不同心房颤动筛查方式在社区老年人中的效果研究

doi:10.12114/j.issn.1007-9572.2023.0723

摘要/Abstract

摘要： 背景老年人是心房颤动（简称房颤）的高危人群，提高社区老年人群房颤的筛查效率有助于降低房颤相关脑卒中的发生风险。目的比较不同的房颤筛查方式在老年人群中的筛查效率。方法于2022年7月—2023年1月选取上海市浦东新区金杨社区香山、黄山、罗山3个居委会的老年人1 300例，先后使用触诊桡动脉脉搏、具有房颤检测功能的电子血压计、单导联心电记录仪进行房颤筛查，三者任一项阳性即为房颤阳性，最后由心电图室医生进行心电图检查并判读（诊断金标准）。绘制不同筛查方法的受试者工作特征（ROC）曲线，计算ROC曲线下面积（AUC），并评估其筛查价值；采用趋势性χ2检验分析房颤卒中评分（CHA2DS2-VASc评分）与房颤之间的相关性。结果 1 300人中共检出房颤93人，其中无症状者57人；触诊脉搏阳性375人，具有房颤检测功能的电子血压计阳性331人，单导联心电记录仪检测阳性128人。触诊脉搏、具有房颤检测功能的电子血压计、单导联心电记录仪诊断社区老年人房颤价值的AUC分别为0.750（95%CI=0.697~0.803，P<0.01）、0.832（95%CI=0.790~0.874，P<0.01）、0.939（95%CI=0.906~0.973，P<0.01）。随着CHA2DS2-VASc评分增加，老年人房颤发生率逐渐增多（χ2趋势=197.46，P<0.01）。结论运用便携式单导联心电仪筛查房颤便捷、高效、准确，可推广用于社区老年人房颤的筛查。

关键词: 心房颤动, 老年人, 社区, 触诊, 血压计, 心电记录仪, CHA₂DS₂-VASc评分, 筛查

Abstract:

Background

Older adults are at high risk for atrial fibrillation (AF). Improving the efficiency of AF screening among the community-based elderly population can help to reduce the risk of AF-related stroke.

Objective

To compare the screening efficiency of different AF screening methods in the elderly population.

Methods

A total of 1 300 cases of older adults were selected from three neighborhood committees of Xiangshan, Huangshan, and Luoshan in Jinyang Community, Pudong New Area, Shanghai from July 2022 to January 2023. AF screening was detected using palpation of radial artery pulse, electronic sphygmomanometer with AF detection function, and single-lead ECG recorder. A positive result of any one of the three methods was considered positive for AF, and finally an electrocardiogram (ECG) was performed and interpreted by a physician in the ECG room. The receiver operating characteristic (ROC) curves of the subjects with different screening methods were plotted, the area under the ROC curve (AUC) was calculated to evaluate the screening value; the association between AF stroke score (CHA₂DS₂-VASc score) and AF was analyzed using the chi-square test for trend.

Results

AF was detected in 93 of the 1 300 people, including 57 asymptomatic people; 375 people had a positive palpated pulse, 331 people had a positive electronic blood pressure monitor with AF detection function, and 128 people had a positive result of single-lead ECG recorder. The AUCs for the diagnostic value of palpation pulse, electronic sphygmomanometer with AF detection function and single-lead ECG recorder in the elderly was 0.750 (95%CI=0.697-0.803, P<0.01), 0.832 (95%CI=0.790-0.874, P<0.01), 0.939 (95%CI=0.906-0.973, P<0.01) ; the incidence of AF in the elderly gradually increased as the CHA₂DS₂-VASc score increased (χ²_trend=197.46, P<0.01) .

Conclusion

Screening for AF using single-lead ECG recorder is convenient, efficient and accurate, and can be promoted in AF screening among community-based elderly population.

Key words: Atrial fibrillation, Aged, Community, Palpation, Sphygmomanometers, Electrocardiogram, CHA₂DS₂-VASc score, Screening

石玉霜,王惠华,李艳,等. 不同心房颤动筛查方式在社区老年人中的效果研究[J]. 中国全科医学, 2024, 27(11): 1316-1319. DOI: 10.12114/j.issn.1007-9572.2023.0723.
SHI Yushuang,WANG Huihua,LI Yan, et al. Analysis of the Effectiveness of Different Atrial Fibrillation Screening Methods in the Community-based Elderly Population[J]. Chinese General Practice, 2024, 27(11): 1316-1319. DOI: 10.12114/j.issn.1007-9572.2023.0723.

