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Objective: To explore the risk factors of death in atrial fibrillation (AF) patients with or without heart failure (HF). Methods: A total of 2015 emergency AF patients from 20 hospitals in China from 2008-11 to 2011-10 were consecutively enrolled. Based on existing HF, the patients were divided into 2 groups: HF group, n=753 and Non-HF group, n=1263. The baseline condition and in-hospital treatment were recorded, patients were followed-up for 1 year to document all-cause death and the relevant risk factors were studied by multivariate Cox regression analysis. Results: Compared with Non-HF group, HF group had less male, lower heart rate (HR) and body mass index (BMI), less patients with previous histories of hypertension and hyperthyreosis, lower application rates of calcium antagonists and amiodarone, all P<0.05; HF group had the higher CHADS2score, more patients with previous histories of myocardial infarction, coronary artery disease, congenital heart disease (HD), valvular HD, rheumatic HD, left ventricular (LV) hypertrophy, smoking, LV dysfunction, cognitive disorder,pneumonectasis/chronic obstructive pulmonary disease (COPD), valvular surgery and major bleeding; higher application rates of diuretics, ACEI, digoxin, aspirin and warfarin, all P<0.05. 1991 patients finished follow-up study and during that period, compared with Non-HF group, HF group showed the lower usage rates of rhythm-control drugs and clopidogrel, while higher usage rates of ventricular-control drugs and warfarin, all P<0.05; higher incidences of death and major bleeding, all P<0.05. Cox regression analysis indicated that HF was the risk factor for 1 year mortality in AF patients (HR=1.50, 95% CI 1.17-1.92, P=0.001). In Non-HF group, age (HR=1.09, 95% CI 1.07-1.11, P<0.001), heart rate (HR=1.011, 95% CI 1.005-1.017, P<0.001), primary diagnosis (HR=1.63, 95% CI 1.13-2.35, P=0.01) and COPD (HR=2.18, 95% CI 1.47-3.22, P<0.001) were related to 1 year death. In HF group, age (HR=1.05, 95% CI 1.03-1.07, P<0.001), BMI (HR=0.92, 95% CI 0.88-0.96, P<0.001), systolic blood pressure (HR=0.991, 95% CI 0.984-0.998, P=0.012) and primary diagnosis (HR=2.50, 95% CI 1.48-4.21, P=0.001) were related to 1 year death. Conclusion: Baseline condition and in-hospital treatment were different in AF patients with or without HF. HF was the risk factor for 1 year mortality and the other risk factors were different in AF patients with or without HF.
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<p><b>OBJECTIVE</b>To explore the impact of hypertension history and baseline blood pressure levels on cardiovascular outcomes in Chinese emergency atrial fibrillation patients during 1 year follow-up.</p><p><b>METHODS</b>This prospective study consecutively enrolled patients presenting to an emergency department with atrial fibrillation from 20 hospitals in China during November 2008 to October 2011. Baseline data and treatment regimen were recorded, all patients were followed up for one year, and major cardiovascular events (MACE including cardiovascular death, stroke, myocardial infarction, and non central nervous systemic embolism) were recorded. Patients were divided into hypertension history group and non-hypertension history group. Univariate Cox analysis was evaluated hypertension history, baseline blood pressure on major cardiovascular events. Multivariate Cox analysis recognized risk factors for major cardiovascular events.</p><p><b>RESULTS</b>A total of 2016 atrial fibrillation patients were enrolled, and the average systolic blood pressure and diastolic blood pressure were (131.9 ± 23.3)mm Hg(1 mm Hg = 0.133kPa), (79.9 ± 14.7)mm Hg respectively. 1118 patients (55.5%) had a history of hypertension, and about 91.1% hypertension patient received antihypertensive treatment. Major cardiovascular events occurred in 314 cases (15.6%) among 1 year follow up, and 191 cases (17.1%) among hypertension group and 123 cases (13.7%) among non-hypertension group. Univariate Cox regression analysis of prognostic factors for major cardiovascular events showed that hypertension history and baseline systemic blood pressure were risk factors (HR = 1.269, 95%CI: 1.012-1.592, P = 0.039; HR = 1.005, 95%CI: 1.000-1.010, P = 0.042). Multivariate Cox regression model analysis, adjusted others risk factors, showed that hypertension history, baseline systolic pressure levels, and baseline diastolic blood pressure did not have independent predictive value for major cardiovascular events. Moreover, multivariate Cox regression analysis showed that age, history of heart failure, history of stroke were independent prognostic factor for one year follow-up of major cardiovascular events in atrial fibrillation patients.</p><p><b>CONCLUSION</b>Age, history of heart failure, history of stroke were independent predictor for 1 year major cardiovascular events in Chinese emergency atrial fibrillation patients.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Age Factors , Atrial Fibrillation , Blood Pressure , Follow-Up Studies , Heart Failure , Hypertension , Prospective Studies , Risk Factors , StrokeABSTRACT
<p><b>OBJECTIVE</b>To compare the differences on therapeutic approach and short-term outcomes between male and female patients with ST-elevation myocardial infarction (STEMI).</p><p><b>METHODS</b>Data of Chinese STEMI patients were retrospectively analyzed from a global multicenter clinical trial of reviparin and metabolic modulation in acute myocardial infarction treatment evaluation (CREATE). The patients were divided into two groups according to gender and difference on demographic, baseline clinical characteristics at admission, reperfusion and drug therapy and 30-day all-cause mortality, re-infarction, stroke, hemorrhage, heart failure and combined end points were compared.</p><p><b>RESULTS</b>Of the 7431 patients, 29.1% were female. Female patients were older than male patients [(68.2 ± 9.1) years vs. (60.3 ± 12.1) years]. On admission, heart rate, diastolic blood pressure and Killip class were higher and the delay between onset of chest pain and arrival at hospital was longer in female patients than in male patients (all P < 0.01). Male patients often presented MI in anterior leads while female patients often presented MI in inferior and lateral leads. History of diabetes mellitus, hypertension and heart failure was significantly higher in female than in male patients (all P < 0.01). Incidence of high blood glucose was higher in female while high blood potassium was higher in male patients (P < 0.01). Rate of reperfusion therapy was lower and the use aspirin and diuretic was more frequent in female patients than in male patients, while frequency of clopidogrel, Glycoprotein IIb/IIIa receptor inhibitor, β-blockers, angiotensin converting enzyme inhibitor, lipid-lowering drug use was significantly higher in male than in female patients (all P < 0.01). Multivariate logistic regression analysis showed that female gender was a predictor for less PCI therapy (P < 0.01). Thirty-day all cause mortality (OR = 1.425, 95%CI: 1.163 - 1.747, P < 0.01) and combined end points (OR = 1.193, 95%CI: 1.010 - 1.410, P = 0.04) were significantly higher in female patients than in male patients.</p><p><b>CONCLUSIONS</b>There are gender-related differences on therapeutic approach and short-term outcome in Chinese STEMI patients. The unfavorable demographic and baseline clinical profile could partially explain the less reperfusion therapy rate and worse prognosis in female patients.</p>