An index of open-access content relevant to atrial fibrillation
Dynamic Trajectory of Exercise Rehabilitation Adherence of Patients with Atrial Fibrillation after Radiofrequency Ablation in the Internet+ Home Cardiac Rehabilitation Mode
WANG Jie1，SUN Guozhen1，2*，YANG Gang2，BAO Zhipeng2，LIU Shenxinyu1，WANG Lin2
1.School of Nursing，Nanjing Medical University，Nanjing 210029，China
2.Department of Cardiology，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China
*Corresponding author：SUN Guozhen，Professor，Master supervisor；E-mail：gzsun100@126.com
Abstract: Background Decreased exercise endurance still exists after atrial fibrillation radiofrequency ablation. A number of studies have proved that atrial fibrillation exercise rehabilitation is effective，and adherence is a key determinant of whether the patient continues to benefit from exercise therapy. Therefore，understanding the dynamic changes and influencing factors of patients' exercise adherence after atrial fibrillation radiofrequency ablation is of great significance to establish the mechanism of internalization of external dynamics in patients' home exercise rehabilitation. Objective To analyze the longitudinal follow-up data of home-based exercise rehabilitation in patients with atrial fibrillation after radiofrequency ablation，reveal the dynamic change of exercise adherence and explore its influencing factors，in order to provide theoretical basis for the formulation of targeted intervention strategies. Methods A total of 72 patients with atrial fibrillation after radiofrequency ablation who were selected by convenient sampling method from February 2019 to August 2020 in the First Affiliated Hospital of Nanjing Medical University，were treated with Internet+ home exercise rehabilitation intervention for 12 weeks，and followed up to 24 weeks. The average adherence rates in seven time periods of 0-1 week，2-4 weeks，5-8 weeks，9-12 weeks，13-16 weeks，17-20 weeks and 21-24 weeks were collected. A multi-stage latent growth curve model was constructed for exercise adherence，and robust maximum likelihood estimation（MLR）was used to estimate the mean，the variance and the covariance. Taking gender，education，working status，the existence of comorbidities and frequency adherence as covariates，the latent growth curve model was constructed for intensity-time adherence and the parameters were estimated by MLR method. Results Intensity-time adherence and frequency adherence both showed a second-stage curve increasing trend model，suggesting that there is a turning point in the development of adherence，in the 12th week of exercise. The first-stage of intensity-time adherence（from the beginning to 12th week）showed a curve increasing trend，and the increasing rate slowed down with time（Q1=-0.062，P<0.05）；The second stage（from 12 weeks to 24 weeks of exercise）showed a linear downward trend（S2=-0.081，P<0.05），and the differences in the initial level and growth rate of individuals were statistically significant（P<0.05）. Frequency adherence showed a quadratic growth trend in the first stage，reaching the peak at the 4th week of exercise，and then decreased slightly；The second stage showed a quadratic downward trend，and the rate of decline accelerated with time（Q2=0.003，P<0.05），and the differences between the individual's initial level and the acceleration of change were statistically significant（P<0.05）. Among the time-constant covariates，only the existence of comorbidities had a significant impact on intensity-time adherence at the first week（P<0.05）. Between the first week and the 24th week，frequency adherence had a positive impact on intensity-time adherence（P<0.05）. Conclusions During the intervention period，the level of intensive-time adherence and frequency adherence are relatively low，both with a curve increasing trend and stabilizing at a higher level，while the adherence decreased gradually during the follow-up period. Patients with comorbidities had poor initial intensity-time adherence，while frequency adherence had a positive impact on intensity-time adherence.
