老年人心律失常的特点及病因分析

目的探讨老年人心律失常的特点及病因,为预防和治疗老年人心律失常提供参考。方法选择517例老年心律失常患者,行常规12导联心电图检查或动态心电图检查,分析各种类型心律失常与患者性别、年龄、基础疾病的关系。结果各类型心律失常发生与性别无关（P〉0.05）,70岁以下人群心律失常发生率明显高于70岁以上人群,差异有统计学意义（P〈0.05）。517例中,心律失常的常见病因为冠心病217例（占41.9%）、肺心病105例（占20.3%）、高血压51例（占9.9%）、糖尿病37例（占7.2%）、脑血管意外35例（占6.8%）;在各种类型心律失常中,以房性心律失常多见（267例,占51.6%）,其次是混合性心律失常（112例,占21.66%）、室性心律失常（71例,占13,73%）。结论房性心律失常可能是老年心脏病变较早的信号,改善心肌的供血与供氧是防治老年人心律失常的重要措施。     

心肌缺血预适应对老年单支动脉闭塞性急性心肌梗死患者的影响

目的观察心肌缺血预适应对老年急性心肌梗死患者的临床意义。方法选择我院收治老年急性心肌梗死患者,分别统计有心绞痛病史组（48例,A组）与无心绞痛病史组（38例,B组）,在常规药物治疗、发病12h内及12～24h行急诊PCI术后住院期间的心律失常、泵功能、心源性休克、临床死亡率等情况。结果两组患者合并心律失常、心衰、心肌梗死后心绞痛间差异有统计学意义（P〈0．05）。两组患者CPK、急性期及发病后4周LVEF间差异均有统计学意义（P〈0．05）。结论心肌缺血预适应效应对老年急性心肌梗死患者心肌的保护作用,可能为降低死亡率及并发症的主要原因。     

老年人与非老年人心律失常的临床对比分析

本文对比分析了90例老年人与75例非老年人的心律失常。结果表明老年人心律失常多伴发于器质性心脏病:感染、低氧、电解质紊乱是主要诱因;并发心衰者或急性呼衰伴MAT者预后差;不少老年患者发病时间不明确,无症状或单纯表现为神经系统症状,应引起临床重视。     

动态心电图监测老年冠心病无症状心肌缺血的临床分析

目的探讨动态心电图（Holter）检测老年冠心病患者无症状心肌缺血（SMI）的临床意义。方法选取2007年9月—2009年9月我院确诊的160例老年冠心病患者,Holter记录和临床资料进行回顾性分析。结果本组常规心电图检出心肌缺血47例（29.4%）,Holter检出心肌缺血103例（64.8%）,缺血性ST段改变506阵次,其中SMI 351阵次（69.4%）,有症状心肌缺血155阵次（30.6%）;SMI的发作具有昼夜规律性,在凌晨6：00～12：00发作频率最高;SMI与有症状心肌缺血在ST段下移幅度及持续时间无显著性差异;SMI组心律失常发生率比有症状心肌缺血组高。结论老年人的SMI发生率较高,Holter能及早检出SMI的存在,因而具有重要的应用价值。     

老年心律失常患者冠状动脉病变的分析

目的探讨老年患者不明原因的心律失常与冠状动脉病变的关系。方法对108例老年心律失常伴（A组）或不伴（B组）心绞痛及缺血性心电图改变者的冠状动脉造影（CAG）结果进行分析。结果A组冠状动脉病变率77%,双支、三支病变占58.14%;B组冠状动脉病变率19.2%,单支病变占80%。A组冠状动脉病变阳性率明显高于B组（P〈0.001）。结论心律失常伴典型心绞痛或心肌缺血者诊断冠心病的可能性大。     

老年冠心病患者心率变异性的临床意义

目的分析49例老年冠心病患者的动态心电图,探讨心率变异性（HRV）的临床意义.方法对49例老年冠心病患者进行动态心电图检查,检测其心律失常、心肌缺血的发生率和心率变异性,并与30例非冠心病老年人对比.结果冠心病组室性心律失常和心肌缺血的发生率显著高于非冠心病组,冠心病组心率变异性指标SDNN低于非冠心病组,冠心病组中有恶性室性心律失常的患者SDNN较低.结论老年冠心病患者心脏自主神经功能紊乱,并可能因此诱发恶性室性心律失常.     

