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消瘦的房颤患者风险高！中国医疗质量改善项目分析

2020-06-12 朱朱 中国循环杂志

房颤医疗质量
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我国房颤患者中，与体重偏轻或体重正常者相比，超重或肥胖者接受药物治疗的比例更高，院内死亡风险较低。

近期，西安交通大学研究人员利用中国心血管疾病医疗治疗质量改善-房颤（CCC-AF）项目数据进行分析后发现，在我国房颤患者中，与体重偏轻或体重正常者相比，超重或肥胖者接受药物治疗的比例更高，院内死亡风险较低。
 
体重不足、体重正常、超重、Ⅰ级肥胖、Ⅱ级肥胖房颤住院患者中，院内死亡率分别为1.08%、0.42%、0.35%、0.21%，心原性休克发生率分别为1.08%、0.50%、0.54%、0.23%，心衰发生率分别为23.97%、16.60%、15.10%、14.16%，但各组的中风发生率无明显差别。
 
多变量logistic模型分析显示，体重指数（BMI）是房颤患者院内死亡的强烈预测因素之一。
 
BMI低于正常的患者院内死亡风险明显增加，是超重和肥胖患者的2.08倍。
 
另外，有心衰、中风、风湿性心脏病病史以及年龄≥75岁的患者院内死亡风险也分别增加1.68倍、1.32倍、1.98倍、2.78倍。
 
研究者指出，尽管体重不足可能与其他合并症和高龄等情况有关，但BMI仍然与房颤患者院内死亡呈负相关。
 
该研究结果说明，我国体重不足的房颤住院患者的医疗质量亟需改善，除了要加强循证药物和其他治疗措施的应用，还要注意体重管理，以降低院内死亡率。
 
CCC-AF项目覆盖全国150家医院，从2015年2月起，一共纳入15 867例房颤患者，其中5.23%体重不足（BMI<18.5 kg/m2），31.29%体重正常（18.5~22.9 kg/m2），23.42%超重（23.0~24.9 kg/m2），33.17%为Ⅰ级肥胖（25.0~29.9 kg/m2），6.89%为Ⅱ级肥胖（≥30.0 kg/m2）。
 
与体重正常的患者相比，体重不足、超重和肥胖患者的CHADS2评分3~6分和CHA2DS2-VASc评分5~9分的比例均增加。
 
住院期间，超重和肥胖患者接受节律控制药物、抗凝药物、介入治疗的比例明显高于体重不足和体重正常的患者。
 
出院时，超重的房颤患者心率比体重不足和体重正常患者要慢。
 
研究者发现，随着BMI增加，房颤患者住院时间缩短。
 
来源：
[1]BMI Differences Among In-Hospital Management and Outcomes in Patients With Atrial Fibrillation: Findings From the Care for Cardiovascular Disease Project in China. BMC Cardiovasc Disord, 2020, 20(1): 270. 
[2] 国家心血管病医疗质量控制中心专家委员会心房颤动专家工作组. 2019 年中国心房颤动医疗质量控制报告. 中国循环杂志, 2020, 35: 427-437.

