timing and the effects of rhythm control strategy in patients with atrial fibrillation: nationwide cohort study.
Treatment timing and the effects of rhythm control strategy in patients with atrial fibrillation: nationwide cohort study.
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治疗时间和节奏控制策略对房颤患者的影响：全国队列研究。
DOI：
10.1136/bmj.n991
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发表时间：
2021-05-11
期刊：
影响因子：
--
通讯作者：
Joung B
中科院分区：
文献类型：
--
作者：
Kim D;Yang PS;You SC;Sung JH;Jang E;Yu HT;Kim TH;Pak HN;Lee MH;Lip GYH;Joung B
研究心律控制策略的结果是否因房颤诊断和治疗开始之间的持续时间而不同。纵向观察队列研究。来自韩国国民健康保险服务数据库的基于人口的队列。2011年7月28日至2015年12月31日期间，22 635名心房颤动和心血管疾病的成年人，新接受心律控制（抗心律失常药物或消融）或心率控制策略治疗。心血管死亡、缺血性中风、因心力衰竭住院或急性心肌梗死的复合结局。研究人群中男性12 200人（53.9%），中位年龄70岁，中位随访时间2.1年。在房颤早期治疗（诊断后1年内发病）的患者中，与发病率控制组相比，心律控制组的主要综合结局风险较低（心律控制组加权发病率每100人年7.42 vs发病率控制组9.25；风险比0.81,95%可信区间0.71 ~ 0.93；P=0.002）。在房颤晚期治疗（诊断1年后开始）患者中，节律控制和速率控制的主要复合结局风险无差异（节律控制的加权发病率每100人年8.67 vs速率控制的8.99;0.97,0.78至1.20；P=0.76）。在不同的治疗时间，节律和速率控制策略在安全性结果上没有显著差异。与心率控制相比，较早开始治疗与更有利的心血管结果线性相关。在新近诊断为房颤的患者中，早期开始节律控制治疗与较低的不良心血管结局风险相关。在房颤超过一年的患者中没有发现这种关联。
To investigate whether the results of a rhythm control strategy differ according to the duration between diagnosis of atrial fibrillation and treatment initiation. Longitudinal observational cohort study. Population based cohort from the Korean National Health Insurance Service database. 22 635 adults with atrial fibrillation and cardiovascular conditions, newly treated with rhythm control (antiarrhythmic drugs or ablation) or rate control strategies between 28 July 2011 and 31 December 2015. A composite outcome of death from cardiovascular causes, ischaemic stroke, admission to hospital for heart failure, or acute myocardial infarction. Of the study population, 12 200 (53.9%) were male, the median age was 70, and the median follow-up duration was 2.1 years. Among patients with early treatment for atrial fibrillation (initiated within one year since diagnosis), compared with rate control, rhythm control was associated with a lower risk of the primary composite outcome (weighted incidence rate per 100 person years 7.42 in rhythm control v 9.25 in rate control; hazard ratio 0.81, 95% confidence interval 0.71 to 0.93; P=0.002). No difference in the risk of the primary composite outcome was found between rhythm and rate control (weighted incidence rate per 100 person years 8.67 in rhythm control v 8.99 in rate control; 0.97, 0.78 to 1.20; P=0.76) in patients with late treatment for atrial fibrillation (initiated after one year since diagnosis). No significant differences in safety outcomes were found between the rhythm and rate control strategies across different treatment timings. Earlier initiation of treatment was linearly associated with more favourable cardiovascular outcomes for rhythm control compared with rate control. Early initiation of rhythm control treatment was associated with a lower risk of adverse cardiovascular outcomes than rate control treatment in patients with recently diagnosed atrial fibrillation. This association was not found in patients who had had atrial fibrillation for more than one year.
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影响因子：
39.3
作者：
Camm AJ;Amarenco P;Haas S;Hess S;Kirchhof P;Kuhls S;van Eickels M;Turpie AG;XANTUS Investigators
通讯作者：
XANTUS Investigators
DOI：
10.1097/ede.0b013e3181d61eeb
发表时间：
2010-05
期刊：
Epidemiology (Cambridge, Mass.)
影响因子：
--
作者：
Lipsitch M;Tchetgen Tchetgen E;Cohen T
通讯作者：
Cohen T
影响因子：
158.5
作者：
Hohnloser, Stefan H.;Crijns, Harry J. G. M.;Connolly, Stuart J.
通讯作者：
Connolly, Stuart J.
影响因子：
158.5
作者：
Roy, D;Talajic, M;Thibault, B
通讯作者：
Thibault, B
DOI：
10.1080/01621459.2016.1260466
发表时间：
2018-01-01
影响因子：
3.7
作者：
Li, Fan;Morgan, Kari Lock;Zaslavsky, Alan M.
通讯作者：
Zaslavsky, Alan M.