原发性高血压患者心律失常检测及心率变异性分析

目的研究原发性高血压患者的心律、心率与心率变异性。方法采用24h动态心电图（Holter）评价331例门诊高血压患者的心律失常情况;并分析202例患者心率变异性（HRV）的时域和频域指标。结果331例患者均为窦性心律,心律失常检出率达93%。房性心律失常检出率（87%）远高于室性心律失常（50%）,房性早搏≤100个/24h占全部房性早搏者的95%,室性早搏≤100个/24h者占全部室性早搏者的85%,10%的患者合并有短暂房性心动过速,室性心动过速发生率为0.9%,II度II型房室传导阻滞3%。各项时域参数值较正常参考值低,高频（HF）、低频（LF）成份亦低于正常参考值,而LF/HF则明显高于正常参考值。结论原发性高血压患者的心律失常具高发生率且广谱的特性,房性心律失常最为多见,HRV明显降低。     

260例老年人心律失常心电图分析

目的 探讨老年人心律失常的特点和病因,为预防和及早诊治老年人心律失常提供参考.方法 以在我院就诊行心电图检查的260例老年心律失常患者为研究对象,观察各类型心律失常与性别、基础疾病等的关系.结果 260例老年患者各类型心律失常发生均与性别无关(P>0.05),各类型心律失常中房性心律失常发生率最高(93例,占35.8%),其次是室性心律失常(56例,占21.5%).其中心律失常最常见的并发症为冠心病(129例,占49.6%),其次是慢性肺心病(61例,占23.5%).发生率较高的房性心律失常与冠心病之间有相关性(P<0.05).结论 房性心律失常是老年人心脏疾病的提示信号.改善心肌供血、预防并发症的发生是防治老年人心律失常的重要措施.     

老年人冠心病无症状性心肌缺血及心律失常

老年人冠心病无症状性心肌缺血及心律失常李崇信，翁昌鸿，刘俭，宾建平，刘伊丽我们应用２４小时动态心电监测，分析１６３例老年冠心病患者心肌缺血的发生与临床症状、昼夜分布及诱发因素的关系，探讨老年人心肌缺血的特点及心律失常情况。一、对象与方法１９９０年３月...     

DCG检查老年人心肌缺血及心律失常的诊断意义

目的利用动态心电图(DCG)分析检测老年患者心律失常及常见心肌缺血的主要特征。方法选取2016年1月~2016年7月来黑龙江省电力医院体检的62岁以上老人的体检报告,共1000人,男性占64.2%,女性占35.8%。结果 72岁以上的患者心率失常患病率增高明显。结论 DCG可以监测到间歇性、过性的心脏电信号变化,老年人使用DCG进行心电检测,能够及早地发现恶性心肌缺血、心律失常等病变。     

慢性心力衰竭急性加重的诱因分析

目的探讨慢性心力衰竭急性加重的诱因。方法回顾性分析我院2007年7月-2008年10月收治169例慢性心力衰竭患者的临床资料。结果其中以感染为诱因的71例,药物使用不当38例,心律失常20例,原发心脏病加重为诱因的15例,劳累、情绪激动为诱因的10例,其他诱因的15例。结论感染,尤其是呼吸道感染是慢性心力衰竭急性加重的主要诱因,药物使用不当也是心力衰竭急性加重的重要诱因。对于慢性心功能不全患者给予防治呼吸道感染,动态监测患者的用药过程是非常重要的。社区卫生服务中心的医生对这种慢性疾病患者应给予更多的关注。     