New Value of CHA2DS2-VASc Scoring System：Screening for Atrial Fibrillation and Ischemic Stroke in Community-living Elderly Population
YANG Hong1，LIU Jun2*，FENG Zhigang1，GAO Dayong1，SONG Weihua2
1.Yongdinglu Community Health Center，Aerospace Center Hospital，Beijing 100036，China
2.Fuwai Hospital，Chinese Academy of Medical Sciences and Peking Union Medical College，Beijing 100037，China
*Corresponding author：LIU Jun，Associate chief physician；E-mail：liujundoctor@163.com
Abstract: Background The elders are a high-risk population for atrial fibrillation（AF）.Improving the level of accurately screening for AF among the elderly in the community can help to reduce the risk of AF-related stroke.Objective To examine whether the CHA2DS2-VASc scoring system is feasible for the screening of AF and ischemic stroke in the elderly in the community.Methods The long-term older residents in a community，Beijing's Haidian District，were enrolled from October 2019 to March 2020.Medical history（including basic characteristics，and morbidity of common diseases），and results of normal 12-lead electrocardiogram were collected.Ischemic stroke risk was estimated by using the CHA2DS2-VASc scoring system.Results A total of 328 olders were enrolled，including 40（12.2%） with AF and 60（18.3%） with ischemic stroke detected by the screen，with a mean CHA2DS2-VASc score of（3.2±1.5） points.Participants with AF had higher mean CHA2DS2-VASc score than those without（P<0.05）.The mean CHA2DS2-VASc score of those with ischemic stroke was higher than that of those without（P<0.05）.The AF prevalence in participants with CHA2DS2-VASc score from 0 to 6 was 0，4.8%（2/42），3.7%（2/54），14.6%（12/82），15.8%（12/76），8.3%（4/48），and 40.0%（8/20），respectively，showing a gradual increase with the CHA2DS2-VASc score（rs=0.248，P<0.001）.The ischemic stroke prevalence in participants with CHA2DS2-VASc score from 0 to 6 was 0，4.8%（2/42），11.1%（6/54），12.2%（10/82），18.4%（14/76），45.8%（22/48），and 30.0%（6/20），respectively，demonstrating a gradual increase with the CHA2DS2-VASc score（rs=0.296，P=0.001）.Conclusion The CHA2DS2-VASc scoring system could be used to screen for AF and ischemic stroke in community-living elderly population.The olders with a higher CHA2DS2-VASc score may have a higher AF or stroke prevalence.
A Six-year Follow-up Study on the Prognosis in Elderly Patients with Ischemic Stroke Combined with Atrial Fibrillation and Coronary Heart Disease
DONG Min1，XU Lei2，HE Qinghua3，PEI Zuowei1，QU Yimei1，YANG Jiefu1，WANG Fang1*
1.Department of Cardiology，Beijing Hospital/National Center of Gerontology/Institute of Geriatric Medicine，Chinese Academy of Medical Sciences，Beijing 100730，China
2.Department of Neurology，Beijing Hospital/National Center of Gerontology/Institute of Geriatric Medicine，Chinese Academy of Medical Sciences，Beijing 100730，China
3.Department of Endocrinology，Beijing Hospital/National Center of Gerontology/Institute of Geriatric Medicine，Chinese Academy of Medical Sciences，Beijing 100730，China
*Corresponding author：WANG Fang，Chief physician；E-mail：bjh_wangfang@163.com
Abstract: Background In recent years，patients with atrial fibrillation and coronary heart disease have attracted more and more attention in clinic.Recent clinical studies mainly focused on the prevention and treatment of stroke and thromboembolic events.Objective To evaluate the long-term survival rate of elderly patients with ischemic stroke combined with atrial fibrillation and coronary heart disease，and analyze the risk factors which affected the prognosis.Methods We conducted a retrospective cohort study.A retrospective analysis of 406 patients over 60 years admitted to hospital due to acute ischemic stroke for the first time were enrolled，and 164 patients with atrial fibrillation and coronary heart disease were selected from them as cerebrovascular disease group，164 patients without cerebrovascular disease but with atrial fibrillation and coronary heart disease matched with age，gender and comorbidities were selected from concurrent hospitalized patients in the Department of Cardiology as non-cerebrovascular disease group.The clinical data，including demographic information，types of diseases，types of medications，blood pressure，heart rate，cardiovascular diseases and other diseases of the two groups were collected，laboratory test，echocardiographic parameters，treatment plan.The CHA2DS2-VASc score and CHADS2 score were used to assess the risk of stroke and thromboembolism，and the HAS-BLED score was used to assess the risk of bleeding.The patients were followed up for at least 6 years by telephone，outpatient and inpatient records after discharge，to record the death，readmission and major adverse cardiovascular events（MACE），and to explore the factors that affect his long-term prognosis.Results Compared with non-cerebrovascular disease group，the proportion of hyperlipidemia and chronic gastrointestinal disease in cerebrovascular disease group was lower.LVEDD，CHA2DS2-VASc score，CHADS2 score，and the HAS-BLED