房颤---流行病与医疗费用.ppt

1、房颤-流行病与医疗费用,董建增 马长生 首都医科大学附属北京安贞医院,房颤的患病率 -ATRIA 研究,JAMA 2001; 2370,北加州 189万 人口 17974 例成人房颤患者 （July 1, 1996 - December 31, 1997）,美国房颤患者预测数量（ 2001年）,JAMA 2001; 2370,Miyasaka.Circulation.2006:119,Year,美国房颤的者数量预测值（2006年）,中国房颤患病率,J Epidemiol 2008; 209,中国房颤总数 1000万,中国-房颤患者的年龄构成,Int J Cardiol 2005; 283,回顾

2、分析来自中国41家医院9297例诊断房颤出院患者资料 Jan 1999-Dec 2001,4,10,20,25,28,13,房颤病因以及相关发病因素（中国）,Int J Cardiol 2005; 283,非瓣膜病房颤卒中率（不抗凝）-中国,Chin J Cardiol 2002;165,8696,房颤/非房颤患者卒中患病率:中国,J Epidemiol 2008; 209,房颤患者住院率增加: 中国,Chinese J Cardiol. 2003:913,房颤患者的抗栓治疗和脑卒中发生率,Int J Cardiol 2005; 283,阵发性房颤的药物治疗现状: 中国,Chinese J C

3、ardiol. 2003:913,慢性房颤的药物治疗: 中国,Chinese J Cardiol. 2003:913,中国房颤经导管消融治疗的发展趋势,不同类型房颤经导管消融疗效（中国）,78.8,71.5,62.3,21.2,28.5,37.7,P0.05,Based on 6435 cases registration in China,Increasing needs of Afib ablation from pts in China,1000,2000,3000,4000,5000,房颤导管消融：中国,开展医院 116家 熟练医生 30人 使用仪器 CARTO :60台 EnSite

4、 Navx :30台 磁导航系统：2台已装、4台在装、5台订购 机器人： 0,慢性房颤消融策略(马长生等，2008),环PV消融至PV隔离或接近隔离,ROOF/MI/CTI消融,CFAE消融（右间隔、CS、心耳根部、间隔部等等）,对诱发的心动过速进一步标测消融,进一步验证并保证PV/CTI/ROOF/MI/SVC* 阻滞,消融至窦性*，房颤不中止者BURST/（20%）,房颤导管消融,冠心病PCI 房颤导管消融 1998年 6,000 1 2008年 180,000 8,000 2018年 800,000 100,000,中国-房颤药物治疗的费用,华法林片 0.75 / # RMB 胺碘酮片

5、3.46/# RMB 年医药费 2000 RMB,消融前检查: CT、TEE、TTE、生化指标等 导管消融： 消融导管、参考电极、Lasso导管等 术后用药 华法令、胺碘酮,中国-导管消融的费用,总体花费: 60,000 - 80,000 RMB,谢谢,Atrial fibrillation： The Epidemic and Cost,Changsheng Ma, M.D. Department of Cardiology Beijing Anzhen Hospital, Capital Medical University Beijing, P.R. China Dem 13, 2008,

6、Prevalence of Diagnosed AF(ATRIA study),JAMA 2001; 2370,Project Number of AF in U.S（2001）,JAMA 2001; 2370,Miyasaka.Circulation.2006:119,Year,Project Number of AF in U.S（2006）,Prevalence of Diagnosed AF in China,J Epidemiol 2008; 209,中国房颤总数 1000万,Age distribution of patients with AF,Int J Cardiol 200

7、5; 283,4.1,10.1,20.1,25.5,27.9,13.3,Causes and associated factors for AF,Int J Cardiol 2005; 283,Incidence of Stroke in patients with NVAF,Chin J Cardiol 2002;165,Prevalence of stroke in AF/non-AF cohorts,J Epidemiol 2008; 209,* P0.001 compared with Non-AF,Hospitalization increased China,Chinese J C

8、ardiol. 2003:913,Antithrombotic treatment and stroke rate in AF,Int J Cardiol 2005; 283,* P=0.001 compared with no antithrombotic group # P=0.316 compared with anticoagulant group,Treatment of paroxysmal AF,Chinese J Cardiol. 2003:913,Treatment of chronic AF,Chinese J Cardiol. 2003:913,Development o

9、f transcatheter ablation of AF in China,Results of ablation in different type of AF,78.8,71.5,62.3,21.2,28.5,37.7,P0.05,Based on 6435 cases（China）,Increasing needs of Afib ablation from pts in China,1000,2000,3000,4000,5000,Catheter Ablation For Afib in China,Hospitals : 116 Experienced Doctors: 30

10、3D Mapping System CARTO :60 EnSite Navx :30 Magnetic Navigation：2 installed、4 installing、5 will be installed in 2009 Robotic ： 0,Approach For Chronic Afib In China,circumferential ablation PVI,ROOF/MI/CTI linear ablation,Abl. of CFAE,Mapping and Abl. of burst induced Tachy.,Make Sure PV/CTI/ROOF/MI/

11、SVC* block,To Sinus Rryhthm*,（20%) terminated by,Project No. of Afib Abl.,PCI Afib Catheter Abl. 1998 6,000 1 2008 180,000 8,000 2018 600,000 50,000100,000,Costs of AF Medication in China,Warfarin tablet 0.75 / # RMB Amiodarone tablet 3.46/# RMB Annual cost 2000 RMB ( VS.1590 Euros*),* PACE 2003; 292,Preablation examinations: CT、TEE、TTE、biochemical test Catheter ablation： Abl catheter、Reference