农村老年慢性心力衰竭住院患者回顾性分析

目的 了解辽宁省农村地区老年心力衰竭住院患者病因谱、诱因、和药物治疗方面的状况.方法 采用回顾性病例分析方法,对2007年度辽宁省4个县的县医院出院诊断为心力衰竭(年龄≥60岁)住院病例进行分析.结果 共调查388例,其中男性177例,女性211例.病因主要是冠心病225例(60.0%)和高血压176例(45.4%).共有168例(约43.3%)患者有明确的诱因,其中感染77例(45.8%)和劳累90例(53.6%).药物治疗应用比例分别是利尿剂257例(66.2%)、ACEI 260例(67.0%)、螺内酯100例(43.8%)、地高辛160例(41.2%)和β-阻滞剂95例(24.5%).结论 辽宁省农村心衰住院患者的病因主要是冠心病和高血压;感染和劳累是心衰的最常见诱因;心衰治疗应用较多的药物是ACEI、利尿剂和地高辛.     

影响心力衰竭的相关因素分析

目的探讨心力衰竭发作的影响因素,为治疗和预防心力衰竭提供参考资料。方法调查分析我科2010年5—7月收住的心血管疾病患者。结果 (1)195例患者中心功能Ⅰ级92例,平均年龄(76.12±9.94)岁。心功能Ⅱ级以上103例,平均年龄(80.54±7.21)岁。随着年龄的增长,心力衰竭发作的风险性上升,不同年龄组间有显著差异(P<0.01)。(2)BNP、尿酸均与心力衰竭的发作有关,不同级别心力衰竭组间BNP有显著差异,但尿酸无明显差异。(3)多因素Logistic分析发现,心力衰竭的发作与吸烟史、高血压、糖尿病、心肌梗死无关,与年龄、BNP、尿酸有关。结论年龄、BNP、尿酸是心力衰竭发作的危险因素。     

初发急性心力衰竭住院患者病因及诱因状况的临床研究

目的 了解老年初发急性心力衰竭（AHF）患者病因、诱因构成和病因聚集性情况，为临床防治提供线索。方法 144例AHF患者按年龄分为老年组和非老年组，对比分析2组间病因、诱因构成和多病因情况。结果 老年组前3位基础病因为冠心痛（52．1％）、高血压（32．1％）、慢性肾功能衰竭（8．5％），非老年组前3位基础病因为风湿性心脏病（32．6％）、慢性肾功能衰竭（21．7％）、扩张型心肌病（19．6％）；在病因聚集性方面，老年组多病因AHF占49．5％，非老年组为9．8％；2组发病诱因均以感染最多见，老年组54．4％，非老年组51．2％；预后方面，老年组住院病死率（33．98％）明显高于非老年组（17．07％）（P〈0．05）。结论 老年与非老年AHF的病因构成比不同，冠心痛、高血压是老年AHF最常见的病因；老年多病因AHF多见；老年AHF患者住院病死率较高；感染是最常见的发病诱因。在老年AHF的预防中应采取有针对性的措施。     

A propensity-matched study of the association of diabetes mellitus with incident heart failure and mortality among community-dwelling older adults

Diabetes mellitus (DM) is a risk factor for incident heart failure (HF) in older adults. However, the extent to which this association is independent of other risk factors remains unclear. Of 5,464 community-dwelling adults ≥65 years old in the Cardiovascular Health Study without baseline HF, 862 had DM (fasting plasma glucose levels ≥126 mg/dl or treatment with insulin or oral hypoglycemic agents). Propensity scores for DM were estimated for each of the 5,464 participants and were used to assemble a cohort of 717 pairs of participants with and without DM who were balanced in 65 baseline characteristics. Incident HF occurred in 31% and 26% of matched participants with and without DM, respectively, during >13 years of follow-up (hazard ratio 1.45 for DM vs no DM, 95% confidence interval [CI] 1.14 to 1.86, p = 0.003). Of the 5,464 participants before matching unadjusted and multivariable-adjusted hazard ratios for incident HF associated with DM were 2.22 (95% CI 1.94 to 2.55, p <0.001) and 1.52 (95% CI 1.30 to 1.78, p <0.001), respectively. All-cause mortality occurred in 57% and 47% of matched participants with and without DM, respectively (hazard ratio 1.35, 95% CI 1.13 to 1.61, p = 0.001). Of matched participants DM-associated hazard ratios for incident peripheral arterial disease, incident acute myocardial infarction, and incident stroke were 2.50 (95% CI 1.45 to 4.32, p = 0.001), 1.37 (95% CI 0.97 to 1.93, p = 0.072), and 1.11 (95% CI 0.81 to 1.51, p = 0.527), respectively. In conclusion, the association of DM with incident HF and all-cause mortality in community-dwelling older adults without HF is independent of major baseline cardiovascular risk factors.     