图/表 2

图1 3种筛查方法诊断老年人房颤的ROC曲线

Figure 1 ROC curve of the diagnostic value of the 3 screening methods for AF in the elderly population

表1 3种房颤筛查方法对老年人房颤的诊断价值

Table 1 The diagnostic value of 3 screening methods for AF in the elderly population

方式	AUC	95%CI	标准误	P值	约登指数	灵敏度	特异度
脉搏触诊	0.750	0.697~0.803	0.027	0.001	0.499	0.752	0.747
具有房颤检测功能的电子血压计	0.832	0.790~0.874	0.021	0.001	0.664	0.871	0.793
单导联心电记录仪	0.939	0.906~0.973	0.017	0.001	0.879	0.914	0.964

参考文献 18

[1]	杨震，李晶，贾绍斌.不明原因脑卒中患者心房颤动的筛查[J]心血管病学进展，2016，37（1）：69-74. DOI：10.16806/j.cnki.issn.1004-3934.2016.01.018.
[2]	SIU C W，LIP G Y，LAM K F，et al. Risk of stroke and intracranial hemorrhage in 9727 Chinese with atrial fibrillation in Hong Kong[J]. Heart Rhythm 2014，11（8）：1401-1408. DOI：10.1016/j.hrthm.2014.04.021.
[3]	HERMANS A N L，GAWALKO M，DOHMEN L，et al. Mobile health solutions for atrial fibrillation detection and management：a systematic review[J]. Clin Res Cardiol，2022，111（5）：479-491. DOI：10.1007/s00392-021-01941-9.
[4]	GUO Y T，WANG H，ZHANG H，et al. Mobile photoplethysmographic technology to detect atrial fibrillation[J]. J Am Coll Cardiol，2019，74（19）：2365-2375. DOI：10.1016/j.jacc.2019.08.019.
[5]	陈婉岚，黄嘉慧，施盈，等. 智能手表心电图应用于检测不同心室率患者心房颤动发作的诊断性能研究[J]. 中华心律失常学杂志，2022，26（3）：277-282. DOI：10.3760/cma.j.cn113859-20220411-00068.
[6]	余超，周伟，王涛，等. 可穿戴设备支持心房颤动人群筛查与管理研究进展[J]. 中国全科医学，2023，26（1）：113-117. DOI：10.12114/j.issn.1007-9572.2022.0449.
[7]	MASON P K，LAKE D E，DIMARCO J P，et al. Impact of the CHA2DS2-VASc score on anticoagulation recommendations for atrial fibrillation[J]. Am J Med，2012，125（6）：603.e1-603.e6. DOI：10.1016/j.amjmed.2011.09.030.
[8]	GIBBS H，FREEDMAN B，ROSENQVIST M，et al. Clinical outcomes in asymptomatic and symptomatic atrial fibrillation presentations in GARFIELD-AF：implications for AF screening[J]. Am J Med，2021，134（7）：893-901.e11. DOI：10.1016/j.amjmed.2021.01.017.
[9]	SGRECCIA D，MANICARDI M，MALAVASI V L，et al. Comparing outcomes in asymptomatic and symptomatic atrial fibrillation：a systematic review and meta-analysis of 81，462 patients[J]. J Clin Med，2021，10（17）：3979. DOI：10.3390/jcm10173979.
[10]	ARONSSON M，SVENNBERG E，ROSENQVIST M，et al. Cost-effectiveness of mass screening for untreated atrial fibrillation using intermittent ECG recording[J]. Europace，2015，17（7）：1023-1029. DOI：10.1093/europace/euv083.
[11]	KIRCHHOF P，BENUSSI S，KOTECHA D，et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS[J]. Eur Heart J，2016，37（38）：2893-2962. DOI：10.1093/eurheartj/ehw210.
[12]	HINDRICKS G，POTPARA T，DAGRES N，et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery（EACTS）：the Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology（ESC） Developed with the special contribution of the European Heart Rhythm Association（EHRA） of the ESC[J]. Eur Heart J，2021，42（5）：373-498. DOI：10.1093/eurheartj/ehaa612.
[13]	PÉRULA-DE TORRES L A，LUQUE-MONTILLA R，et al. Validation of taking arterial pulse in Primary Care for the detection of atrial fibrillation and other cardiac rhythm disorders in patients over 65 years old[J]. Semergen，2017，43（6）：425-436. DOI：10.1016/j.semerg.2016.06.015.
[14]	ORCHARD J，LI J L，FREEDMAN B，et al. Atrial fibrillation screen，management，and guideline-recommended therapy in the rural primary care setting：a cross-sectional study and cost-effectiveness analysis of eHealth tools to support all stages of screening[J]. J Am Heart Assoc，2020，9（18）：e017080. DOI：10.1161/JAHA.120.017080.
[15]	LEE R，MITTAL S. Utility and limitations of long-term monitoring of atrial fibrillation using an implantable loop recorder[J]. Heart Rhythm，2018，15（2）：287-295. DOI：10.1016/j.hrthm.2017.09.009.
[16]	LEE C T，STRAUSS D M，STONE L E，et al. Preoperative CHA2DS2-VASc score predicts postoperative atrial fibrillation after lobectomy[J]. Thorac Cardiovasc Surg，2019，67（2）：125-130. DOI：10.1055/s-0038-1675638.
[17]	WOJSZEL Z B，KASIUKIEWICZ A，SWIETEK M，et al. CHA2DS2-VASc score can guide the screening of atrial fibrillation - cross-sectional study in a geriatric ward[J]. Clin Interv Aging，2019，14：879-887. DOI：10.2147/CIA.S206976.
[18]	杨红，刘俊，冯志刚，等. CHA2DS2-VASc评分法筛查社区老年人群心房颤动与缺血性卒中患病情况的价值研究[J]. 中国全科医学，2021，24（18）：2281-2284，2290. DOI：10.12114/j.issn.1007-9572.2021.00.501.