中國心房顫動流行病學(xué)現(xiàn)實(shí)與問題

1、中國心房顫動流行病學(xué)現(xiàn)實(shí)與問題中國心房顫動流行病學(xué)現(xiàn)實(shí)與問題心房顫動 (AF)最常見的心律失常 發(fā)病率隨年齡增長和器質(zhì)性心臟病的發(fā)展而增加卒中常見的病因之一 (占所有卒中10-15%)明顯增加心血管死亡和致殘即使經(jīng)過抗心律失常藥物治療，半數(shù)患者有復(fù)發(fā)傾向心房顫動 (AF)最常見的心律失常 34% Atrial Fibrillation6% PSVT6% PVCs4% Atrial Flutter9% SSS8% Conduction Disease3% SCD10% VTAF占心律失常出院診斷1/3Bialy D. J Am Coll Cardiol. 1992; 19: 41A.18% Un

2、specified34% Atrial Fibrillation6% PPercent of subject died in follow-upyearsAF 死亡率Benjamin EJ, Circulation 1998; 946-95210%30%50%01346527891070%Women, No AFMen, AFWomen, AFMen, No AFOdds Ratio for Deathmenwomen1.2-1.81.5-2.2Percent of subjectyearsAF 死亡率Dorian P et al. J Am Coll Cardiol. 2000; 36: 1

3、303-1309 .生活質(zhì)量Higher scores = better QQL02468GeneralhealthPhysicalfunctionSocial functionMentalhealthSF-36 score10*AFCADControls* P0.05, patients with AF compared to healthy controls P 35 歲連續(xù)采樣Hu D, et al. 2004 Chin J Intern Med; in press.方法中國心房顫動的流行病學(xué)調(diào)查中國自然人群Hu D, et al中國AF患病率 -年齡/性別分層Age Group, yR

4、ate per 10030-3940-4950-5960-69OverallMen (n=13358)Women (n=15521)0.30.20.50.61.41.13.62.67.57.470-79800.90.7Data collected from 13 natural populations from 14 different provinces across China Hu D, et al. 2004 Chin J Intern Med; in press. P0.050.77中國AF患病率 -年齡/性別分層Age Group, y不同國家患病率比較FHS: the Frami

5、ngham study. Wolf PA et al. Sroke 1991; 22: 983-988Australia: Lake FR, et al. Aust NZ Med 1989; 19: 321-326UK: Hill JD et al. J R Coll Gen Pract 1987; 37: 172-173%years不同國家患病率比較FHS: the Framingham sAF患病率：中國及其他地區(qū)5.5%5.4% 50 yrs, USA (CHS), single ECG 65 yrs, UK, single ECG 60 yrs, Netherlands, single

6、 ECG & medical record 50 yrs, UK, single ECG 55 yrs, Netherlands, single ECG 35 yrs, USA, medical record 50 yrs, UK, single ECG Review results 60 yrs, Australia, triennial survey 40 yrs, Japan, single ECG 60 yrs, Hong Kong, single ECG 35 yrs, main land, China, single ECG 35 yrs, Denmark, single ECG2

7、5 - 64 yrs, west German, single ECG 15 yrs, India, single ECG0.1%5.1%3.7%3.0%2.8%2.4%1.5%1.3%1.3%0.77%0.60%0.28%8 millionPatients with AF In ChinaAF患病率：中國及其他地區(qū)5.5%5.4% 50 yrs,陣發(fā)性/持續(xù)性AF的趨勢Hu D, et al. 2004 Chin J Intern Med; in press.陣發(fā)性/持續(xù)性AF的趨勢Hu D, et al. 2004 陣發(fā)性AF的轉(zhuǎn)歸64例17.9住院病人回顧分析 陣發(fā)性心房顫動 358例平

8、均5年后 64例（17.96%）變?yōu)槌掷m(xù)性房顫 2004 中國心臟起搏與心電生理雜志陣發(fā)性AF的轉(zhuǎn)歸64例17.9住院病人回顧分析 陣發(fā)性心中國AF卒中的患病率 %12.95%24.81%17.5%Hu D, 2004Qi W, 200305%10%15%20%25%Hu D, 2003Hu D, et al. 2004 Chin J Intern Med; in press. Random sample of populationQi W, et al. 2003 Chin J Cardiol; 31: 913-916. Case-control study. Hospitalized pa

9、tientsHu D, et al. 2003 Chin J Intern Med; 42: 157-161. Case-control study. Hospitalized patients中國AF卒中的患病率 %12.95%24.81%17.5%H0510Ma C, et al. Chin J cardiol 2002; 30: 165-16780AF患者卒中發(fā)生率：每年5.3% %Without risk factor With risk factorAge Range (years)1.01.63.15.14.08.87.77.9520 consecutive nonvalvular

10、 AF patients without taking warfarin were followed 6.754.03 years. Hypertension, diabetes and ischemic stroke history has a positive correlation with incidence of AF related stroke.0510Ma C, et al. Chin J cardio中國AF卒中危險(xiǎn)因素: 病例對照研究回顧性研究, 18家醫(yī)院，2年RVD: rheumatic valvular diseaseHU D, et al. Chin J Inter

