胡大一孙艺红北京大学人民医院
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positive correlation with incidence of AF related stroke.
Ma C, et al. Chin J cardiol 2002; 30: 165-167
中国AF卒中危险因素: 病例对照研究
回顾性研究, 18家医院，2年
4 511 例
Non-valvular disease
≥ 50 yrs, USA (CHS), single ECG ≥ 65 yrs, UK, single ECG ≥ 60 yrs, Netherlands, single ECG & medical record ≥ 50 yrs, UK, single ECG ≥ 55 yrs, Netherlands, single ECG ≥ 35 yrs, USA, medical record ≥ 50 yrs, UK, single ECG Review results ≥ 60 yrs, Australia, triennial survey ≥ 40 yrs, Japan, single ECG ≥ 60 yrs, Hong Kong, single ECG ≥ 35 yrs, Denmark, single ECG 25 - 64 yrs, west German, single ECG ≥ 15 yrs, India, single ECG
6% PSVT 6% PVCs
9% SSS
18% Unspecified
34% Atrial Fibrillation
8% Conduction
Disease
10% VT
3% SCD
Bialy D. J Am Coll Cardiol. 1992; 19: 41A.
AF 死亡率
70% 50%
Odds Ratio for Death
AF住院率增加：中国
% of hospitalization
9.0% 8.0% 7.5% 7.0% 6.5% 6.0%
7.65% 1999
7.90% 2000
8.16% 2001
Qi W, et al. Chinese J Cardiol, 2003；31：913-916
7.90%
Average
中国AF的流行病学
中国心房颤动流行病学 现实与问题
胡大一 孙艺红
北京大学人民医院
心房颤动 (AF)
最常见的心律失常 发病率随年龄增长和器质性心脏病的发展而增加 卒中常见的病因之一 (占所有卒中10-15%) 明显增加心血管死亡和致残 即使经过抗心律失常药物治疗，半数患者有复发 倾向
AF占心律失常出院诊断1/3
4% Atrial Flutter
AF
AF
AF
heart rate
HU D, et al. Chin J Intern Med, 2003; 42: 157-161
NVAF患者卒中危险因素
AGE >76 yrs Hypertension
Diabetes SBP
LA thrombi
1.76 (1.08-2.89) 1.52 (1.28-1.80)
14个自然人群, 13 个省
中国心房颤动的流行病学调查
方法
中国自然人群 国际标准化方法 29079 人 年龄> 35 岁 连续采样
Hu D, et al. 2004 Chin J Intern Med; in press.
中国AF患病率 ---年龄/性别分层
8 Men (n=13358)
9 10
生活质量
*
10
†
8
6
4
* †
†*
†*
AF
CAD
Controls
SF-36 score
2
0
General Physical health function
Social function
Mental health
* P<0.05, patients with AF compared to healthy controls
CAD CHF RVD Idiopathic AF caidiomyopathy Diabetes
7.4% 5.4% 4.1%
34.8% 33.1% 24.1%
58.1% 56.3%
0
10%
20% 30%
40% 50% 60%
CAD: coronary artery disease; CHF: congestive heart failure; RVD: rheumatic valve disease
Patients with AF In China 8 million
阵发性/持续性AF的趋势
8% 7% 6% 5% 4% 3% 2% 1% 0% 30～
persistent AF paroxysmal AF
40～
50～
60～
Hu D, et al. 2004 Chin J Intern Med; in press.