score in cerebrovascular disease group were higher（P<0.05）.In the 164 patients with cerebrovascular disease group，2 cases were lost to follow-up（1.2%），and 80 cases died（49.4%）.They were divided into death group（80 cases） and survival group（82 cases） according to the survival outcome.The death group was older and had lower systolic and diastolic blood pressure than the survival group，and the proportion of hypertension，hyperlipidemia，serum albumin and the use of statins were also lower than the survival group.The resting heart rate and the proportion of old myocardial infarction，the proportion of heart failure，chronic kidney disease，NYHA，D-dimer and NT-proBNP levels in death group were higher than the survival group（P<0.05）.The results of multivariate Cox regression analysis showed that for every 10 years of age increase〔HR=1.63，95%CI（1.05，2.51）〕，history of old myocardial infarction〔HR=2.19，95%CI（1.14，4.22）〕 and D-Dimer ≥148 μg/L〔HR=6.99，95%CI（2.10，23.28）〕 were independent risk factors for long-term mortality in elderly patients with ischemic stroke combined with atrial fibrillation and coronary heart disease，while hypertension〔HR=0.28，95%CI（0.11，0.72）〕 and statins use〔HR=0.38，95%CI（0.19，0.78）〕 were the protective factors for long-term death in these patients.Conclusion The long-term mortality of patients with atrial fibrillation and coronary heart disease after the first occurrence of cerebrovascular disease is not related to the coexisting cerebrovascular disease，but related to aging，history of old myocardial infarction and D-dimer level.Maintaining an appropriate blood pressure level and using statins may reduce the long-term mortality patients with atrial fibrillation and coronary heart disease.
Antithrombotic Therapies for Patients with Nonvalvular Atrial Fibrillation：a Single-center Comparative Analysis and Recommendations
XIE Huanglie 1，HAN Pengyu1，ZHENG Chaoyang2*，ZHU Wei3，TAO Wenxiang 1，WANG Hengkun1
1.The Second Clinical Medical College of Guangzhou University of Chinese Medicine，Guangzhou 510403，China
2.Department of Cardiovascular，Guangdong Provincial Hospital of Chinese Medicine，Guangzhou 510403，China
3.Key Laboratory of Clinical Research for Traditional Chinese Medicine Syndrome，Guangdong Provincial Hospital of Chinese Medicine，Guangzhou 510403，China
*Corresponding author：ZHENG Chaoyang，Chief physician；E-mail：zhengchaoyang2233@163.com
Abstract: Background Nonvalvular atrial fibrillation（AF）is a common clinical arrhythmia disease，and AF-related stroke is one of its commonest complications.Available relevant clinical studies mainly focus on antithrombotic therapies or the achievement of antithrombotic goals in coronary heart disease（CHD）patients with AF，but rarely compare the long-term safety and efficacy of different therapies.Objective To compare the efficacy，safety and one-year AF-related endpoint events of different antithrombotic therapies in nonvalvular AF patients，regardless of age and by age group.Methods The included 354 nonvalvular AF inpatients were recruited from Department of Cardiovascular，Guangdong Provincial Hospital of Chinese Medicine from January to October 2018.Information was collected，including gender，age，type of AF（paroxysmal，perpetual，persistent，long-standing persistent），complications（stroke/ transient ischemic attack，heart failure，hypertension，diabetes，CHD，hyperlipidemia），cTnT，CHA2DS2-VASc score，and HAS-BLED score.Also，the incidence of thromboembolic events，hemorrhagic events，all-cause deaths and readmission within one-year follow-up period was obtained.The efficacy and safety were compared between groups treated with non-antithrombotic regimen（42 cases），aspirin（21 cases），clopidogrel（51 cases），dual antiplatelet therapy（25 cases），warfarin（49 cases），dabigatran（89 cases）and rivaroxaban（89 cases）.And these regimens' efficacy and safety were further analyzed based on age group﹝<65 age group（60 cases），65-75 age group（92 cases），>75 age group（202 cases）﹞.Results The proportion of men in dual antiplatelet therapy group was higher than that in non-antithrombotic regimen group（P<0.05）.The average age of warfarin group was younger than that of clopidogrel group（P<0.05）.Paroxysmal AF prevalence in rivaroxaban group was lower than that in dual antiplatelet therapy group（P<0.05）.CHD prevalence in non-antithrombotic group was lower than that of clopidogrel group or dual antiplatelet therapy group，and so did that in warfarin group（P<0.05）.CHD prevalence in dual antiplatelet therapy group was higher than that of rivaroxaban group or dabigatran group（P<0.05）.The average cTnT level of dual antiplatelet therapy group was higher than that of other five groups（P<0.05）.Clopidogrel group had higher average HAS-BLED score than dabigatran group（P<0.05）.The groups treated with different regimens showed statistically significant differences in the incidence of thromboembolic events within one-year follow-up（χ2=12.404，P=0.054）.They also showed statistically obvious differences in the incidence of bleeding events within one-year follow-up（χ2=14.420，P=0.019）.But they demonstrated similar incidence of all-cause deaths（χ2=9.925，P=0.128）.The readmission rate of patients in three age groups was significantly different（P<0.05）.Conclusion Early identification of AF and timely antithrombotic therapy are of great significance in preventing thromboembolism.New oral anticoagulants（NOAC）or warfarin may be the first choice for antithrombotic treatment of nonvalvular AF.NOAC is not inferior to warfarin in preventing thrombosis and bleeding，but the risk of gastrointestinal bleeding should be paid attention to.For elderly AF patients，individualized anticoagulant therapy may be more effective.
