PDF(Pubmed)
Abstract：
In a recent position paper, the European Heart Rhythm Association (EHRA) proposed an algorithm for the screening and management of arrhythmias using digital devices. In patients with prior stroke, a systematic screening approach for atrial fibrillation (AF) should always be implemented, preferably immediately after the event. Patients with increasing age and with specific cardiovascular or non-cardiovascular comorbidities are also deemed to be at higher risk. From a large nationwide database, the aim was to analyse AF incidence rates derived from this new EHRA algorithm.
Using the French administrative hospital discharge database, all patients hospitalized in 2012 without a history of AF, and with at least a 5-year follow-up (FU) (or if they died earlier), were included. The yearly incidence of AF was calculated in each subgroup defined by the algorithm proposed by EHRA based on a history of previous stroke, increasing age, and eight comorbidities identified via International Classification of Diseases 10th Revision codes. Out of the 4526 104 patients included (mean age 58.9 ± 18.9 years, 64.5% women), 1% had a history of stroke. Among those with no history of stroke, 18% were aged 65-74 years and 21% were ≥75 years. During FU, 327 012 patients had an incidence of AF (yearly incidence 1.86% in the overall population). Implementation of the EHRA algorithm divided the population into six risk groups: patients with a history of stroke (group 1); patients > 75 years (group 2); patients aged 65-74 years with or without comorbidity (groups 3a and 3b); and patients < 65 years with or without comorbidity (groups 4a and 4b). The yearly incidences of AF were 4.58% per year (group 2), 6.21% per year (group 2), 3.50% per year (group 3a), 2.01% per year (group 3b), 1.23% per year (group 4a), and 0.35% per year (group 4b). In patients aged < 65 years, the annual incidence of AF increased progressively according to the number of comorbidities from 0.35% (no comorbidities) to 9.08% (eight comorbidities). For those aged 65-75 years, the same trend was observed, i.e. increasing from 2.01% (no comorbidities) to 11.47% (eight comorbidities).
These findings at a nationwide scale confirm the relevance of the subgroups in the EHRA algorithm for identifying a higher risk of AF incidence, showing that older patients (>75 years, regardless of comorbidities) have a higher incidence of AF than those with prior ischaemic stroke. Further studies are needed to evaluate the usefulness of algorithm-based risk stratification strategies for AF screening and the impact of screening on major cardiovascular event rates.
Using the French administrative hospital discharge database, all patients hospitalized in 2012 without a history of AF, and with at least a 5-year follow-up (FU) (or if they died earlier), were included. The yearly incidence of AF was calculated in each subgroup defined by the algorithm proposed by EHRA based on a history of previous stroke, increasing age, and eight comorbidities identified via International Classification of Diseases 10th Revision codes. Out of the 4526 104 patients included (mean age 58.9 ± 18.9 years, 64.5% women), 1% had a history of stroke. Among those with no history of stroke, 18% were aged 65-74 years and 21% were ≥75 years. During FU, 327 012 patients had an incidence of AF (yearly incidence 1.86% in the overall population). Implementation of the EHRA algorithm divided the population into six risk groups: patients with a history of stroke (group 1); patients > 75 years (group 2); patients aged 65-74 years with or without comorbidity (groups 3a and 3b); and patients < 65 years with or without comorbidity (groups 4a and 4b). The yearly incidences of AF were 4.58% per year (group 2), 6.21% per year (group 2), 3.50% per year (group 3a), 2.01% per year (group 3b), 1.23% per year (group 4a), and 0.35% per year (group 4b). In patients aged < 65 years, the annual incidence of AF increased progressively according to the number of comorbidities from 0.35% (no comorbidities) to 9.08% (eight comorbidities). For those aged 65-75 years, the same trend was observed, i.e. increasing from 2.01% (no comorbidities) to 11.47% (eight comorbidities).
These findings at a nationwide scale confirm the relevance of the subgroups in the EHRA algorithm for identifying a higher risk of AF incidence, showing that older patients (>75 years, regardless of comorbidities) have a higher incidence of AF than those with prior ischaemic stroke. Further studies are needed to evaluate the usefulness of algorithm-based risk stratification strategies for AF screening and the impact of screening on major cardiovascular event rates.
