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Relation of Frailty to Outcomes After Catheter Ablation of Atrial Fibrillation.

心房颤动导管消融后虚弱与预后的关系。

  • 影响因子:2.86
  • DOI:10.1016/j.amjcard.2020.01.049
  • 作者列表:"Kundi H","Noseworthy PA","Valsdottir LR","Shen C","Yao X","Yeh RW","Kramer DB
  • 发表时间:2020-05-01
Abstract

:Catheter ablation for atrial fibrillation (AF) improves outcomes compared with medical treatment alone. Risk stratification for outcomes following AF ablation remains an important area of uncertainty. This analysis evaluated the association between frailty and outcomes following AF ablation. We evaluated US inpatients receiving AF ablation between January 1, 2016 and December 1, 2016 using Medicare fee-for-service billing codes. Diagnosis codes were used to calculate patients' Hospital Frailty Risk Score, with the cohort divided according to established cut-points of low (<5), intermediate (5 to 15), and high (>15) risk for frailty. The primary outcome was survival. Among 5,070 in patients treated with catheter ablation (mean age 74.9 ± 6.8 years, 51.1% female), 38.6% were defined as frail with a Hospital Frailty Risk Score >5, including 8.3% at high risk. Mortality rates (up to 630 days) were 5.8% in the low-risk group, 23.4% in the intermediate-risk group, and 42.2% in the high-risk group (log-rank p values <0.001 for comparison between categories). In restricted cubic spline regression analysis, the adjusted hazard ratios for long-term mortality monotonically increased with increasing values of the Hospital Frailty Risk Score (adjusted hazard ratio 1.065, 95% confidence interval 1.054 to 1.077). In secondary end points, frailty was independently associated with length of stay, postprocedure 30-day mortality, 30-day readmission and postdischarge 30-day mortality rates. In conclusion, frailty as assessed by a claims-based score is common in inpatient recipients of AF ablation, and provides risk stratification for mortality and other key clinical outcomes.

摘要

: 导管消融治疗心房颤动 (AF) 与单独药物治疗相比改善预后。房颤消融术后结局的风险分层仍然是一个重要的不确定性领域。该分析评估了虚弱与AF消融后结果之间的相关性。我们使用Medicare收费服务账单代码评估了2016年1月1日至20 16年12月1日期间接受AF消融的美国住院患者。诊断代码用于计算患者的医院虚弱风险评分,队列根据确定的虚弱风险的低 (<5) 、中 (5至15) 和高 (>15) 切点进行划分。主要结局是生存。在接受导管消融治疗的5,070例患者 (平均年龄74.9 ± 6.8岁,51.1% 为女性) 中,38.6% 被定义为医院虚弱风险评分> 5的虚弱者,包括8.3% 的高风险者。低危组的死亡率 (高达630天) 为5.8%,中危组为23.4%,高危组为42.2% (类别间比较的对数秩p值 <0.001).在限制性三次样条回归分析中,调整后的长期死亡率风险比随着医院虚弱风险评分值的增加而单调增加 (调整后的风险比为1.065,95% 置信区间为1.054 ~ 1.077).在次要终点中,虚弱与住院时间、术后30天死亡率、30天再入院和出院后30天死亡率独立相关。总之,通过基于索赔的评分评估的虚弱在房颤消融的住院患者中很常见,并为死亡率和其他关键临床结局提供了风险分层.

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心律失常方向

心律失常(arrhythmia)是由于窦房结激动异常或激动产生于窦房结以外,激动的传导缓慢、阻滞或经异常通道传导,即心脏活动的起源和(或)传导障碍导致心脏搏动的频率和(或)节律异常。心律失常是心血管疾病中重要的一组疾病,可单独发病,亦可与其他心血管病伴发。其预后与心律失常的病因、诱因、演变趋势、是否导致严重血流动力障碍有关,可突然发作而致猝死,亦可持续累及心脏而致其衰竭。

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