Computer-aided Diagnosis Model Assists Paroxysmal Atrial Fibrillation Diagnosis in Primary Care
YAO Yi1，LIAO Xiaoyang1*，LI Zhichao2*
1.International Medical Center，General Practice Unit，West China Hospital，Sichuan University，Chengdu 610041，China
2.Day Surgery Center，West China Hospital，Sichuan University，Chengdu 610041，China
*Corresponding authors：LIAO Xiaoyang，Chief physician，Professor；E-mail：625880796@qq.com
LI Zhichao，Attending physician；E-mail：5348203@qq.com
Abstract: Atrial fibrillation is a common arrhythmia that can cause many serious complications.Among them，paroxysmal atrial fibrillation is difficult to diagnose due to paroxysmal and asymptomatic characteristics.Big ECG data obtained by long-term ECG can improve the detection rate of paroxysmal atrial fibrillation.However，the interpretation of ECG big data has become a burden and problem for primary medical institutions.To solve the problems，a variety of shallow learning models based on ECG features have been developed，which highly rely on manual feature extraction and have limitations.Deep learning is a data-driven automatic feature learning algorithm，which can make up for the shortcomings of shallow learning.As an emerging method for rapid analysis of ECG big data，the Lorenz scatterplots using two-dimensional graphs is high-quality materials for deep learning.This paper reviews the latest advances in ECG features of atrial fibrillation using computer-aided model for diagnosis，and the application of machine learning in atrial fibrillation diagnosis，providing new insights into the development of a good computer-aided diagnosis model，and a new perspective for the interpretation of ECG big data in primary care.
Refection on the Collaborative and Integrated Management Pathway for Atrial Fibrillation by a Large Tertiary General Hospital and a Community Hospital
YANG Rong1，LIU Changming1，LIAO Xiaoyang1*，WANG Lei2
1. International Medical Center，General Practice Unit，West China Hospital，Sichuan University，Chengdu 610041，China
2. Shuangliu District Xihanggang Community Hospital，Chengdu 610041，China
*Corresponding author：LIAO Xiaoyang，Chief physician，Professor，Master supervisor；E-mail：625880796@qq.com
YANG Rong and LIU Changming are the first authors
Abstract: Atrial fibrillation（AF） is one of the least manageable cardiovascular diseases in the 21st century. As a result of deepening understanding of AF，continuous promotion of the implementation of hierarchical medical system，and appropriately allocating medical resources to primary care gradually，a tertiary general hospital actively cooperates with a community hospital to carry out a new pattern for integrated management of AF has become an exploratory focus during the medical consortium development. AF，as a high-risk chronic disease，plays an important role in the cardiovascular disease continuum，given that hypertension is its high-risk factor and stroke is one of its complications. Therefore，in addition to managing patients with hypertension，it is necessary for community hospitals to early screen hypertension or stroke or other coexisting conditions in AF patients，and deliver a series of targeted comprehensive management accordingly. We introduced an example of comprehensive management of AF by West China Hospital，Sichuan University and Shuangliu District Xihanggang Community Hospital，a tertiary general hospital in combination with a community hospital. Specifically，by means mainly consist of providing online and offline precise trainings for community general practitioners by physicians from West China Hospital，providing AF-related health education and free consultations for contracted residents，and adopting a bi-directional referral pathway for AF patients，the two hospitals collaboratively managed AF dynamically and comprehensively based on the patient's conditions using integrated general care or/and specialty care in an exploratory way. By presenting a detailed analysis and concise summary of the collaborative experience of these two hospitals，we aimed to offer help for the development of a systematic and standard pattern for collaborative management of AF by a tertiary general hospital and a community hospital，and for the empirical exploration of new ways for the specific implementation of hierarchical medical system.
