https://scholars.lib.ntu.edu.tw/handle/123456789/508365
標題: | Influence of Different Treatment Strategies on New-Onset Atrial Fibrillation Among Patients With Primary Aldosteronism: A Nationwide Longitudinal Cohort-Based Study | 作者: | CHIEN-TING PAN CHE-WEI LIAO CHENG-HSUAN TSAI ZHENG-WEI CHEN Chen, Likwang CHI-SHENG HUNG Liu, Yu-Chen Lin, Po-Chin CHIN-CHEN CHANG Chang, Yi-Yao VIN-CENT WU YEN-HUNG LIN SHIH-CHIEH CHUEH |
公開日期: | 2020 | 卷: | 9 | 期: | 5 | 起(迄)頁: | e013699 | 來源出版物: | Journal of the American Heart Association | 摘要: | Background-—Primary aldosteronism (PA) is associated with higher atrial fibrillation prevalence and other cardiovascular complications. However, the effect of target treatment to prevent new-onset atrial fibrillation (NOAF) remains unclear. This study investigated incidence of NOAF under different treatment strategies in patients with PA. Methods and Results-—We analyzed longitudinal data for patients with PA without atrial fibrillation history from 1997 to 2009 within the National Health Insurance Research Database in Taiwan. Patients with essential hypertension matched by propensity score were enrolled as controls. The primary outcome measurement was NOAF, and secondary outcome measurements were mortality, major cardiac and cardiac/cerebrovascular events, and a combined end point of NOAF and mortality. We identified 2202 patients with PA (534 adrenalectomy, 1668 mineralocorticoid receptor antagonist [MRA] therapy) and 8808 essential hypertension controls with mean follow-up of 4.4 years. In primary outcome measurement, patients with PA who underwent adrenalectomy had a lower incidence of NOAF (adjusted hazard ratio; 0.28, P=0.011) than controls. In contrast, the patients with PA who received MRA therapy had comparable risk of NOAF (adjusted hazard ratio, 1.20; P=0.224). In secondary outcome measurement, patients with PA who underwent adrenalectomy had a lower rate of mortality and combined end point of NOAF and mortality than controls. Patients with PA who received MRA therapy had a higher risk of mortality, major cardiac and cardiac/cerebrovascular events, and combined NOAF with mortality than the essential hypertension controls. Conclusions-—Compared with patients with essential hypertension, patients with PA who underwent adrenalectomy had a lower incidence of NOAF. However, this finding was not observed in patients with PA who received MRA therapy with a lower dose. Differences between the 2 strategies may reduce with a higher dose of MRA therapy. ( J Am Heart Assoc. 2020;9:e013699. DOI: 10.1161/JAHA.119.013699.). ? 2020 The Authors. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/508365 | ISSN: | 2047-9980 | DOI: | 10.1161/JAHA.119.013699 | SDG/關鍵字: | aldosterone; spironolactone; mineralocorticoid antagonist; adrenalectomy; adult; all cause mortality; Article; cerebrovascular disease; clinical outcome; cohort analysis; controlled study; data analysis; essential hypertension; factual database; female; follow up; high risk patient; human; incidence; longitudinal study; major clinical study; male; middle aged; mortality rate; mortality risk; new-onset atrial fibrillation; outcome assessment; primary hyperaldosteronism; priority journal; retrospective study; Taiwan; adrenalectomy; adverse event; aged; atrial fibrillation; comparative study; epidemiology; hyperaldosteronism; mortality; risk factor; treatment outcome; Adrenalectomy; Aged; Atrial Fibrillation; Databases, Factual; Female; Humans; Hyperaldosteronism; Incidence; Longitudinal Studies; Male; Middle Aged; Mineralocorticoid Receptor Antagonists; Retrospective Studies; Risk Factors; Taiwan; Treatment Outcome |
顯示於: | 法醫學科所 |
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