中国中西医结合急救杂志2025，Vol.32Issue(4)：414-420,7.DOI:10.3969/j.issn.1008-9691.2025.04.006
房颤合并疾病临床干预现状及对房颤发生类型的影响
Intervention status of comorbidities and their impact on atrial fibrillation subtype in atrial fibrillation patients
摘要
Abstract
Objective To analyze the distribution characteristics of comorbid diseases in patients with atrial fibrillation(AF)and the current status of their medical intervention.Methods A retrospective cohort study was conducted using clinical data from AF patients at the AF center of Hainan Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine between October 2020 and September 2022.The data included information on hospitalizations,diagnoses and treatments,health assessments,physical examinations,tests,laboratory results,and medication treatments.Descriptive research methods were used to analyze the clinical distribution characteristics,comorbid diseases,and stroke intervention status.A Logistic regression model was employed to analyze the impact of comorbid diseases on the type of AF.Receiver operator characteristic curve(ROC curve)analysis was performed to evaluate the predictive value of comorbid diseases in AF for the development of persistent AF.Results Among the 667 AF patients,89.21%(595 cases)had comorbidities,with a total of 64 different comorbidity combinations observed.These combinations consisted of AF coexisting with 1-5 diseases,72.44%had 1-2 comorbidities.The top 5 most frequent comorbidity patterns,in descending order,were hypertension,hypertension and chronic heart failure,hypertension and coronary heart disease and chronic heart failure,hypertension and coronary heart disease,hypertension and diabetes.These 5 patterns accounted for 49.41%(294/595)of the total cases.All 8 diseases were associated with high abnormality rates in four key indicators:the CHA2DS2-VASc score,brain natriuretic peptide/N-terminal pro-brain natriuretic peptide(BNP/NT-proBNP),creatinine clearance rate(CCr),and left atrial diameter.The highest medication rates were observed for anticoagulants in valvular heart disease(84.62%),for antiarrhythmics in thyroid disease(70.97%),and for blood pressure control agents across all other diseases.For the 4 disease comorbidity combinations,the monitoring rates were highest for hypertension(100.00%)and lowest for diabetes mellitus(83.12%).The treatment rates were as follows:hypertension(highest 63.16%,lowest 60.91%),coronary heart disease(CHD,highest 73.96%,lowest 44.44%),diabetes mellitus(highest 75.29%,lowest 64.94%),chronic heart failure(highest 67.63%,lowest 62.50%).For stroke intervention in the 4 disease comorbidity combinations,the proportion of high-stroke-risk population was highest in patients with diabetes(98.46%)and lowest in those with chronic heart failure(92.18%).The anticoagulation therapy rate was highest in the chronic heart failure(56.25%)and lowest in the diabetes(46.88%).The proportion of patients with high bleeding risk was highest in the diabetes group(44.53%)and lowest in the chronic heart failure group(32.59%).Multivariate binary Logistic regression analysis revealed that AF comorbid with coronary heart disease[odds ratio(OR)=1.499,95%confidence interval(95%CI)was 1.016-2.214,P=0.042],valvular heart disease(OR=3.362,95%CI was 1.473-7.674,P=0.004),and chronic heart failure(OR=1.903,95%CI was 1.309-2.767,P=0.001)were all independent risk factors for the development of persistent AF.ROC curve analysis showed that coronary heart disease,valvular heart disease,and chronic heart failure all had certain predictive value for persistent AF,with areas under the curve(AUC)of 0.538,0.536,and 0.572,respectively.Combined assessment demonstrated an AUC of 0.654(95%CI was 0.610-0.698,P<0.001),sensitivity 54.50%,and specificity 69.20%.Conclusions The distribution of high-frequency comorbidity combinations in AF patients is highly clustered and warrants focused attention.In this center,patients with comorbidities exhibited high abnormality rates in comorbid disease detection and elevated stroke risk scores,yet targeted interventions remain insufficient and require optimization.AF combined with coronary artery disease,valvular heart disease,and chronic heart failure were identified as independent risk factors for persistent AF.关键词
心房颤动/合并疾病/干预/心房颤动类型Key words
Atrial fibrillation/Comorbidities/Intervention/Type of atrial fibrillation引用本文复制引用
Li Pinhui,Huang Zhengxin,Ji Meng..房颤合并疾病临床干预现状及对房颤发生类型的影响[J].中国中西医结合急救杂志,2025,32(4):414-420,7.基金项目
海南省卫生计生行业科研项目(20A200506) Scientific Research Project in the Health and Family Planning Industry in Hainan Province(20A200506) （20A200506）