Investigation of Anticoagulation Strategies in Nonvalvular Atrial Fibrillation Patients Aged 80 and Over
CHEN Jingwen，PEI Linghua，CHEN Chao，WANG Shen，HUANG Shuwei*
Cardiovascular Department，the Second Affiliated Hospital of Zhejiang Chinese Medical University，Hangzhou 310005，China
*Corresponding author：HUANG Shuwei，Chief physician；E-mail：cc123X@163.com
Abstract: Background The proportion of anticoagulant therapy in elderly patients with nonvalvular atrial fibrillation is generally low.The actual situation of anticoagulation in this population is greatly different from the guideline and there is a lack of clinical evidence in the decision of anticoagulant regimens.Objective The study aimed to investigate anticoagulant regimen use and prognosis in nonvalvular atrial fibrillation patients aged 80 and over.Methods 516 patients （≥80 years）with an initial diagnosis of nonvalvular atrial fibrillation or with a previous diagnosis but without anticoagulant therapy treated in the Second Affiliated Hospital of Zhejiang Chinese Medical University between September 2016 and September 2018 were selected.An analysis was performed on clinical data obtained via reviewing the electronic medical records in the hospital information system and follow-up data，including gender，age，smoking history，comorbidities 〔hypertension，diabetes，coronary artery disease，cardiomyopathy，heart failure，and chronic obstructive pulmonary disease（COPD）〕，types of atrial fibrillation（persistent，paroxysmal or permanent atrial fibrillation），history of ischemic stroke，history of hemorrhage，estimated glomerular filtration rate（eGFR），CHA2DS2-VASc score，HAS-BLED score，post-discharge anticoagulant regimen（warfarin，rivaroxaban，dabigatran or using no anticoagulant therapy），duration of anticoagulant treatment，use of antiplatelet drugs，adverse reactions（bleeding events，ischemic stroke，hemorrhagic stroke，and all-cause mortality）.The influencing factors of death，ischemic stroke and bleeding events were analyzed using binary Logistic regression.Results Among the participants，137（26.6%）received anticoagulation therapy，including 21 received oral warfarin（4.1%），67 received oral rivaroxaban（13.0%），and 49 received oral dabigatran（9.5%）；379（73.5%）received non-anticoagulant therapy，including 266 received single antiplatelet agents（51.6%），53 received dual antiplatelet agents（10.3%），and 60 received no antiplatelet agent（11.6%）.Sex ratio，average age，prevalence of comorbidities（hypertension，diabetes，coronary artery disease，cardiomyopathy，heart failure，and COPD），prevalence of having a history of smoking，ischemic stroke or hemorrhage，and average eGFR，CHA2DS2-VASc score，and HAS-BLED score，and hemorrhage（mild，moderate，severe）showed no significant differences among participants used warfarin，rivaroxaban，dabigatran and those used no anticoagulant therapy（P>0.05），but ischemic stroke prevalence and all-cause mortality were significantly different（P<0.05）.There was no significant difference in the duration of anticoagulation treatment between three anticoagulation treatment groups（P>0.05）.Binary Logistic regression analysis showed that CHA2DS2-VASc score and anticoagulant regimen were associated with ischemic stroke（P<0.05）.Anticoagulant regimen was associated with death（P<0.05）.HAS-BLED score was associated with bleeding events（P<0.05）.Conclusion The prevalence of anticoagulant therapy was relatively low in this group of elderly patients with nonvalvular atrial fibrillation.Non-anticoagulant therapy（including oral antiplatelet agents）increased the risk of death and ischemic stroke，while warfarin showed similar safety and effectiveness to new oral anticoagulants without increasing the risk of bleeding and death.
