符合ABC管理路径对中国急诊心房颤动患者预后的影响

目的探讨符合心房颤动（房颤）更好的管理（atrial fibrillation better care，ABC）管理路径对中国急诊房颤患者预后的影响。 方法纳入2008年11月至2011年10月在中国20家医院急诊就诊的房颤患者，并随访12个月。根据患者是否符合ABC管理路径分为2组：符合ABC路径组与不符合ABC路径组。主要临床结局事件为全因死亡，次要临床结局事件为心血管死亡、卒中和大出血事件。应用Cox回归模型分析上述事件的影响因素。 结果共纳入2 015例房颤患者，年龄（68.5±13.3）岁，其中女1 104例（54.8%）。随访12个月，符合ABC路径组（126/2 015例，6.3%）患者死亡4例（3.2%，4/126），其中心血管死亡1例（0.8%，1/126）；不符合ABC路径组（1 889/2 015例，93.7%）患者死亡275例（14.6%，275/1 889），其中心血管死亡163例（8.6%，163/1 889）。两组患者卒中和大出血发生率差异无统计学意义。多因素Cox模型分析显示，与不符合ABC路径组比，符合ABC路径组的全因死亡风险（HR 0.211，95% CI 0.078~0.572，P=0.002）和心血管死亡风险（HR 0.085，95%CI 0.012~0.612，P=0.014）均显著下降。 结论在当代真实的中国急诊房颤患者队列中，符合ABC路径的临床综合管理与显著降低全因死亡、心血管死亡风险相关，采用ABC路径的综合管理可以改善房颤患者的预后。

Influence of compliance with atrial fibrillation better care (ABC) management pathway on prognosis of Chinese emergency patients with atrial fibrillation

ObjectiveTo investigate the impact of atrial fibrillation better care (ABC) pathway on the prognosis of Chinese emergency patients with atrial fibrillation (AF). MethodsThis study included patients with AF who presented to the emergency department of 20 hospitals in China from November 2008 to October 2011, and every patient had a 12-months follow-up. Patients were divided into 2 groups according to whether they followed the ABC pathway: ABC adherent and Non-ABC adherent. The primary clinical outcome measure was all-cause death, and the secondary clinical outcome measure was cardiovascular death, stroke, and major bleeding. Univariate and multivariable Cox regression models were used to analyze the effects of the ABC adherence on the clinical outcomes. ResultsA total of 2 015 patients with AF were included in this study.The average age was (68.5±13.3) years, 1 104 (54.8%) were female, and the patients in the ABC/Non-ABC adherent were 126 (6.3%,126/2 015) and 1 889 (93.7%,1 889/2 015), respectively. During the 12-month follow-up, all-cause death and cardiovascular death occurred in 4 (3.2%, 4/126) patients and 1 (0.8%,1/126) in the ABC adherent group, and 275 (14.6%, 275/1 889) and 163 (8.6%, 163/1 889) in the Non-ABC adherent group. Multivariable Cox model analysis showed that the risk of all-cause mortality (HR 0.211, 95% CI 0.078~0.572, P=0.002) and cardiovascular mortality (HR 0.085, 95% CI 0.012~0.612, P=0.014) were significantly decreased in the ABC adherent group compared with the Non-ABC adherent group. The incidence of stroke and major bleeding was not statistically different between the two groups. ConclusionIn a contemporary cohort of Chinese emergency patients with AF, comprehensive clinical management with the ABC pathway was associated with a significant decrease in the risk of all-cause death and cardiovascular death, and integrated management using the ABC pathway could improve the prognosis of patients with AF.