DM
1.4 (1.0-2.0) 1.6 (1.1-2.2)
0
1
2
3
4
5
6
78
9
Benjamin EJ, et al. JAMA, 1994; 271: 840-844
AF患病率的地理差异
5.5% 5.4%
5.1% 3.7% 3.0% 2.8% 2.4%
1.5% 1.3% 1.3%
0.60% 0.28% 0.1%
AF患者卒中发生率：每年5.3%
Without risk factor With risk factor
10
%
5
1.0 1.6
5.1 3.1
8.8 4.0
7.9 7.7
0
<60
60–69
70–79
>80 Age Range (years)
520 consecutive nonvalvular AF patients without taking warfarin were followed 6.75±4.03 years. Hypertension, diabetes and ischemic stroke history has a
1.2-1.8
1.5-2.2
men
women
Men, AF Women, AF
Percent of subject died in follow-up
30% 10%
Men, No AF Women, No AF
01 2 3
Benjamin EJ, Circulation 1998; 946-952
45 6 7 8 years
China FHS, USA Australia UK
90 years
AF患病率：中国及其他地区
5.5% 5.4%
5.1% 3.7% 3.0% 2.8% 2.4% 1.5% 1.3% 1.3%
0.77% 0.60%
0.28% 0.1%
≥ 50 yrs, USA (CHS), single ECG ≥ 65 yrs, UK, single ECG ≥ 60 yrs, Netherlands, single ECG & medical record ≥ 50 yrs, UK, single ECG ≥ 55 yrs, Netherlands, single ECG ≥ 35 yrs, USA, medical record ≥ 50 yrs, UK, single ECG Review results ≥ 60 yrs, Australia, triennial survey ≥ 40 yrs, Japan, single ECG ≥ 60 yrs, Hong Kong, single ECG ≥ 35 yrs, main land, China, single ECG ≥ 35 yrs, Denmark, single ECG 25 - 64 yrs, west German, single ECG ≥ 15 yrs, India, single ECG
HU D, et al. Chin J Intern Med, 2003; 42: 157-161
NVAF卒中危险:病例对照研究
P<0.001
100
97.7
P=0.009
75
%
75.2
P=0.21
51.9 50
25
2.3
24.8 18.8
0
Lone
AF
None valve Persistence Paroxymal Control of Conversion
7
6
Women (n=15521)
7.5 7.4
Rate per 100
5
0.77
3.6
4
2.6
P<0.05
3
2
1.4 1.1 0.5 0.6
1
0.3 0.2
0.9 0.7
0 30-39 40-49 50-59 60-69 70-79 ≥80 Overall
Age Group, y
Data collected from 13 natural populations from 14 different provinces across China
AGE CHF VHD Prior MI HTN
2.1 (1.8-2.5) 2.2 (1.9-2.6)
1.4 (1.0-2.0)
1.5 (1.2-2.0) 1.4 (1.1-1.8)
1.8 (1.2-2.5) 3.4 (2.5-4.5)
Male Female
4.5 (3.1-6.6) 4.2 (4.2-8.4)
HU D, et al. Chin J Intern Med, 2003; 42: 157-161
Prevalence (%)
NVAF患者卒中患病率：年龄分层
32.1
30
28.9
25
21.0
20
15.2
15
9.7
10
5
4.9
0 >40
40～49 50-59 60～69 70～79 >80 years
70～
80～
阵发性AF的转归
住院病人回顾分析 阵发性心房颤动 358例 平均5年后 64例（17.96%）变为持续性房颤
30
25
ַٰȱ£¨%©£
20
15
10
5
0
0
1
2
3
4
5
2004 中国心脏起搏与心电生理杂志
ʱ¼ä £¨Äê £©
64例 17.9％
中国AF卒中的患病率
% 25% 20% 15% 10%
12.95%
17.5%
24.81%
5%
0 Hu D, 2004 Qi W, 2003 Hu D, 2003
Hu D, et al. 2004 Chin J Intern Med; in press. Random sample of population Qi W, et al. 2003 Chin J Cardiol; 31: 913-916. Case-control study. Hospitalized patients Hu D, et al. 2003 Chin J Intern Med; 42: 157-161. Case-control study. Hospitalized patients
3 425 例
RVD
1 086 例
stroke
827
2598
HU D, et al. Chin J Intern Med, 2003; 42: 157-161
stroBaidu Nhomakorabeae
273 813
RVD: rheumatic valvular disease
AF住院患者一般情况
Advanced age Hypertension
Estimate of prevalence of AF vary based on the characteristics of population studied and how AF is ascertained.
Ryder KM, et al. Am J Cardiol 1999; 84: 131R-138R.
† P<0.05, patients with AF compared to those with CAD
Higher scores = better QQL
Dorian P et al. J Am Coll Cardiol. 2000; 36: 1303-1309 .
Framingham 研究: AF危险因素
Hu D, et al. 2004 Chin J Intern Med; in press.
不同国家患病率比较
14
% 12
10
8
6
4
2
0
30
40
50
60
70
80
FHS: the Framingham study. Wolf PA et al. Sroke 1991; 22: 983-988 Australia: Lake FR, et al. Aust NZ Med 1989; 19: 321-326 UK: Hill JD et al. J R Coll Gen Pract 1987; 37: 172-173
Ma C, et al. Chin J cardiol 2002; 30: 165-167
中国AF卒中危险因素: 病例对照研究
回顾性研究, 18家医院，2年
4 511 例
Non-valvular disease
≥ 50 yrs, USA (CHS), single ECG ≥ 65 yrs, UK, single ECG ≥ 60 yrs, Netherlands, single ECG & medical record ≥ 50 yrs, UK, single ECG ≥ 55 yrs, Netherlands, single ECG ≥ 35 yrs, USA, medical record ≥ 50 yrs, UK, single ECG Review results ≥ 60 yrs, Australia, triennial survey ≥ 40 yrs, Japan, single ECG ≥ 60 yrs, Hong Kong, single ECG ≥ 35 yrs, Denmark, single ECG 25 - 64 yrs, west German, single ECG ≥ 15 yrs, India, single ECG
6% PSVT 6% PVCs
9% SSS
18% Unspecified
34% Atrial Fibrillation
8% Conduction
Disease
10% VT
3% SCD
Bialy D. J Am Coll Cardiol. 1992; 19: 41A.
AF 死亡率
70% 50%
Odds Ratio for Death
AF住院率增加：中国
% of hospitalization
9.0% 8.0% 7.5% 7.0% 6.5% 6.0%
7.65% 1999
7.90% 2000
8.16% 2001
Qi W, et al. Chinese J Cardiol, 2003；31：913-916
7.90%
Average
中国AF的流行病学
中国心房颤动流行病学 现实与问题
胡大一 孙艺红
北京大学人民医院
心房颤动 (AF)
最常见的心律失常 发病率随年龄增长和器质性心脏病的发展而增加 卒中常见的病因之一 (占所有卒中10-15%) 明显增加心血管死亡和致残 即使经过抗心律失常药物治疗，半数患者有复发 倾向
AF占心律失常出院诊断1/3
4% Atrial Flutter
AF
AF
AF
heart rate
HU D, et al. Chin J Intern Med, 2003; 42: 157-161
NVAF患者卒中危险因素
AGE >76 yrs Hypertension
Diabetes SBP
LA thrombi
1.76 (1.08-2.89) 1.52 (1.28-1.80)
14个自然人群, 13 个省
中国心房颤动的流行病学调查
方法
中国自然人群 国际标准化方法 29079 人 年龄> 35 岁 连续采样
Hu D, et al. 2004 Chin J Intern Med; in press.
中国AF患病率 ---年龄/性别分层
8 Men (n=13358)
9 10
生活质量
*
10
†
8
6
4
* †
†*
†*
AF
CAD
Controls
SF-36 score
2
0
General Physical health function
Social function
Mental health
* P<0.05, patients with AF compared to healthy controls
CAD CHF RVD Idiopathic AF caidiomyopathy Diabetes
7.4% 5.4% 4.1%
34.8% 33.1% 24.1%
58.1% 56.3%
0
10%
20% 30%
40% 50% 60%
CAD: coronary artery disease; CHF: congestive heart failure; RVD: rheumatic valve disease
Patients with AF In China 8 million
阵发性/持续性AF的趋势
8% 7% 6% 5% 4% 3% 2% 1% 0% 30～
persistent AF paroxysmal AF
40～
50～
60～
Hu D, et al. 2004 Chin J Intern Med; in press.
DM
1.4 (1.0-2.0) 1.6 (1.1-2.2)
0
1
2
3
4
5
6
78
9
Benjamin EJ, et al. JAMA, 1994; 271: 840-844
AF患病率的地理差异
5.5% 5.4%
5.1% 3.7% 3.0% 2.8% 2.4%
1.5% 1.3% 1.3%
0.60% 0.28% 0.1%
AF患者卒中发生率：每年5.3%
Without risk factor With risk factor
10
%
5
1.0 1.6
5.1 3.1
8.8 4.0
7.9 7.7
0
<60
60–69
70–79
>80 Age Range (years)
520 consecutive nonvalvular AF patients without taking warfarin were followed 6.75±4.03 years. Hypertension, diabetes and ischemic stroke history has a
1.2-1.8
1.5-2.2
men
women
Men, AF Women, AF
Percent of subject died in follow-up
30% 10%
Men, No AF Women, No AF
01 2 3
Benjamin EJ, Circulation 1998; 946-952
45 6 7 8 years
China FHS, USA Australia UK
90 years
AF患病率：中国及其他地区
5.5% 5.4%
5.1% 3.7% 3.0% 2.8% 2.4% 1.5% 1.3% 1.3%
0.77% 0.60%
0.28% 0.1%
≥ 50 yrs, USA (CHS), single ECG ≥ 65 yrs, UK, single ECG ≥ 60 yrs, Netherlands, single ECG & medical record ≥ 50 yrs, UK, single ECG ≥ 55 yrs, Netherlands, single ECG ≥ 35 yrs, USA, medical record ≥ 50 yrs, UK, single ECG Review results ≥ 60 yrs, Australia, triennial survey ≥ 40 yrs, Japan, single ECG ≥ 60 yrs, Hong Kong, single ECG ≥ 35 yrs, main land, China, single ECG ≥ 35 yrs, Denmark, single ECG 25 - 64 yrs, west German, single ECG ≥ 15 yrs, India, single ECG
HU D, et al. Chin J Intern Med, 2003; 42: 157-161
NVAF卒中危险:病例对照研究
P<0.001
100
97.7
P=0.009
75
%
75.2
P=0.21
51.9 50
25
2.3
24.8 18.8
0
Lone
AF
None valve Persistence Paroxymal Control of Conversion
7
6
Women (n=15521)
7.5 7.4
Rate per 100
5
0.77
3.6
4
2.6
P<0.05
3
2
1.4 1.1 0.5 0.6
1
0.3 0.2
0.9 0.7
0 30-39 40-49 50-59 60-69 70-79 ≥80 Overall
Age Group, y
Data collected from 13 natural populations from 14 different provinces across China
AGE CHF VHD Prior MI HTN
2.1 (1.8-2.5) 2.2 (1.9-2.6)
1.4 (1.0-2.0)
1.5 (1.2-2.0) 1.4 (1.1-1.8)
1.8 (1.2-2.5) 3.4 (2.5-4.5)
Male Female
4.5 (3.1-6.6) 4.2 (4.2-8.4)
HU D, et al. Chin J Intern Med, 2003; 42: 157-161
Prevalence (%)
NVAF患者卒中患病率：年龄分层
32.1
30
28.9
25
21.0
20
15.2
15
9.7
10
5
4.9
0 >40
40～49 50-59 60～69 70～79 >80 years
70～
80～
阵发性AF的转归
住院病人回顾分析 阵发性心房颤动 358例 平均5年后 64例（17.96%）变为持续性房颤
30
25
ַٰȱ£¨%©£
20
15
10
5
0
0
1
2
3
4
5
2004 中国心脏起搏与心电生理杂志
ʱ¼ä £¨Äê £©
64例 17.9％
中国AF卒中的患病率
% 25% 20% 15% 10%
12.95%
17.5%
24.81%
5%
0 Hu D, 2004 Qi W, 2003 Hu D, 2003
Hu D, et al. 2004 Chin J Intern Med; in press. Random sample of population Qi W, et al. 2003 Chin J Cardiol; 31: 913-916. Case-control study. Hospitalized patients Hu D, et al. 2003 Chin J Intern Med; 42: 157-161. Case-control study. Hospitalized patients
3 425 例
RVD
1 086 例
stroke
827
2598
HU D, et al. Chin J Intern Med, 2003; 42: 157-161
stroBaidu Nhomakorabeae
273 813
RVD: rheumatic valvular disease
AF住院患者一般情况
Advanced age Hypertension
Estimate of prevalence of AF vary based on the characteristics of population studied and how AF is ascertained.
Ryder KM, et al. Am J Cardiol 1999; 84: 131R-138R.
† P<0.05, patients with AF compared to those with CAD
Higher scores = better QQL
Dorian P et al. J Am Coll Cardiol. 2000; 36: 1303-1309 .
Framingham 研究: AF危险因素
Hu D, et al. 2004 Chin J Intern Med; in press.
不同国家患病率比较
14
% 12
10
8
6
4
2
0
30
40
50
60
70
80
FHS: the Framingham study. Wolf PA et al. Sroke 1991; 22: 983-988 Australia: Lake FR, et al. Aust NZ Med 1989; 19: 321-326 UK: Hill JD et al. J R Coll Gen Pract 1987; 37: 172-173