Level and Influencing Factors of Exercise Capacity in Atrial Fibrillation Patients after Radiofrequency Ablation
BAO Zhipeng1，SUN Guozhen1，2*，SHANG Shuhua1，YANG Gang2，WANG Lin2
1.School of Nursing，Nanjing Medical University，Nanjing 210029，China
2.Department of Cardiovascular Medicine，the First Affiliated Hospital with Nanjing Medical University，Nanjing 210029，China
*Corresponding author：SUN Guozhen，Professor；E-mail：gzsun100@126.com
Abstract: Background Low exercise capacity level is associated with high risk of death caused by cardiovascular disease.Exercise capacity may be an important factor affecting quality of life and clinical prognosis for patients with atrial fibrillation（AF）.Even among those with successful radiofrequency ablation，exercise capacity is still not optimistic in general.At present，there are few studies on its current situation and influencing factors in this group.Objective To investigate the exercise capacity level and its influencing factors among AF patients after radiofrequency ablation.Methods From May 2018 to June 2019，by use of convenience sampling，189 AF patients with radiofrequency ablation were selected from Department of Cardiovascular Medicine，the First Affiliated Hospital with Nanjing Medical University.A self-developed general situation questionnaire was used to survey their general characteristics.Cardiopulmonary exercise test （CPET） was used to evaluate patients' exercise capacity.Multiple linear regression was used to analyze the influencing factors of exercise capacity.Results The mean maximal oxygen uptake （VO2max） in the participants was （19.7±6.1）ml?kg-1?min-1.According to the Weber classification in cardiac rehabilitation，VO2max was classified as level A in 85 cases （45.0%），level B in 45 cases （23.8%），level C in 52 cases （27.5%） and level D in 7 cases （3.7%）.The postoperative VO2max differed obviously by sex，age，education level，smoking，drinking，exercise habit，preoperative NYHA class，preoperative EHRA class，and BMI （P<0.05）.Multiple linear regression analysis revealed that exercise habit 〔β=3.956，95%CI（2.746，5.269）〕，preoperative EHRA score 〔β=-4.651，95%CI（-5.318，-3.983）〕，and BMI 〔β=-0.224，95%CI（-0.383，-0.066）〕 were associated factors of VO2max in patients with AF after radiofrequency ablation（P<0.05）.Conclusion Despite the success of radiofrequency ablation for patients with AF，there is still varying degrees of decline in exercise capacity in the short term.Clinical interventions should be taken according to exercise habit，preoperative EHRA score，and BMI of patients to promote the improvement of exercise capacity and quality of life.
Clinical Characteristics of Patients with Cardiovascular Disease and Chronic Pulmonary Disease Complicated with Atrial Fibrillation
LIU Xiang，XIANG Li，ZHANG Lan，TONG Guangming*
Department of Cardiology，the Second Affiliated Hospital of Soochow University，Suzhou 215004，China
*Corresponding author：TONG Guangming，Chief physician；E-mail：tgm1@sina.com
Abstract: Background Atrial fibrillation is an independent risk factor for cerebral infarction.With the introduction of new anticoagulants in recent years，the anticoagulation ratio in patients with cardiovascular disease and atrial fibrillation has gradually increased，and the incidence of cerebral infarction shows the downward trend.However，relatively few reports on the incidence of cerebral infarction and current status of anticoagulant therapy in chronic pulmonary patients with atrial fibrillation are available.Objective To explore the clinical characteristics of patients with cardiovascular disease and chronic pulmonary disease complicated with atrial fibrillation in the same period of admission and the incidence of long-term cerebral infarction among them，and to evaluate the incidence of cerebral infarction and anticoagulation status in patients with chronic pulmonary disease and atrial fibrillation，in order to provide the early intervention and improve the prognosis.Methods 287 Patients with persistent or permanent atrial fibrillation admitted to the Second Affiliated Hospital of Soochow University were selected prospectively and continuously as the study subjects from June 2012 to May 2013.According to the main complications，the subjects were divided into the cardiovascular disease group（combined with cardiovascular diseases，n=162） and the lung disease group（combined with chronic pulmonary diseases，n=125）.The general data of patients，blood examination results in the early morning of the day after admission，echocardiographic data and CHA2DS2-VASc scores were recorded.The patients were followed up for a period of five years，and the use of anticoagulants and the incidence of cerebral