心房顫動病人控制心率治療與缺血性腦中風和死亡率之相關性

Association of rate control treatment with ischemic stroke and mortality in the patients with atrial fibrillation

林瑛哲(Ying-Che Lin)

指導教授 ： 賴德仁

中山醫學大學/醫學院/醫學研究所/碩士(2018年)

摘要

研究目的：本研究旨在研究心房顫動病人使用控制心率藥物與缺血性腦中風風險和死亡率的相關性，以提供未來醫師在治療心房顫動的病人時有更好的治療準則。

研究方法及資料：本研究採用台灣健保資料庫百萬歸人檔，從西元2000年到2013年的全國性的醫療紀錄與病人資料。首先我們從資料庫選出新診斷為心房顫動的病人(從2002年到2012年共11,377人)，再排除掉診斷後六個月內就死亡或發生腦中風的病人，總共剩8,771人，再從中分成五組，分別是未接受控制心率藥物治療組、接受乙型交感神經接受體阻斷劑（beta-blocker）治療組、接受非二氫

關鍵字

心房顫動 ； 世代研究 ； 控制心率 ； 缺血性腦中風 ； 死亡率

並列摘要

Objective：The objective of this study is to assess the effects of rate control treatment on the risk of ischemic stroke and mortality in the patients with AF (atrial fibrillation).

Methods and Materials：We used Taiwan National Health Insurance (NHI) database, a nationally representative data that contain the medical records of 1 million Taiwan residents and comprise the patient data from 2000 to 2013. We enrolled patients who were newly diagnosed with atrial fibrillation (n=11,377) between year 2002 and 2012, excluding patients who died or had stroke or TIA (transient ischemic attack) within 6 months from the date of the newly diagnosis (n=8,771). We assigned patients into five groups, included without rate control treatment group (n=4,552), β blockers group (n=1,529), calcium-channel antagonists group (n=494), digoxin group (n=790) and more than one drugs group(n=7,365). The end points of our study were the occurrence of ischemic stroke/TIA and death. The Cox’s proportion hazard regression analysis was used to estimate the adjusted hazard ratios (HRs) and 95% confidence interval (CI) for the risk of stroke and mortality.

Results：The use of beta-blockers was associated with a decreased risk of mortality, with an adjusted hazard ratio of 0.72 (95% confidence interval [CI], 0.65-0.81) compared with control group. In contrast, the use of digoxin was associated with an increased risk of ischemic stroke or TIA, with an adjusted hazard ratio of 1.31 (95% CI, 1.07-1.59) compared with control group.

Conclusion and Suggestion：In this nationwide cohort study, patients with AF receiving β blockers have a lower risk of mortality compared with those not taking rate-control drugs. In contrast, the use of digoxin was associated with a higher risk of ischemic stroke or TIA compared with those not taking rate-control drugs. Prospective, randomized trials are necessary to confirm these findings in the future. We suggested β blockers may be a better choice for controlling ventricular rate in patients with AF and digoxin may be the second-line treatment for patients with AF.

並列關鍵字

Atrial fibrillation ； cohort studies ； rate control ； ischemic stroke ； mortality

參考文獻

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