摘要：
目标：在最近的立场文件中，欧洲心律协会(EHRA)提出了一种使用数字设备筛查和管理心律失常的算法.在先前中风的患者中，应始终实施系统的房颤筛查方法，最好是在事件发生后立即。年龄增长且具有特定心血管或非心血管合并症的患者也被认为处于较高风险。从一个全国性的大型数据库中，目的是分析从这种新的EHRA算法得出的AF发生率.
结果：使用法国行政医院出院数据库，2012年所有住院患者无房颤史,并且至少有5年的随访（FU）（或者如果他们更早死亡），包括在内。根据EHRA提出的算法，根据既往卒中病史，计算每个亚组的房颤年发生率。年龄越来越大,以及通过国际疾病分类第10次修订代码确定的八种合并症。在4526名患者中，包括104名患者（平均年龄58.9±18.9岁，64.5％的妇女），1%有中风史。在没有中风史的人中，18％的年龄为65-74岁，21％的年龄≥75岁。FU期间,327012例患者发生房颤（总人群年发病率为1.86%）。实施EHRA算法将人群分为六个风险组：有中风史的患者（第1组）；>75岁的患者（第2组）；65-74岁有或没有合并症的患者（第3a和3b组）；<65岁有或没有合并症的患者（第4a和4b组）。房颤的年发病率为每年4.58%(第2组),每年6.21%（第2组），每年3.50%(第3a组)，每年2.01%(第3b组)，每年1.23%(4a组)，和每年0.35%(第4b组)。在年龄<65岁的患者中，根据合并症的数量，房颤的年发病率从0.35%(无合并症)逐渐增加到9.08%(8种合并症)。对于65-75岁的人来说，观察到相同的趋势，即从2.01%(无合并症)增加到11.47%(八种合并症)。
结论：这些在全国范围内的发现证实了EHRA算法中的亚组对于确定房颤发生率较高风险的相关性。显示老年患者(>75岁，无论合并症如何），房颤的发生率均高于既往有缺血性卒中的患者。需要进一步的研究来评估基于算法的风险分层策略对房颤筛查的有用性以及筛查对主要心血管事件发生率的影响。
结果：使用法国行政医院出院数据库，2012年所有住院患者无房颤史,并且至少有5年的随访（FU）（或者如果他们更早死亡），包括在内。根据EHRA提出的算法，根据既往卒中病史，计算每个亚组的房颤年发生率。年龄越来越大,以及通过国际疾病分类第10次修订代码确定的八种合并症。在4526名患者中，包括104名患者（平均年龄58.9±18.9岁，64.5％的妇女），1%有中风史。在没有中风史的人中，18％的年龄为65-74岁，21％的年龄≥75岁。FU期间,327012例患者发生房颤（总人群年发病率为1.86%）。实施EHRA算法将人群分为六个风险组：有中风史的患者（第1组）；>75岁的患者（第2组）；65-74岁有或没有合并症的患者（第3a和3b组）；<65岁有或没有合并症的患者（第4a和4b组）。房颤的年发病率为每年4.58%(第2组),每年6.21%（第2组），每年3.50%(第3a组)，每年2.01%(第3b组)，每年1.23%(4a组)，和每年0.35%(第4b组)。在年龄<65岁的患者中，根据合并症的数量，房颤的年发病率从0.35%(无合并症)逐渐增加到9.08%(8种合并症)。对于65-75岁的人来说，观察到相同的趋势，即从2.01%(无合并症)增加到11.47%(八种合并症)。
结论：这些在全国范围内的发现证实了EHRA算法中的亚组对于确定房颤发生率较高风险的相关性。显示老年患者(>75岁，无论合并症如何），房颤的发生率均高于既往有缺血性卒中的患者。需要进一步的研究来评估基于算法的风险分层策略对房颤筛查的有用性以及筛查对主要心血管事件发生率的影响。
