中国心房颤动流行病学现实与问题

1、中国心房颤动流行病学现实与问题中国心房颤动流行病学现实与问题心房颤动 (AF)最常见的心律失常 发病率随年龄增长和器质性心脏病的发展而增加卒中常见的病因之一 (占所有卒中10-15%)明显增加心血管死亡和致残即使经过抗心律失常药物治疗，半数患者有复发倾向心房颤动 (AF)最常见的心律失常 34% Atrial Fibrillation6% PSVT6% PVCs4% Atrial Flutter9% SSS8% Conduction Disease3% SCD10% VTAF占心律失常出院诊断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 .生活质量Higher scores = better QQL02468GeneralhealthPhysicalfunctionSocial functionMentalhealthSF-36 score10*AFCADControls* P0.05, patients with AF compared to healthy controls P 35 岁连续采样Hu D, et al. 2004 Chin J Intern Med; in press.方法中国心房颤动的流行病学调查中国自然人群Hu D, et al中国AF患病率 -年龄/性别分层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中国AF患病率 -年龄/性别分层Age Group, y不同国家患病率比较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不同国家患病率比较FHS: the Framingham sAF患病率：中国及其他地区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：中国及其他地区5.5%5.4% 50 yrs,阵发性/持续性AF的趋势Hu D, et al. 2004 Chin J Intern Med; in press.阵发性/持续性AF的趋势Hu D, et al. 2004 阵发性AF的转归64例17.9住院病人回顾分析 阵发性心房颤动 358例平

8、均5年后 64例（17.96%）变为持续性房颤 2004 中国心脏起搏与心电生理杂志阵发性AF的转归64例17.9住院病人回顾分析 阵发性心中国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中国AF卒中的患病率 %12.95%24.81%17.5%H0510Ma C, et al. Chin J cardiol 2002; 30: 165-16780AF患者卒中发生率：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中国AF卒中危险因素: 病例对照研究回顾性研究, 18家医院，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中国AF卒中危险因素: 病例对照研究回顾性研究, 18家医院AF住院患者一般情况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住院患者一般情况Idiopathic AFRVDCHFCNVAF患者卒中患病率：年龄分层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：年龄分层years051015202NVAF

13、卒中危险:病例对照研究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患者卒中危险因素

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老年人心房颤动 年龄是抗凝的禁忌吗?老年人禁忌症多出血并发症多对华法林敏感严密监测INR，年龄不是危险因素Fihn SD, et al; Ann Int Med; 1996; 124: 970-979老年人心房颤动 年龄是抗凝的禁忌吗?老年人禁忌症多Fih抗栓治疗明显降低住院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抗栓治疗明显降低住院AF患者的卒中Number of Str华法林抗凝 433例（9.64）平均年龄 61.4812.44岁治疗时间中位数为 7个月（1个月3年）平均剂量 2.770.83mg（1-6mg）Hu D, et al. 2004 Chin J Intern Med; 中国住院AF病人华法林抗凝治疗华法林抗凝 433例（9.64）Hu D, et非瓣膜性心房颤动华法林年龄分层Hu D, et al. 2004 Chin J Intern Med; 非瓣膜性心房颤动华法林年龄分层H

17、u D, et al. 20华法林抗凝监测INR分布情况中国住院AF病人INR监测情况24Hu D, et al. 2004 Chin J Intern Med; 华法林抗凝监测INR分布情况中国住院AF病人INR监测情况2 华法林 阿司匹林 非抗栓1.4%6.33.3%P=0.001抗栓治疗总出血发生率中国住院AF病人华法林抗凝的安全性Hu D, et al. 2004 Chin J Intern Med; 轻微出血（84%）严重出血（16%） 华法林 阿司匹林 非抗栓1.4%6.3出血事件 31例 严重出血 5例 脑出血 2例 严重上消化道出血 2例 硬膜下腔出血 1例轻微出血 26例 鼻

18、出血 6例 齿龈出血 6例 血尿 5例 皮肤粘膜瘀斑 5例 黑便 3例 球结膜出血 1例中国住院AF病人华法林抗凝的安全性出血事件 31例 p=0.25965 62OR=3.73 (p=0.001)华法林抗凝并发出血的危险因素中国住院AF病人华法林抗凝的安全性p=0.25965 62OR=3.73 华法林抗凝56% Rhythm control20% Rate control24% NO therapyAmiodarone 31.0%Cedilanid 29.6%-Blocker 18.3%Propafenone 14.3%阵发性AF住院患者 治疗现状Qi W, et al. Chinese J Cardiol, 2003；31：913-91656% Rhythm control20% Rate coRate Control 83%Rhythm Control 14% No treatment3%AmiodaroneDigoxin-BlockerCCB持续性AF住院患者 治疗现状Qi W, et al. Chinese J Cardiol, 2003；31：913-916Rate Control 83%Rhythm Control2% Warfarin60% NoneAspirin38%AF患者抗栓治疗现状：人群