Trends in the incidence of atrial fibrillation in older patients initiating dialysis in the United States.
Trends in the incidence of atrial fibrillation in older patients initiating dialysis in the United States.
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DOI：
10.1161/circulationaha.112.099606
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发表时间：
2012-11-06
期刊：
影响因子：
37.8
通讯作者：
Winkelmayer WC
中科院分区：
文献类型：
--
作者：
Goldstein BA;Arce CM;Hlatky MA;Turakhia M;Setoguchi S;Winkelmayer WC
美国65岁以上的透析患者中有六分之一被诊断患有心房颤动/扑动（AF），并且患病率正在增加。然而，关于这一人群中AF的发病率知之甚少。从美国肾脏数据系统中，我们确定了1995年至2007年期间开始透析的258，605名老年患者（≥67岁），他们在过去2年内未被诊断为AF。对患者进行新诊断的AF随访，新诊断的AF是从1例住院患者或2例门诊患者包含AF代码的索赔中确定的。多变量比例风险回归用于检查时间趋势以及种族和种族与新发AF的相关性。我们还研究了新发AF后缺血性卒中死亡率和风险的时间趋势。在514，395人年的随访中，76，252例患者发生了新发AF，其粗AF发生率为148/1，000人年。从1995年到2007年，AF的发病率增加了11%（95%CI：5%-16%）。与非西班牙裔白人相比，非洲裔美国人（-30%），亚洲人（-19%），美洲原住民（-42%）和西班牙裔（-29%）的AF发病率均较低。在这些年中，缺血性卒中的发生率下降更为明显。在美国开始透析的老年患者中，AF的发生率较高，并且在13年的研究中一直在增加。在此期间死亡率下降，但在新诊断的AF后的第一年内仍保持>50%。由于华法林使用的数据不可用，我们无法理解近年来口服抗凝剂的比例较高是否可以解释更好的结局趋势。
One sixth of U.S. dialysis patients older than 65 years have been diagnosed with atrial fibrillation/flutter (AF) and the prevalence is increasing. Little is known, however, about the incidence of AF in this population. From the U.S. Renal Data System, we identified 258,605 older patients (≥67 years) with fee-for-service Medicare initiating dialysis between 1995 and 2007, who had not been diagnosed with AF within the previous 2 years. Patients were followed for newly diagnosed AF, which was ascertained from 1 inpatient or 2 outpatient claims containing an AF code. Multivariable proportional hazards regression was used to examine temporal trends and associations of race and ethnicity with incident AF. We also studied temporal trends in the mortality and risk of ischemic stroke after new AF. Over 514,395 person years of follow-up, 76,252 patients experienced incident AF for a crude AF incidence rate of 148/1,000 person years. Incidence of AF increased by 11% (95%CI: 5%-16%) from 1995-2007. Compared with non-Hispanic whites, African Americans (−30%), Asians (−19%), Native Americans (−42%), and Hispanics (−29%) all had lower rates of incident AF. Mortality after incident AF decreased by 22% from 1995-2008. Even more pronounced reductions were seen for incident ischemic stroke during these years. The incidence of AF is high in older patients initiating dialysis in the U.S. and has been increasing over the 13 years of study. Mortality declined during that time, but remained >50% during the first year after newly diagnosed AF. Since data on warfarin use were not available, we were unable to understand whether trends towards better outcomes could be explained by higher rates of oral anticoagulation in more recent years.