心力衰竭住院后亚临床心房颤动的患病率及临床结局

IF 2.1 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2026-09-01 Epub Date: 2026-06-01 DOI:10.1016/j.cjco.2026.05.012

Jorge A. Wong MD, MPH, Priya Mistry MSc, Ameen Patel MD, Umjeet Jolly MD, Alex Benz MD, Fei Yuan MMath, Natalia Pinilla-Echeverri MD, Ghaith Almidani MD, Nicole Latendresse BSc, Alex Grinvalds BSc, Elorm Vowotor MD, Jerry Chen MD, Alex Grindal MD, Sabina Rajkumar BSc, Ali Almhri MD, Shrikant Bangdiwala PhD, William F. McIntyre MD, PhD, David Conen MD MPH, P.J. Devereaux MD, PhD, Jeff S. Healey MD, MSc, Stuart J. Connolly MD

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引用次数: 0

摘要

背景：亚临床心房颤动（SCAF）在老年人中很常见，但其在心力衰竭（HF）患者中的临床意义尚不清楚。我们评估了无房颤（AF）住院HF患者中SCAF的患病率，并检查了其与HF相关结局的关系。方法前瞻性地从加拿大安大略省的5个地点招募初步诊断为心衰加重而无房颤的住院患者。出院后进行28天的连续心电图监测以检测SCAF。在1年随访中，SCAF与心衰再入院、心血管死亡和其他心衰相关结局之间的关系通过logistic回归模型确定。结果242例患者平均年龄70.9±13.3岁；51%为男性；平均体重指数为31.6±10.8 kg/m2；平均左室射血分数为42.3%±17.1%。17例患者（7.1%）检测到SCAF，包括31次发作，中位持续时间为6.3小时（四分位数范围：0.21-32.5）。SCAF与心血管死亡相关(6 vs 28个事件；调整优势比（aOR） 4.22[95%可信区间{CI}， 1.34-12.8]；P = 0.014)和进展为临床房颤（5 vs 14个事件；aOR 8.26, [95% CI, 2.33-28.2]; P = 0.001），而与HF再住院无显著关联（4 vs 54个事件；aOR 1.12 [95% CI, 0.32-3.31]; P = 0.85）。结论：在心力衰竭住院且既往无房颤的患者中，大约每14人中就有1人在出院后早期检测到SCAF，并且SCAF与较高的心血管死亡率和进展为临床房颤相关。未观察到与心力衰竭再住院的关联，尽管该研究可能对这一结果的支持不足。临床试验注册号nct03541616

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Prevalence and Clinical Outcomes of Subclinical Atrial Fibrillation After Heart Failure Hospitalization

Background

Subclinical atrial fibrillation (SCAF) is common in older adults, but its clinical significance in heart failure (HF) patients remains unclear. We evaluated the prevalence of SCAF in patients hospitalized with HF without prior atrial fibrillation (AF) and examined its association with HF-related outcomes.

Methods

Hospitalized patients with a primary diagnosis of HF exacerbation without prior AF were prospectively recruited across 5 sites in Ontario, Canada. Participants were discharged home with 28-day continuous electrocardiogram monitoring to detect SCAF. The association between SCAF and HF readmission, cardiovascular death, and other HF-related outcomes at 1-year follow-up was determined using logistic regression models.

Results

Among 242 participants, the mean age was 70.9 ± 13.3 years; 51% were male; the mean body mass index was 31.6 ± 10.8 kg/m²; and the mean left ventricular ejection fraction was 42.3% ± 17.1%. SCAF was detected in 17 patients (7.1%), comprising 31 episodes with a median duration of 6.3 hours (interquartile range: 0.21-32.5). SCAF was associated with cardiovascular death (6 vs 28 events; adjusted odds ratio (aOR) 4.22 [95% confidence interval {CI}, 1.34-12.8]; P = 0.014) and progression to clinical AF (5 vs 14 events; aOR 8.26, [95% CI, 2.33-28.2]; P = 0.001), whereas a significant association was not observed with HF rehospitalization (4 vs 54 events; aOR 1.12 [95% CI, 0.32-3.31]; P = 0.85).

Conclusions

In patients hospitalized with HF and no prior AF, SCAF was detected in approximately 1 in 14 individuals early after discharge and was associated with higher cardiovascular mortality and progression to clinical AF. No association with HF rehospitalization was observed, although the study may have been underpowered for this outcome.