老年心力衰竭急性加重住院病人临床特点分析

目的探讨老年心力衰竭急性加重病人住院的临床特点,为老年心力衰竭急性加重的防治提供理论依据。方法回顾性分析2017年1月-2017年12月住院急性心力衰竭病人的临床资料,收集65岁及以上病人且以80岁为界,分为高龄组和老年组进行分析。共纳入3914例老年急性心力衰竭住院病人,其中老年组1602例,高龄组2312例。结果两组年龄、男性、住院天数、死亡率、住院费用比较差异均有统计学意义(P<0.05)。老年组前5位住院原因分别是高血压病(18.3%)、慢性阻塞性肺疾病急性发作(13.4%)、冠状动脉粥样硬化性心脏病(12.4%)、脑卒中(7.8%)、其他类型心脏病(6.2%)。高龄组前5位住院原因分别为慢性阻塞性肺疾病急性发作(15.9%)、冠状动脉粥样硬化性心脏病(13.6%)、高血压病(12.2%)、肺炎(7.7%)、脑卒中(6.7%)。结论慢性阻塞性肺疾病急性发作是导致老年特别是高龄病人心力衰竭急性加重入院的重要原因。     

Acute heart failure: clinical presentation, one-year mortality and prognostic factors

AIMS: Acute heart failure (HF) is a common but ill-defined clinical entity. We describe patients hospitalised with acute HF in regard of clinical presentation, mortality, and risk factors for an unfavourable outcome. METHODS AND RESULTS: We conducted a prospective study including 312 consecutive patients from two European centers hospitalised with acute HF, defined as new onset or worsening of symptoms and signs of HF within 7 days. The mean age was 73 years and 56% were men. Twenty-eight percent had de-novo acute HF and 72% a decompensation of chronic HF. Coronary heart disease (CHD) was the most frequent underlying heart disease, elevated blood pressure >150 mmHg and acute ischemia being the most important triggers. Four percent of the patients had cardiogenic shock, 13% presented with pulmonary edema. LV-EF was <35%, 35-50% and >50% in 35%, 32% and 33% of the patients, respectively. ICU-treatment was necessary in 39% of the patients. Thirty-day mortality (11%) was increased in the presence of shock or elevated troponin T levels. Twelve-month all-cause mortality (29%) increased in the presence of shock, left ventricular dysfunction, renal insufficiency, CHD, and age. CONCLUSIONS: This prospective study shows that despite modern treatment, morbidity and mortality of patients hospitalised with acute HF remain high.     

National Patterns of Heart Failure Hospitalizations and Mortality by Sex and Age

BackgroundEarlier work has demonstrated significant sex and age disparities in ischemic heart disease. However, it remains unclear if an age or sex gap exists for heart failure (HF) patients.Methods and ResultsUsing data from the 2007–2008 Healthcare Cost and Utilization Project, we constructed hierarchic regression models to examine sex differences and age-sex interactions in HF hospitalizations and in-hospital mortality. Among 430,665 HF discharges, 51% were women and 0.3%, 27%, and 73% were aged <25, 25–64, and >64 years respectively. There were significant sex differences among HF risk factors, with a higher prevalence of coronary disease among men. Men had higher hospitalization rates for HF and in-hospital mortality across virtually all ages. The relationship between age and HF mortality appeared U-shaped; mortality rates for ages <25, 25–64, and >64 years were 2.9%, 1.4%, and 3.8%, respectively. No age-sex interaction was found for in-hospital mortality for adults >25 years old.ConclusionsUsing a large nationally representative administrative dataset we found age and sex disparities in HF outcomes. In general, men fared worse than women regardless of age. Furthermore, we found a U-shaped relationship between age and in-hospital mortality during an HF hospitalization, such that young adults have similar mortality rates to older adults. Additional studies are warranted to elucidate the patient-specific and treatment characteristics that result in these patterns.     

