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CHC2017 :中国房颤流行病学的变迁 11年间患病率增20倍 , 房颤相关卒中增加13倍

2017-08-10 佚名 中国循环杂志

中国一项使用1千万人的医保数据库47万居民的调查结果显示, 中国房颤及其相关脑卒中负担增加显着,近11年房颤患病率增加20倍,房颤相关卒中增加13倍。

中国一项使用1千万人的医保数据库47万居民的调查结果显示, 中国房颤及其相关脑卒中负担增加显着,近11年房颤患病率增加20倍,房颤相关卒中增加13倍。

房颤及其相关脑卒中负担增加,与中国人口基数大、老龄化及老年共病的发生密切相关。估计每5个中国成年人一生中,就有1人有发生房颤的风险,略低于西方人群;75岁以上的高龄老年人群发生房颤的风险比50岁以上人群增加2倍。

与 51~60岁的人相比,71~80岁的人群中房颤患病率增加5倍,80岁以上的高龄老年房颤患病率增加了6倍。

房颤危险因素有变化

过去20年,风湿性心脏病、扩张型心肌病、心力衰竭、甲状腺功能亢进症、冠心病、慢性阻塞性肺疾病、糖尿病高血压及高龄是房颤常见的危险因素。

近15年,房颤合并风湿性心脏病和慢阻肺患者减少,而合并高血压、冠心病、动脉粥样硬化、糖尿病、非风湿性瓣膜病等疾病的房颤患者显着增加。

房颤抗凝面临挑战

过去20 年,中国房颤患者中阿司匹林使用较为普遍,口服抗凝治疗率显着低于欧美国家,社区研究报道的华法林抗凝治疗率波动在0.5%~2.7%,医院基础研究报道的抗凝治疗率为 6.6%~9.1%。

多个真实世界研究报道,华法林未能有效防治脑卒中。阜外医院杨艳敏教授团队开展的中国房颤注册研究显示,房颤患者中脑卒中年发生率为7.4%,用华法林治疗与未抗凝治疗的患者相比无差异。

近7年,中国房颤患者中阿司匹林使用率开始下降,但抗血小板药物使用率仍高于口服抗凝药物,而非抗栓药物的使用率仍达到23.5%。

进入新型口服抗凝药(NOAC)时代,口服抗凝治疗率逐渐提高。正在全国 44 家中心进行的 ChiOTEAF 研究数据显示,目前中国房颤患者平均抗凝治疗率达39%,NOAC使用比例已达到17%,接近华法林使用率。

然而,房颤抗凝管理有待优化,20%的血栓高危患者仍未接受有效的抗凝治疗。
另一方面,40%的血栓高危患者同时有出血高危风险,临床医生需重视房颤患者的出血风险管理

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    2017-10-24 topnew

    学习学习有用的

    0

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    2017-08-12 mei536
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    2017-08-10 131****1460

    学习了受益匪浅。

    0

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