Prediction of Congestive Heart Failure in Patients with Non Valvular Atrial Fibrillation
Prediction of Congestive Heart Failure in Patients with Non Valvular Atrial Fibrillation
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DOI：
10.2169/internalmedicine.53.0962
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发表时间：
2014-01-01
影响因子：
1.2
通讯作者：
Yoshida, Kiyoshi
中科院分区：
文献类型：
--
作者：
Imai, Koichiro;Okura, Hiroyuki;Yoshida, Kiyoshi
目的 房颤 (AF) 患者发生充血性心力衰竭 (CHF) 和缺血性中风的风险增加。本研究的目的是探讨非瓣膜性房颤 (NVAF) 患者发生 CHF 的临床预测因素。方法 对 2004 年至 2005 年间 347 例 NVAF 患者（衍生队列）进行回顾性评估。使用 Cox 比例风险分析测试潜在危险因素与 CHF 之间的关联，并创建预测 CHF 的风险评分。然后，该模型在 2008 年至 2010 年间招募的 161 名患者（验证队列）中进行了验证。在随访期间，衍生队列中的 41 名患者因纽约心脏协会 (NYHA) III 级或 IV 级疾病而发展为需要住院治疗的 CHF。确定了四个独立的危险因素，每个因素都被分配如下分数：年龄> = 72岁（1分），心率> = 80 bpm（1分），高血压（1分）和既往充血性心力衰竭病史（2分）。根据计算的风险评分（ARC(2)H评分）将患者分为三个风险类别之一：低风险（0分）、中风险（1-3分）和高风险（4-5分）。结果在推导队列中，这些风险类别的CHF年发生率分别为0%、2.5%和18%。在验证队列中，相应的发生率分别为每年 0.8%、8% 和 35%。 结论 开发了一种简单的临床风险评分 ARC(2)H 评分来预测 NVAF 患者的 CHF，并在独立队列中进行了验证。
Objective Patients with atrial fibrillation (AF) have an increased risk of congestive heart failure (CHF) as well as ischemic stroke. The aim of this study was to investigate the clinical predictors of CHF in patients with non-valvular AF (NVAF).Methods Three hundred and forty-seven patients (derivation cohort) with NVAF were retrospectively evaluated between 2004 and 2005. The associations between potential risk factors and CHF were tested using a Cox proportional hazards analysis, and a risk score for predicting CHF was created. The model was then validated in 161 patients (validation cohort) enrolled between 2008 and 2010. During the follow-up period, 41 patients in the derivation cohort developed CHF requiring hospitalization due to New York Heart Association (NYHA) class III or IV disease. Four independent risk factors were identified, each of which was assigned a number of points as follows: Age >= 72 years (1 point), heart rate >= 80 bpm (1 point), hypertension (1 point), and a previous history of congestive heart failure (2 points). The patients were grouped into one of three risk categories according to the calculated risk score (ARC(2)H score): low risk (0 points), intermediate risk (1-3 points) and high risk (4-5 points).Result In the derivation cohort, the annual rates of CHF in these risk categories were 0%, 2.5% and 18% per year respectively. In the validation cohort, the corresponding rates were 0.8%, 8% and 35% per year respectively.Conclusion A simple clinical risk score, the ARC(2)H score, was developed to predict CHF in patients with NVAF and validated in an independent cohort.