Analysis of one-year follow-up results of ≥75-year-old atrial fibrillation inpatients with high CHA2DS2-VASc score

doi:10.3969/j.issn.1004-583X.2023.02.003

Abstract

Abstract:

Objective Atrial fibrillation (AF) is a common arrhythmia that increases the risk of ischemic stroke with age. It is a prospective study to analyze the prognosis of ≥75-year-old AF patients with high CHA2DS2-VASc scores, and to explore the risk factors. Methods A total of 196 elderly patients older than 75 years with high CHA2DS2-VASc scores who were hospitalized in the Department of Cardiology, Affilated Hospital of Hebei University, from December 2015 to November 2017 were recruited, including 90 in the AF group and 106 in the non-AF group. A 1-year follow-up was performed, the primary endpoint events of all-cause death, heart failure (HF), and ischemic stroke were recorded. Data processing was performed using the SPSS19.0 statistical software package. Results ①There were 31 deaths (15.8%) at 1-year follow-up. The incidence of all-cause death, stroke and HF in AF group was significantly higher than that in non-AF group (P <0.05). ②Age and history of heart failure were independent risk factors for death and HF in elderly patients older than 75 years with high CHA2DS2-VASc scores. ③Female gender and hypertension were independent risk factors for stroke at 1-year follow-up in elderly patients older than 75 years with high CHA2DS2-VASc scores. Conclusion Elderly patients (≥75 years old) with high CHA2DS2-VASc scores have a poor prognosis, and those combined with AF have a worse prognosis. Sex and age are the independent risk factors for assessing the prognosis. As an independent risk factor, HF has a significant power, and active control can significantly improve the prognosis. Our prospective and observational study provides some theoretical basis for the current clinical treatment of such patients.

Key words: atrial fibrillation, stroke, all cause death, heart failure, advanced

CLC Number:

R541.75

Zhang Fang, Zhang Yichao, Jia Xinwei, Li Jianlong, Chen Chunhong. Analysis of one-year follow-up results of ≥75-year-old atrial fibrillation inpatients with high CHA2DS2-VASc score[J]. Clinical Focus, 2023, 38(2): 117-120.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.02.003

https://huicui.hebmu.edu.cn/EN/Y2023/V38/I2/117

Figures/Tables 5

Tab.1 Comparison of baseline data and treatment condition between groups

临床特征	AF组( $n$ =90)	非AF组( $n$ =106)	统计值	$P$ 值
男性[例(%)]	42(46.7)	52(49.1)	χ²=0.111	0.739
年龄(岁)	81.83±4.47	78.52±2.81	$t$ =55.789	0.000
合并临床疾病[例(%)]
高血压	68(75.6)	84(79.2)	χ²=0.381	0.537
既往外周栓塞史	12(13.3)	18(17.0)	χ²=0.500	0.480
血管疾病	14(15.6)	22(20.8)	χ²=0.878	0.349
充血性心衰	68(75.6)	34(32.1)	χ²=36.896	0.000
糖尿病	24(26.7)	32(30.2)	χ²=0.296	0.568
既往脑卒中	42(46.7)	30(28.3)	χ²=7.064	0.008
肾功能不全	6(6.7)	34(32.1)	χ²=2.840	0.092
甲状腺功能亢进症	4(4.4)	6(5.7)	χ²=0.249	0.700
基础用药[例(%)]
利尿剂	34(37.8)	44(41.5)	χ²=0.283	0.595
血管紧张素转换酶抑制剂	42(46.7)	50(47.2)	χ²=0.050	0.944
β受体阻滞剂	42(46.7)	38(35.8)	χ²=2.358	0.125
他汀类	72(80.0)	80(75.5)	χ²=0.573	0.449
Ca离子拮抗剂	10(11.1)	10(9.4)	χ²=0.149	0.699
阿司匹林	56(62.2)	82(77.4)	χ²=5.235	0.021
CHA2DS2-VASc 评分[例(%)]
3~4分	38(42.2)	38(35.8)	χ²=0.833	0.361
≥5分	52(57.8)	68(64.2)

