Epidemiology, management, and outcomes of atrial fibrillation among 30 million citizens in Shanghai, China from 2015 to 2020: A medical insurance database study

被引:29
作者
Chen, Mu [1 ]
Li, Cheng [1 ]
Liao, Peng [2 ]
Cui, Xin [3 ]
Tian, Wenqi [3 ]
Wang, Qunshan [1 ]
Sun, Jian [1 ]
Yang, Mei [1 ]
Luo, Li [2 ]
Wu, Hong [4 ]
Li, Yi-Gang [1 ]
机构
[1] Shanghai Jiao Tong Univ, Sch Med, Xinhua Hosp, Dept Cardiol, 1665 Kongjiang Rd, Shanghai 200092, Peoples R China
[2] Fudan Univ, Sch Publ Hlth, Shanghai, Peoples R China
[3] Shanghai Hlth Stat Ctr, Shanghai, Peoples R China
[4] Shanghai Municipal Hlth Commiss, Shanghai, Peoples R China
来源
LANCET REGIONAL HEALTH-WESTERN PACIFIC | 2022年 / 23卷
基金
中国国家自然科学基金;
关键词
Cardiovascular disease; Prevalence; Arrhythmia; Anticoagulation; Ablation; Left atrial appendage closure; COVID-19; Sex differences; PREVALENCE; POPULATION; TRENDS;
D O I
10.1016/j.lanwpc.2022.100470
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background Atrial fibrillation(AF) has become a significant public health concern in China, with population aging and urbanization. Methods Data screening was performed for 30,244,930 subjects with medical insurance in the Shanghai Municipal Health Commission database between 2015 and 2020. Patients diagnosed with AF were identified and further assessed for treatment information and clinical outcomes, as well as sex differences and impact of COVID-19 pandemic on AF managment. Findings AF prevalence was 0.88% in Shanghai, which increased with age and reached 6.70% at subjects 80 years and over. AF was more prevalent in women compared with men (0.89% vs. 0.88%, p< 0.0001), which could be attributed to higher AF burden in women over 80 years. Driven by increased prescription of non-vitamin K antagonist oral anticoagulants, anticoagulant use increased from 19.46% in 2015 to 56.57% in 2020. The number of left atrial appendage closure increased from 0.16% in 2015 to 1.23% in 2020. Rhythm control strategy was increasingly adopted, as the use of antiarrhythmic drugs doubled and ablation increased by 21% in 2020 compared to 2015. Compared with men, women were less prone to receive rhythm control treatments, including antiarrhythmics, ablation and cardioversion, but more likely to adopt rate control drugs. During the 5.5 years follow-up, the incidences of stroke, transient ischemic attack, systemic embolism, bleeding, myocardial infarction, and in-hospital death were 6.09%, 5.74%, 1.44%, 5.11%, 8.41%, and 12.84% in patients with index diagnosis of AF in 2015, respectively. Interpretation The burdens of AF and AF-related outcomes in Shanghai are high. Management of AF is markedly improved in recent years, and was not or only slightly impeded by the COVID-19 pandemic. There are sex differences in the prevalence, management, and outcomes of AF. Funding Shanghai Hospital Development Center, National Natural Science Foundation of China and Shanghai Municipal Science and Technology Commission. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.
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页数:13
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