Chronic heart failure – Impact of the condition on patients and the healthcare system in the Czech Republic: A retrospective cost-of-illness analysis

BackgroundThe number of patients with heart failure is steadily increasing, as are the costs of their treatment. Nearly 70% of the costs associated with the treatment of heart failure are direct medical costs, and 70–80% of these are spent on hospitalizations. The aim of our study is to describe the all-cause hospitalization costs of patients with chronic heart failure (chronic HF) from the perspective of the healthcare system in the Czech Republic.MethodsIn total, 1274 consecutively collected patients discharged in a stable condition from hospitalization for acute heart failure (= index hospitalization) from 2006 to 2012 were followed-up for 2 years. Their all-cause mortality and all-cause hospitalizations were retrospectively evaluated. The in-patient costs were calculated based on the relative weights of DRG codes for particular hospitalization events and on the basic DRG tariff for 2013 (CZK 28,898).ResultsAt the end of the 2-year follow-up, a total of 1511 hospitalizations were recorded. A total of 31.8% of patients survived without any hospitalization, 32.1% of patients survived with at least one hospitalization, and 36.1% of patients died. Re-hospitalizations for acute heart failure accounted for 31.2% of all cases. The average cost for one chronic HF patient hospitalized for any reason was CZK 85,414; the cost for acute heart failure re-hospitalization was CZK 31,320 during the 2-year follow-up period. The cost of all-cause hospitalizations within the first year after the index hospitalization was higher compared to the cost during the second year (CZK 58,528/year vs. CZK 23,082/year). As the estimated number of chronic HF patients is 230,000 (data from the Institute of Health Information and Statistics of the Czech Republic), we can calculate the total cost of all-cause hospitalizations of chronic HF patients to be approximately CZK 7.98 billion per year in the Czech Republic.ConclusionThe data from clinical practice confirm that patients with chronic HF discharged from acute heart failure hospitalization are at high risk of death and/or subsequent hospitalization. The average annual costs for all-cause hospitalizations of CHS patients within the first and second years are CZK 58,528 and CZK 23,082 per patient, respectively. The costs attributed to all-cause hospitalization care of chronic HF patients can be estimated as approximately 7.7% of all annual inpatient expenses of health insurance companies and 2.7% of total healthcare expenditures in the Czech Republic.     

Pulse pressure and risk of cardiovascular events in the systolic hypertension in the elderly program.

Pulse pressure has been related to higher risk of cardiovascular events in older persons. Isolated systolic hypertension is common among the elderly and is accompanied by elevated pulse pressure. Treatment of isolated systolic hypertension may further increase pulse pressure if diastolic pressure is lowered to a greater extent than systolic pressure. Little is known regarding pulse pressure as a predictor of cardiovascular outcomes in elderly persons with isolated systolic hypertension, and the influence of treatment on the pulse pressure effect. We assessed the relation between pulse pressure, measured throughout the follow-up period, and the incidence of coronary heart disease (CHD), heart failure (HF), and stroke in 4,632 participants in the Systolic Hypertension in the Elderly Program, a 5-year randomized, placebo-controlled clinical trial of treatment of isolated systolic hypertension in older adults. In the treatment group, a 10-mm Hg increase in pulse pressure was associated with a statistically significant 32% increase in risk of HF and a 24% increase in risk of stroke after controlling for systolic blood pressure and other known risk factors, as well as with a 23% increase in risk of HF and a 19% increase in risk of stroke after controlling for diastolic blood pressure and other risk factors. Pulse pressure was not significantly associated with HF or stroke in the placebo group, nor with incidence of CHD in either the placebo or treatment group. These results suggest that pulse pressure is a useful marker of risk for HF and stroke among older adults being treated for isolated systolic hypertension.