Tab.1 Comparison of baseline data and treatment condition between groups

临床特征	AF组( $n$ =90)	非AF组( $n$ =106)	统计值	$P$ 值
男性[例(%)]	42(46.7)	52(49.1)	χ²=0.111	0.739
年龄(岁)	81.83±4.47	78.52±2.81	$t$ =55.789	0.000
合并临床疾病[例(%)]
高血压	68(75.6)	84(79.2)	χ²=0.381	0.537
既往外周栓塞史	12(13.3)	18(17.0)	χ²=0.500	0.480
血管疾病	14(15.6)	22(20.8)	χ²=0.878	0.349
充血性心衰	68(75.6)	34(32.1)	χ²=36.896	0.000
糖尿病	24(26.7)	32(30.2)	χ²=0.296	0.568
既往脑卒中	42(46.7)	30(28.3)	χ²=7.064	0.008
肾功能不全	6(6.7)	34(32.1)	χ²=2.840	0.092
甲状腺功能亢进症	4(4.4)	6(5.7)	χ²=0.249	0.700
基础用药[例(%)]
利尿剂	34(37.8)	44(41.5)	χ²=0.283	0.595
血管紧张素转换酶抑制剂	42(46.7)	50(47.2)	χ²=0.050	0.944
β受体阻滞剂	42(46.7)	38(35.8)	χ²=2.358	0.125
他汀类	72(80.0)	80(75.5)	χ²=0.573	0.449
Ca离子拮抗剂	10(11.1)	10(9.4)	χ²=0.149	0.699
阿司匹林	56(62.2)	82(77.4)	χ²=5.235	0.021
CHA2DS2-VASc 评分[例(%)]
3~4分	38(42.2)	38(35.8)	χ²=0.833	0.361
≥5分	52(57.8)	68(64.2)

Tab.2 1-year follow-up endpoint events (cases[%])

组别	例数	全因死亡	脑卒中	充血性心衰
AF组	90	22(24.4)	29(32.2)	48(53.3)
非AF组	106	9(8.5)	14(13.2)	26(24.5)
χ²值		9.304	10.276	17.185
$P$ 值		0.002	0.001	0

Tab.2 1-year follow-up endpoint events (cases[%])

组别	例数	全因死亡	脑卒中	充血性心衰
AF组	90	22(24.4)	29(32.2)	48(53.3)
非AF组	106	9(8.5)	14(13.2)	26(24.5)
χ²值		9.304	10.276	17.185
$P$ 值		0.002	0.001	0

Tab.3 Risk factors of 1-year follow-up all-cause death

因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.543	0.203	7.142	0.008	1.721	1.156	2.562
充血性心衰	3.279	1.062	9.532	0.002	26.539	3.311	12.719

Tab.3 Risk factors of 1-year follow-up all-cause death

因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.543	0.203	7.142	0.008	1.721	1.156	2.562
充血性心衰	3.279	1.062	9.532	0.002	26.539	3.311	12.719

Tab.4 Risk factors of 1-year follow-up stroke

因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
性别	0.653	0.164	15.854	0.000	1.921	1.393	2.650
高血压	0.882	0.193	20.884	0.000	2.416	1.655	3.526

Tab.4 Risk factors of 1-year follow-up stroke

因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
性别	0.653	0.164	15.854	0.000	1.921	1.393	2.650
高血压	0.882	0.193	20.884	0.000	2.416	1.655	3.526

Tab.5 Risk factors of 1-year follow-up cardiovascular mortality

因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.441	0.124	12.648	0.001	1.554	1.219	1.982
既往充血性心衰	3.652	1.038	12.378	0.001	38.552	5.041	294.854

Tab.5 Risk factors of 1-year follow-up cardiovascular mortality

因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.441	0.124	12.648	0.001	1.554	1.219	1.982
既往充血性心衰	3.652	1.038	12.378	0.001	38.552	5.041	294.854

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