11、n Med, 2003; 42: 157-161stroke82725984 511 例3 425 例Non-valvular disease1 086 例RVDstroke813273中國AF卒中危險(xiǎn)因素: 病例對照研究回顧性研究, 18家醫(yī)院AF住院患者一般情況Idiopathic AFRVDCHFCAD Advanced age040%50%60%30%20%10%58.1%56.3%Hypertensioncaidiomyopathy34.8%33.1%24.1%7.4%5.4%4.1%DiabetesCAD: coronary artery disease; CHF: congest

12、ive heart failure; RVD: rheumatic valve disease HU D, et al. Chin J Intern Med, 2003; 42: 157-161AF住院患者一般情況Idiopathic AFRVDCHFCNVAF患者卒中患病率：年齡分層years0510152025Prevalence (%)30404049606950-59707980HU D, et al. Chin J Intern Med, 2003; 42: 157-1614.99.715.221.028.932.1NVAF患者卒中患病率：年齡分層years051015202NVAF

13、卒中危險(xiǎn):病例對照研究HU D, et al. Chin J Intern Med, 2003; 42: 157-161%Lone AFPersistenceAFControl of heart rate75.22.397.7 P76 yrsHypertensionDiabetesLA thrombiSBP1.76 (1.08-2.89)1.52 (1.28-1.80)1.39 (1.11-1.76)1.71 (1.21-2.28)123452.77 (1.25-6.13)HU D, et al. Chin J Intern Med, 2003; 42: 157-161NVAF患者卒中危險(xiǎn)因素

14、AGE 76 yrsHyperte02468AFASAK58%7 81SPAF67%27 85BAATAF86%51 96 CAFA42%- 68 80SPINAF79%52 90TOTAL68%5079Risk reductionAF Investigators. Arch Intern Med 1994;154:1449-1457.Atwood et al. Herz 1993;18:27-38.Stroke Incidence (%)95% CI AF Investigators: Meta-analysisWarfarin for Stroke Preventionp 0.03p 0.

15、01p 0.2p 0.002p 0.001Controls Warfarin02468AFASAKSPAFBAATAF CAFASPIN老年人心房顫動 年齡是抗凝的禁忌嗎?老年人禁忌癥多出血并發(fā)癥多對華法林敏感嚴(yán)密監(jiān)測INR，年齡不是危險(xiǎn)因素Fihn SD, et al; Ann Int Med; 1996; 124: 970-979老年人心房顫動 年齡是抗凝的禁忌嗎?老年人禁忌癥多Fih抗栓治療明顯降低住院AF患者的卒中Number of Strokes PreventedQi W, et al. Chinese J Cardiol, 2003；31：913-91605%10%15%20%2

16、5%No TherapyAnticoagulation5.5%24.2%P0.001stroke rate抗栓治療明顯降低住院AF患者的卒中Number of Str華法林抗凝 433例（9.64）平均年齡 61.4812.44歲治療時(shí)間中位數(shù)為 7個(gè)月（1個(gè)月3年）平均劑量 2.770.83mg（1-6mg）Hu D, et al. 2004 Chin J Intern Med; 中國住院AF病人華法林抗凝治療華法林抗凝 433例（9.64）Hu D, et非瓣膜性心房顫動華法林年齡分層Hu D, et al. 2004 Chin J Intern Med; 非瓣膜性心房顫動華法林年齡分層H

17、u D, et al. 20華法林抗凝監(jiān)測INR分布情況中國住院AF病人INR監(jiān)測情況24Hu D, et al. 2004 Chin J Intern Med; 華法林抗凝監(jiān)測INR分布情況中國住院AF病人INR監(jiān)測情況2 華法林 阿司匹林 非抗栓1.4%6.33.3%P=0.001抗栓治療總出血發(fā)生率中國住院AF病人華法林抗凝的安全性Hu D, et al. 2004 Chin J Intern Med; 輕微出血（84%）嚴(yán)重出血（16%） 華法林 阿司匹林 非抗栓1.4%6.3出血事件 31例 嚴(yán)重出血 5例 腦出血 2例 嚴(yán)重上消化道出血 2例 硬膜下腔出血 1例輕微出血 26例 鼻

18、出血 6例 齒齦出血 6例 血尿 5例 皮膚粘膜瘀斑 5例 黑便 3例 球結(jié)膜出血 1例中國住院AF病人華法林抗凝的安全性出血事件 31例 p=0.25965 62OR=3.73 (p=0.001)華法林抗凝并發(fā)出血的危險(xiǎn)因素中國住院AF病人華法林抗凝的安全性p=0.25965 62OR=3.73 華法林抗凝56% Rhythm control20% Rate control24% NO therapyAmiodarone 31.0%Cedilanid 29.6%-Blocker 18.3%Propafenone 14.3%陣發(fā)性AF住院患者 治療現(xiàn)狀Qi W, et al. Chinese J Cardiol, 2003；31：913-91656% Rhythm control20% Rate coRate Control 83%Rhythm Control 14% No treatment3%AmiodaroneDigoxin-BlockerCCB持續(xù)性AF住院患者 治療現(xiàn)狀Qi W, et al. Chinese J Cardiol, 2003；31：913-916Rate Control 83%Rhythm Control2% Warfarin60% NoneAspirin38%AF患者抗栓治療現(xiàn)狀：人群