infarction were recorded.Results The age，proportion of male，resting heart rate，heart failure proportion，right atrial long axis diameter，right atrial short axis diameter，right ventricular diameter（RVD） of basal segment，pulmonary artery pressure，prothrombin time（PT），D-dimer，international normalized ratio（INR），NT-proBNP，CHA2DS2-VASc scores and proportion of CHA2DS2-VASc scores≥4 in the lung disease group were higher than those in the cardiovascular disease group，while the level of thrombin Ⅲ was lower（P<0.05）.There was no significant difference in the use of anticoagulants between the two groups（P=0.208）.The proportion of clopidogrel，ACEI/ARB and amiodarone in the cardiovascular disease group was higher than that in the lung disease group（P<0.05）.During five consecutive years of follow-up，16（9.9%） patients in the cardiovascular disease group and 29（23.2%） patients in the lung disease group suffered from cerebral infarction.The difference between the two groups was statistically significant（χ2=9.477，P=0.002）.Multivariate Logistic regression analysis showed that age，CHA2DS2-VASc scores，right atrial short axis diameter and pulmonary artery pressure were the risk factors of cerebral infarction in patients with atrial fibrillation（P<0.05）.Conclusion The incidence of long-term cerebral infarction in patients with chronic pulmonary disease and atrial fibrillation is high during the same period of admission，and these patients have high CHA2DS2-VASc scores，right atrial diameter（RAD），RVD and pulmonary artery pressure.For patients with chronic pulmonary disease and atrial fibrillation，anticoagulation indications should be evaluated in time，and corresponding treatment schemes should be strengthened，and the treatment of comorbidities such as heart failure and pneumonia should be emphasized.
Application and challenge of novel oral anticoagulants in patients with nonvalvular atrial fibrillation
LIU Yue1，2，REN Yirong1，2，ZHU Huolan1，2，WANG Fang1，2*
1.Beijing Hospital/National Center of Gerontology，Beijing 100730，China
2.Graduate School of Peking Union Medical College，Beijing 100005，China
*Corresponding author: WANG Fang，Chief physician，Doctoral supervisor；E-mail: bjh_wangfang@163.com
Abstract: Risk assessment and prevention of stroke is an important part of comprehensive management of atrial fibrillation，the most common cardiac arrhythmia.Anticoagulation therapy is one intervention that can effectively reduce the incidence of atrial fibrillation-related stroke.Novel oral anticoagulants（NOACs）take effect by specifically blocking the key link in the development of clotting cascade，namely，the action of thrombin（coagulation factor Ⅱa） or coagulation factor Ⅹa，to inhibit the final stage of the coagulation pathway.NOACs，with the advantages of using a fixed dose，rapid oral absorption，small food-drug interactions，and using without monitoring routine coagulation indices，have become a hot research theme recently.This paper introduces the advances in clinical research and application of NOACs in atrial fibrillation，it is found that NOACs has the advantages of good efficacy and high safety，so as to guide clinical treatment.
Integrated Care Model for Screening and Multidisciplinary Collaboration of Community Patients with Atrial Fibrillation
LIU Yanli，MA Li*
General Practice Department，Beijing Tiantan Hospital，Capital Medical University，Beijing 100070，China
*Corresponding author：MA Li，Chief physician，Master supervisor；E-mail：mali_ttyy@126.com
Abstract: With the aging of the population，atrial fibrillation（AF） has become a major public health problem in China and worldwide.AF is an important risk factor for stroke，cardiovascular disease and embolism，which seriously threatens patient's health and quality of life.Studies abroad have shown that a multidisciplinary，nurse-led，patient-centered integrated care model can help reduce the readmission rate，incidence of cardiovascular events，and all-cause mortality of AF patients，as well as improve their satisfaction and quality of life.At present，there are many problems in the AF management in China，and a standardized integrated care model has not yet been formed.Based on domestic and foreign AF management guidelines and related literature，this paper reviewed the process of integrated care model for AF，including its screening，comprehensive evaluation，management strategy development，health education，regular follow-up and referrals，and specific content of each process.The process of AF screening and integrated care model suitable for the community in China were formulated preliminarily in this paper，which could provide a reference for the establishment of a AF standardized management system in the community.