不同心房颤动筛查方式在社区老年人群中的效果研究
nalysis of the Effectiveness of Different Atrial Fibrillation Screening Methods in the Community-based Elderly Population
背景 老年人是心房颤动（简称房颤）的高危人群，提高社区老年人群房颤的筛查效率有助于降低房颤相关脑卒中的发生风险。目的 比较不同的房颤筛查方式在老年人群中的筛查效率。方法 于 2022 年 7 月—2023年 1 月选取上海市浦东新区金杨社区香山、黄山、罗山 3 个居委的老年人 1 300 例，先后使用触诊桡动脉脉搏、具有房颤检测功能的电子血压计、单导联心电记录仪进行房颤筛查，三者任一项阳性即为房颤阳性，最后由心电图室医生进行心电图检查并判读。绘制不同筛查方法的受试者工作特征（ROC）曲线，计算 ROC 曲线下面积（AUC），并评估其筛查价值；采用趋势性 χ2 检验分析房颤卒中评分（CHA2DS2-VASc 评分）与房颤之间的相关性。结果 1 300 人中共检出房颤 93 人，其中无症状者 57 人；触诊脉搏阳性 375 人，具有房颤检测功能的电子血压监测仪阳性 331 人，单导联心电记录仪检测阳性 128 人。触诊脉搏、具有房颤检测功能的电子血压监测仪、单导联心电记录仪诊断社区老年人房颤价值的 AUC 分别为 0.750（95%CI=0.697~0.803，P<0.01）、0.832（95%CI=0.790~0.874，P<0.01）、0.939（95%CI=0.916~0.973，P<0.01）。随着 CHA2DS2-VASc 评分增加，老年人房颤发生率逐渐增多（χ2 趋势 =197.46，P<0.01）。结论 运用便携式单导联心电仪筛查房颤便捷、高效、准确，可推广用于社区老年人房颤的筛查。
Background?Older adults are at high risk for atrial fibrillationAF. Improving the efficiency of AF screening among the community-based elderly population can help to reduce the risk of AF-related stroke. Objective?To compare the screening efficiency of different AF screening methods in the elderly population. Methods?A total of 1 300 cases of older adults were selected from three neighborhood committees of XiangshanHuangshanand Luoshan in Jinyang Community Pudong New AreaShanghai from July 2022 to January 2023. AF screening was detected using palpation of radial artery pulse electronic sphygmomanometer with AF detection functionand single-lead ECG recorder. A positive result of any one of the three methods was considered positive for AFand finally an electrocardiogramECG was performed and interpreted by a physician in the ECG room. The receiver operating characteristicROC curves of the subjects with different screening methods were plottedthe area under the ROC curveAUC was calculated to evaluate the screening valuethe association between AF stroke scoreCHA2DS2-VASc score and AF was analyzed using the chi-square test for trend. Results?AF was detected in 93 of the 1 300 peopleincluding 57 asymptomatic people375 people had a positive palpated pulse331 people had a positive electronic blood pressure monitor with AF detection functionand 128 people had a positive result of single-lead ECG recorder. The AUCs for the diagnostic value of palpation pulseelectronic sphygmomanometer with AF detection function and singlelead ECG recorder in the elderly was 0.75095%CI=0.697-0.803P<0.010.83295%CI=0.790-0.874P<0.010.93995%CI=0.916-0.973P<0.01the incidence of AF in the elderly gradually increased as the CHA2DS2-VASc score increasedχ2 trend=197.46P<0.01. Conclusion?Screening for AF using single-lead ECG recorder is convenientefficient and accurateand can be promoted in AF screening among community-based elderly population.
陆萍、李艳、石玉霜、王惠华、潘桂俊、宋玮
医药卫生理论预防医学内科学
心房颤动老年人社区触诊血压计心电记录仪HA2DS2-VASc 评分筛查
陆萍,李艳,石玉霜,王惠华,潘桂俊,宋玮.不同心房颤动筛查方式在社区老年人群中的效果研究[EB/OL].(2023-12-19)[2025-08-10].https://chinaxiv.org/abs/202312.00243.点此复制
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