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1742045, encodeId=fb5b1e420452f, content=<a href='/topic/show?id=6e29658163e' target=_blank style='color:#2F92EE;'>#消瘦#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65816, encryptionId=6e29658163e, topicName=消瘦)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6ab635012667, createdName=fengyqf, createdTime=Fri May 07 07:20:05 CST 2021, time=2021-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1743359, encodeId=dc7e1e4335945, content=<a href='/topic/show?id=95ad9239ee2' target=_blank style='color:#2F92EE;'>#质量改善#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92397, encryptionId=95ad9239ee2, topicName=质量改善)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ea3d35104371, createdName=huhuaidong399, createdTime=Sun Aug 09 14:20:05 CST 2020, time=2020-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=908507, encodeId=2b5690850ef3, content=学习文献，加强吸收, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4KDsF1g1gUHzGM0LHxX5B5uhEMln8y8iagso9N4XBTQVPmHrCNoT3o8bw80Ds53TpTgcPnKUIfkyw/0, createdBy=bc101976400, createdName=suibian2007bbb, createdTime=Wed Dec 16 11:36:12 CST 2020, time=2020-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1722826, encodeId=3cc51e22826e0, content=<a href='/topic/show?id=95a821e42a1' target=_blank style='color:#2F92EE;'>#中国医疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21742, encryptionId=95a821e42a1, topicName=中国医疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Mon Jan 04 20:20:05 CST 2021, time=2021-01-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1310369, encodeId=74c4131036996, content=<a href='/topic/show?id=ef29351686f' target=_blank style='color:#2F92EE;'>#医疗质量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35168, encryptionId=ef29351686f, topicName=医疗质量)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8ca5383, createdName=bbjsj_1979, createdTime=Sun Jun 14 06:20:05 CST 2020, time=2020-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614551, encodeId=d9381614551c8, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=937e19519012, createdName=hittouch, createdTime=Sun Jun 14 06:20:05 CST 2020, time=2020-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031275, encodeId=960110312e505, content=房颤，临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Fri Jun 12 18:20:05 CST 2020, time=2020-06-12, status=1, ipAttribution=)]
    2021-05-07 fengyqf

    #消瘦#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1742045, encodeId=fb5b1e420452f, content=<a href='/topic/show?id=6e29658163e' target=_blank style='color:#2F92EE;'>#消瘦#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65816, encryptionId=6e29658163e, topicName=消瘦)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6ab635012667, createdName=fengyqf, createdTime=Fri May 07 07:20:05 CST 2021, time=2021-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1743359, encodeId=dc7e1e4335945, content=<a href='/topic/show?id=95ad9239ee2' target=_blank style='color:#2F92EE;'>#质量改善#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92397, encryptionId=95ad9239ee2, topicName=质量改善)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ea3d35104371, createdName=huhuaidong399, createdTime=Sun Aug 09 14:20:05 CST 2020, time=2020-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=908507, encodeId=2b5690850ef3, content=学习文献，加强吸收, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4KDsF1g1gUHzGM0LHxX5B5uhEMln8y8iagso9N4XBTQVPmHrCNoT3o8bw80Ds53TpTgcPnKUIfkyw/0, createdBy=bc101976400, createdName=suibian2007bbb, createdTime=Wed Dec 16 11:36:12 CST 2020, time=2020-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1722826, encodeId=3cc51e22826e0, content=<a href='/topic/show?id=95a821e42a1' target=_blank style='color:#2F92EE;'>#中国医疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21742, encryptionId=95a821e42a1, topicName=中国医疗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Mon Jan 04 20:20:05 CST 2021, time=2021-01-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1310369, encodeId=74c4131036996, content=<a href='/topic/show?id=ef29351686f' target=_blank style='color:#2F92EE;'>#医疗质量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35168, encryptionId=ef29351686f, topicName=医疗质量)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8ca5383, createdName=bbjsj_1979, createdTime=Sun Jun 14 06:20:05 CST 2020, time=2020-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1614551, encodeId=d9381614551c8, content=<a href='/topic/show?id=64f95426122' target=_blank style='color:#2F92EE;'>#房颤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54261, encryptionId=64f95426122, topicName=房颤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=937e19519012, createdName=hittouch, createdTime=Sun Jun 14 06:20:05 CST 2020, time=2020-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031275, encodeId=960110312e505, content=房颤，临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Fri Jun 12 18:20:05 CST 2020, time=2020-06-12, status=1, ipAttribution=)]
    2020-08-09 huhuaidong399

    #质量改善#

    0

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    2020-12-16 suibian2007bbb

    学习文献，加强吸收

    0

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    2021-01-04 一叶知秋

    #中国医疗#

    0

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    2020-06-14 bbjsj_1979

    #医疗质量#

    0

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    2020-06-14 hittouch

    #房颤患者#

    0

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    2020-06-12 心介

    房颤，临床上碰到很多哦

    0

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