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45年来房颤相关死亡风险不存在时间趋势
作者:小柯机器人 发布时间:2020/8/13 14:48:26

美国波士顿大学公共卫生学院Ludovic Trinquart团队分析了45年来房颤相关超额死亡率的趋势。2020年8月11日,该研究发表在《英国医学杂志》上。

为了评估新诊断的房颤与死亡相关的时间趋势,研究组在美国马萨诸塞州弗雷明翰市进行了一项基于社区的队列研究,分别于1972-1985年、1986-2000年和2001-2015年设计了3个阶段的心脏研究队列。

研究组招募无房颤的参与者,每个时间段的年龄均在45-95岁之间,且在该时间段内均新诊断为房颤。主要结局为全因死亡率,并计算房颤时间变化趋势与全因死亡之间的风险比。

第1阶段共招募了5671名参与者,第2阶段招募了6177名,第3阶段招募了6174名。在第1阶段,房颤参与者的全因死亡率与无房颤者相比,校正后的风险比为1.9,第2阶段为1.4,第3阶段为1.7,P趋势为0.70。诊断为房颤后十年,房颤参与者与相匹配的对照组相比,平均生存时间缩短了31%,其中第1阶段平均缩短了2.9年,第2阶段缩短了2.1年,第3阶段缩短了2.0年,P趋势为0.03。

总之,没有证据表明房颤与全因死亡的风险比有时间趋势。房颤确诊10年后缩短的平均生命年数已显著改善,但与未发生房颤的参与者相比仍存在两年的差距。

附:英文原文

Title: Trends in excess mortality associated with atrial fibrillation over 45 years (Framingham Heart Study): community based cohort study

Author: Nicklas Vinter, Qiuxi Huang, Morten Fenger-Grn, Lars Frost, Emelia J Benjamin, Ludovic Trinquart

Issue&Volume: 2020/08/11

Abstract: Objective To assess temporal trends in the association between newly diagnosed atrial fibrillation and death.

Design Community based cohort study.

Setting Framingham Heart Study cohort, in 1972-85, 1986-2000, and 2001-15 (periods 1-3, respectively), in Framingham, MA, USA.

Participants Participants with no atrial fibrillation, aged 45-95 in each time period, and identified with newly diagnosed atrial fibrillation (or atrial flutter) during each time period.

Main outcome measures The main outcome was all cause mortality. Hazard ratios for the association between time varying atrial fibrillation and all cause mortality were calculated with adjustment for time varying confounding factors. The difference in restricted mean survival times, adjusted for confounders, between participants with atrial fibrillation and matched referents at 10 years after a diagnosis of atrial fibrillation was estimated. Meta-regression was used to test for linear trends in hazard ratios and restricted mean survival times over the different time periods.

Results 5671 participants were selected in time period 1, 6177 in period 2, and 6174 in period 3. Adjusted hazard ratios for all cause mortality between participants with and without atrial fibrillation were 1.9 (95% confidence interval 1.7 to 2.2) in time period 1, 1.4 (1.3 to 1.6) in period 2, and 1.7 (1.5 to 2.0) in period 3 (Ptrend=0.70). Ten years after diagnosis of atrial fibrillation, the adjusted difference in restricted mean survival times between participants with atrial fibrillation and matched referents decreased by 31%, from 2.9 years (95% confidence interval 3.2 to 2.5) in period 1, to 2.1 years (2.4 to 1.8) in period 2, to 2.0 years (2.3 to 1.7) in period 3 (Ptrend=0.03).

Conclusions No evidence of a temporal trend in hazard ratios for the association between atrial fibrillation and all cause mortality was found. The mean number of life years lost to atrial fibrillation at 10 years had improved significantly, but a two year gap compared with individuals without atrial fibrillation still remained.

DOI: 10.1136/bmj.m2724

Source: https://www.bmj.com/content/370/bmj.m2724

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj