| 王紫晨,张丽,高歌,等.心房颤动综合管理路径对老年非瓣膜性心房颤动患者预后的影响[J].中国临床保健杂志,2026,29(3):348-353. |
| 心房颤动综合管理路径对老年非瓣膜性心房颤动患者预后的影响 |
| The impact of comprehensive management of atrial fibrillation pathway on the prognosis of elderly patients with non-valvular atrial fibrillation |
| 投稿时间：2026-05-08 |
| DOI：10.3969/J.issn.1672-6790.2026.03.010 |
| 中文关键词: 心房颤动 ABC路径 风险评估与减低 预后 老年人 |
| 英文关键词: Atrial fibrillation Atrial fibrillation Better Care pathway Risk evaluation and mitigation Prognosis Aged Fund programs:National Key Research and Development Program Project |
| 基金项目:国家重点研发计划项目 |
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| 中文摘要: |
| 目的 探讨心房颤动综合管理[ABC(Atrial fibrillation Better Care)]路径对老年非瓣膜性心房颤动患者预后的影响。方法 采用观察性研究。选取2018年10月至2020年3月首都医科大学宣武医院住院的老年非瓣膜性心房颤动患者363例。根据患者是否符合ABC路径分为ABC路径组与非ABC路径组。比较两组患者基本临床指标、药物使用及心房颤动的管理情况。随访患者全因死亡、心血管不良事件(MACE)、缺血性脑卒中、大出血以及复合结局。采用Cox比例风险回归模型评价ABC路径对临床结局的影响。结果 本研究中ABC路径组139例,非ABC路径组224例。ABC路径组患者心房颤动类型以永久性心房颤动为主,合并高血压、脑卒中的比例更高,应用非维生素K拮抗剂口服抗凝剂比例更高。ABC路径组和非ABC路径组的全因死亡率分别为6.5%和15.2%,MACE发生率分别为9.4%和17.0%,缺血性卒中发生率分别为7.2%和14.3%,复合结局发生率分别为24.5%和47.8%,差异均有统计学意义(均P<0.05)。两组患者大出血发生率差异无统计学意义。Cox比例风险回归模型分析显示,ABC路径与更低的全因死亡风险(HR=0.406,95%CI:0.195~0.846)、MACE风险(HR=0.500,95%CI:0.266~0.939)、缺血性卒中(HR=0.457,95%CI:0.225~0.929)和复合结局风险(HR=0.471,95%CI:0.320~0.693)独立关联。结论 遵循ABC路径可降低老年非瓣膜性心房颤动患者的死亡风险,可改善患者预后。 |
| 英文摘要: |
| Objective To explore the impact of the ABC pathway (Atrial fibrillation Better Care,ABC) on the prognosis of elderly patients with non-valvular atrial fibrillation.Methods An observational study was conducted. A total of 363 elderly patients with non-valvular atrial fibrillation hospitalized at Xuanwu Hospital of Capital Medical University from October 2018 to March 2020 were selected,patients were divided into an ABC pathway group and a non-ABC pathway group.Basic clinical indicators,medication use,and atrial fibrillation management were compared between the two groups.Patients were followed up for all-cause mortality,cardiovascular adverse events (MACE),ischemic stroke,major bleeding,and a composite outcome of these four endpoints.The Cox proportional hazards regression model was used to evaluate the impact of the ABC pathway on clinical outcomes.Results In this study,there were 139 patients in the ABC pathway group and 224 in the non-ABC pathway group.Patients in the ABC pathway group had a higher proportion of permanent atrial fibrillation,a higher prevalence of underlying diseases such as hypertension and stroke,and a higher rate of non-vitamin K antagonist oral anticoagulant use.The all-cause mortality rates were 6.5% and 15.2% in the ABC and non-ABC pathway groups,respectively;MACE rates were 9.4% and 17.0%;ischemic stroke rates were 7.2% and 14.3%;and composite outcome rates were 24.5% and 47.8%,all showing statistically significant differences (all P<0.05).There was no significant difference in major bleeding between the two groups.Cox proportional hazards model analysis showed that the ABC pathway was independently associated with a lower risk of all-cause mortality (HR=0.406,95%CI:0.195-0.846),cardiovascular adverse events (HR=0.500,95%CI:0.266-0.939),ischemic stroke (HR=0.457,95%CI:0.225-0.929),and composite outcome (HR=0.471,95%CI:0.320-0.693).Conclusions Following the optimized comprehensive management of atrial fibrillation (ABC pathway) is significantly associated with a lower mortality risk in elderly patients with non-valvular atrial fibrillation and can improve prognosis. |
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