Causes of death of patients with non-valvular atrial fibrillation in Asians.
Causes of death of patients with non-valvular atrial fibrillation in Asians.
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亚洲人非瓣膜性房颤患者的死亡原因。
DOI：
10.1371/journal.pone.0282455
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发表时间：
2023
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
--
作者：
本研究的目的是确定在全国性房颤登记中心登记的亚洲非瓣膜性房颤（AF）患者的死亡原因，并研究正在服用和未服用口服抗凝剂（OAC）的AF患者之间死亡原因的差异。泰国非瓣膜性房颤患者抗血栓药物使用和最佳INR水平的COOL-AF研究在2014-2017年期间招募了来自泰国27家中心的非瓣膜性房颤患者，以创建COOL-AF泰国登记研究。死亡原因分类为心血管（CV）死亡、非CV死亡或死因不明。所有事件均由独立裁定委员会进行评价和验证。共有3，405例患者（平均年龄：67.8岁，41.8%为女性），平均随访时间为31.8±8.7个月。380例患者（11.2%）在随访期间死亡。CV死亡、非CV死亡和原因不明分别占121例（31.8%）、189例（49.7%）和70例（18.4%）患者。在已知死亡原因的患者中，心力衰竭（10%）、颅内出血（ICH; 10%）、心源性猝死（6.8%）和缺血性卒中（5.8%）是最常见的死亡原因。关于非CV死亡，感染/脓毒症（27.7%）、癌症（5.5%）、呼吸道（5.2%）和大出血（4.5%）是最常见的死亡原因。OAC的使用和类型是ICH和大出血发生率的主要决定因素。在亚洲AF患者中，缺血性卒中导致的死亡仅占所有死亡的4.7%。在亚洲AF患者中，非CV死亡（如感染/脓毒症或恶性肿瘤）的发生率远高于CV死亡。需要改进的综合护理方法来降低亚洲AF患者的非CV死亡患病率。
The aim of this study was to determine the causes of death among Asian non-valvular atrial fibrillation (AF) patients who were registered in a nationwide AF registry, and to investigate the differences in the causes of death in AF patients compared between those who were taking and not taking oral anticoagulant (OAC). The COhort of antithrombotic use and Optimal INR Level in patients with non-valvular Atrial Fibrillation in Thailand (COOL-AF) study enrolled non-valvular AF patients from 27 centers in Thailand during 2014–2017 to create the COOL-AF Thailand registry. Cause of death was classified as cardiovascular (CV) death, non-CV death, or undetermined cause of death. All events were evaluated and verified by an independent adjudication committee. There was a total of 3,405 patients (mean age: 67.8 years, 41.8% female), and the mean follow-up duration was 31.8±8.7 months. Three hundred and eighty patients (11.2%) died during follow-up. CV death, non-CV death, and undetermined cause accounted for 121 (31.8%), 189 (49.7%), and 70 (18.4%) patients, respectively. Of those with a known cause of death, heart failure (10%), intracranial hemorrhage (ICH; 10%), sudden cardiac death (6.8%), and ischemic stroke (5.8%) were the most often observed causes of death. Concerning non-CV death, infection/sepsis (27.7%), cancer (5.5%), respiratory (5.2%), and major bleeding (4.5%) were the most prevalent causes of death. The use and type of OAC were found to be major determinants of ICH and major bleeding incidence. Death due to ischemic stroke was responsible for only 4.7% of all deaths in Asian AF patients. Non-CV death, such as infection/sepsis or malignancy, was more far more prevalent than CV death in Asian AF patients. An improved integrated care approach is needed to reduce the prevalence of non-CV death in Asian AF patients.
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