Temporal Trends in the Incidence, Prevalence, and Survival of Patients With Atrial Fibrillation From 2004 to 2016
Temporal Trends in the Incidence, Prevalence, and Survival of Patients With Atrial Fibrillation From 2004 to 2016
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DOI：
10.1016/j.amjcard.2017.08.014
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发表时间：
2017-12-01
影响因子：
2.8
通讯作者：
Berger, Peter B.
中科院分区：
文献类型：
--
作者：
Williams, Brent A.;Honushefsky, Ashley M.;Berger, Peter B.
尽管自2010年以来没有关于美国房颤负担的数据报告，但预计房颤（AF）的流行率将不断上升。本研究的目的是（1）描述2004年至2016年大型医疗保健系统中AF发病率、患病率和诊断后生存率的趋势，（2）将观察到的患病率外推至整个美国人群，以估计国家AF负担。这项回顾性队列研究纳入了Geisinger健康系统的患者和电子病历，Geisinger健康系统是一个服务于宾夕法尼亚州中部和东北部的综合医疗保健提供系统。按日历年计算每1,000人年的标准化发病率，并在2004年至2016年的相应年份的7月1日估计点患病率。根据泊松回归估计率比，作为随时间推移的年度相对变化。共有464，363例患者符合研究入选标准。在研究期间，年龄和性别校正的AF发生率增加：2004年、2008年、2012年和2016年分别为4.7、5.0、5.8和6.2（率比每年1.03，95%置信区间1.02，1.03）。年龄和性别调整的患病率随着时间的推移不断增加，分别从2004年的2.7%，2008年的3.0%，2012年的3.4%，到2016年的4.1%。2004年，估计有610万美国人诊断出AF，2008年、2012年和2016年分别增加到670万、780万和930万。近年来，诊断后生存率没有改善。总之，自2004年以来，房颤的发病率和患病率稳步上升，而诊断后生存率没有改善。(C)2017爱思唯尔公司All rights reserved.
A growing epidemic of atrial fibrillation (AF) has been predicted, although no data on the AF burden has been reported for the United States since 2010. The objectives of this study were to (1) describe trends in AF incidence, prevalence, and postdiagnosis survival from 2004 to 2016 within a large health-care system and (2) extrapolate observed prevalence rates to the entire US population to estimate the national AF burden. This retrospective cohort study incorporates the patients and electronic medical record of the Geisinger Health System, an integrated health-care delivery system serving central and northeast Pennsylvania. Standardized incidence rates were calculated per 1,000 person-years by calendar year, and point prevalence rates estimated on July 1st of the respective years from 2004 to 2016. Rate ratios were estimated from Poisson regression as the annual relative change over time. A total of 464,363 patients met study inclusion criteria. Age- and sex-adjusted AF incidence rates increased over the study period: 4.7, 5.0, 5.8, and 6.2 in 2004, 2008, 2012, and 2016, respectively (rate ratio 1.03 per year, 95% confidence interval 1.02, 1.03). Age- and sex-adjusted prevalence rates increased consistently over time from 2.7%, 3.0%, 3.4%, to 4.1% in 2004, 2008, 2012, and 2016, respectively. In 2004, an estimated 6.1 million Americans had diagnosed AF, increasing to 6.7, 7.8, and 9.3 million in 2008, 2012, and 2016, respectively. Postdiagnosis survival has not improved in recent years. In conclusion, AF incidence and prevalence have increased steadily since 2004, whereas postdiagnosis survival has not improved. (C) 2017 Elsevier Inc. All rights reserved.