Page 29 - 2023-05-中国全科医学

·542· http: //www.chinagp.net E-mail: zgqkyx@chinagp.net.cn February 2023, Vol.26 No.5

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Corresponding author: XIAO Hua，Chief Physician；E-mail：xiaoheart1974@163.com
【Abstract】 Background Atrial fibrillation（AF） is a common clinical tachyarrhythmia with high prevalence，
and a predisposing factor of stroke. In addition，it has a causal relationship with heart failure（HF）. Treatment options for
AF have changed recently owing to the emergence of new drugs. Many investigations are focused on anticoagulant therapies for
AF，but relevant multicenter investigations on AF and HF are rare. Objective To investigate the clinical characteristics and
treatment of patients with AF combined with HF in Chongqing，China. Methods A total of 4 011 patients with AF and HF
who were discharged from 21 hospitals in Chongqing in 2018 were included. Data were collected through the electronic medical
record system of the hospitals，including sex，age，basic comorbid conditions，type of AF，NYHA class，thromboembolism
history，bleeding history，Color Doppler echocardiography results，HF type and use of drugs（including antithrombotic drugs，
rhythm/ventricular rate-control drugs，ACEIs/ARBs，cardiotonic drugs）. The risk of thromboembolism and bleeding were
assessed using admission CHA 2 DS 2 -VASc score and HAS-BLED score. Sex，basic comorbid conditions，AF type，NYHA
class，admission CHA 2 DS 2 -VASc score and HAS-BLED score，left atrial diameter，left ventricular end-diastolic diameter，
left ventricular ejection fraction，endpoint events（thromboembolism and bleeding），HF type，and treatment options were
compared across three age groups（<65，65-75，>75） and across patients by the level of hospitalized hospital（secondary
and tertiary）. Results In terms of clinical characteristics，the patients had an average age of（74.0±10.6）years，2 279
（56.8%） were female. The top three prevalent basic comorbid conditions were coronary heart disease （65.1%），hypertension
（51.0%），and diabetes（17.5%）. 3 346 （83.4%） patients with nonvalvular atrial fibrillation （NVAF）. NYHA class
was Ⅲ and Ⅳ in 3 059 patients （76.3%），thromboembolism events occurred in 531 patients （13.2%），and bleeding events
occurred in 176 patients （4.4%）. In Color Doppler echocardiography results，The average left atrial diameter was（44.12±9.21）
mm. The average left ventricular end-diastolic diameter was（48.45±10.06）mm. The average left ventricular ejection fraction
was（54.23±11.94）mm. The main type of HF was HF with preserved ejection fraction，accounting for 66.2%. The average
CHA 2 DS 2 -VASc score was （3.9±1.5） points，and the admission CHA 2 DS 2 -VASc score was positively correlated with age
（r=0.589，P<0.001）. The average HAS-BLED score was （1.7±1.0） points. 3 641 （90.8%） patients were at high risk
of thromboembolism and 723（18.0%） patients were at high risk of bleeding. In terms of antithrombotic treatment，the overall
prevalence of anticoagulation treatment was 47.1%，warfarin was the main anticoagulant（37.8%），the prevalence of use of the
new oral anticoagulant was only 9.3%. The overall prevalence of antiplatelet treatment was 44.6%，most of them were monoclonal
2
antiplatelet agents （13.2%）. The prevalence of anticoagulation treatment decreased with age（χ trend =136.502，P<0.001），
2
but that of antiplatelet treatment increased with age（χ trend =135.730，P<0.001）. The prevalence of anticoagulation treatment，
and use of warfarin and new oral anticoagulants in secondary hospitals was significantly lower than that in tertiary hospitals （P<0.001）.
A total of 3 162 （78.8%） patients with atrial fibrillation received ventricular rate control. The prevalence of use of beta-
blockers，digoxin and ACEIs/ARBs was 61.6%，17.6%，and 59.7%，respectively. Conclusion The majority of patients with
AF complicated with HF in Chongqing are elderly，and the proportion of women is relatively high. HFpEF is the main type of atrial
fibrillation，and the NYHA classification is mainly class Ⅲ and Ⅳ . Most were at high risk for thromboembolism，but less than 1/4
were at high risk of bleeding. The prevalence of antithrombotic treatmentin all ages and levels of hospitals was unsatisfactory，and
there was a large gap between current treatment and guideline recommendations in improving HF. In view of this，hospitalphysicians
should increase their awareness and capability of standardized diagnosis and treatmentregarding AF with HF.
【Key words】 Atrial fibrillation；Heart failure；Clinical characteristics；Treatment status；Chongqing，Multicenter
study；Cross-sectional studies

心房颤动作为临床上常见的心律失常，其患病率 性心脏病等。心房颤动会加重心力衰竭症状并使心力衰
及发病率不断上升。目前亚洲人群心房颤动患病率为 竭患病率增加 3 倍，除此之外，严重心力衰竭也会使心
0.2%~7.9%，西方人群心房颤动患病率为 0.5%~7.5% ［1］ 。 房颤动患者心室率增快 ［3］ 。另一方面，心房颤动是脑
年龄是引起心房颤动的重要危险因素，每增长 10 岁心 卒中的独立危险因素，其会使脑卒中风险增加 5 倍，导
房颤动发病率会增加 1 倍 ［2］ 。随着人口老龄化加剧， 致心房颤动合并心力衰竭患者预后不佳或因反复住院进
全球心房颤动带来的经济、家庭负担将进一步加重。心 一步加重经济负担 ［4］ 。抗凝治疗是预防心房颤动相关
房颤动患者常合并心力衰竭，且两种疾病发病率在全球 性脑卒中的关键策略，近年来各地区调查研究显示，综
范围内均逐渐升高。心房颤动和心力衰竭互为因果并有 合医院心房颤动患者抗凝情况有所改善，但总体抗凝比
相同的危险因素，如年龄增加、高血压、糖尿病和器质 例仍不高，尤其是高龄人群 ［5］ ；同时合并心力衰竭者