本文由小咖机器人翻译整理

期刊来源：JAMA

文献发表时间：2023-09-12

原文链接：https://jamanetwork.com/journals/jama/article-abstract/2809418

关键点内容如下：

问题

久坐行为与老年人全因痴呆风险之间是否存在关联？

调查结果

这项回顾性研究前瞻性地收集了参与英国生物库的49841名成年人的数据，研究发现，久坐行为时间越长（通过对腕戴式加速计数据进行基于机器学习的分析确定）与发生痴呆的风险越高显著相关。

意义

在老年人中，久坐时间越长，发生全因痴呆的风险越高。

摘要内容如下：

重要性

久坐行为与心脏代谢疾病和死亡率相关，但其与痴呆的关系尚不清楚。

目的

调查加速度计评估的久坐行为是否与痴呆事件有关。

研究设计和参与者

一项回顾性研究前瞻性地收集了来自英国生物银行的数据，包括49841名年龄在60岁或以上的成年人，他们在佩戴腕部加速计时未被诊断为痴呆，并且居住在英格兰、苏格兰或威尔士。随访开始于佩戴加速计时（2013年2月至2015年12月），并持续至英格兰2021年9月、苏格兰2021年7月和威尔士。

暴露

2018年2月。平均每日久坐行为时间（包括在主要分析中）和平均每日久坐回合长度、最大每日久坐回合长度和平均每日久坐回合次数（包括在次要分析中）是通过对1周腕戴式加速计数据进行基于机器学习的分析得出的。

主要结局和措施

住院记录和死亡登记数据中的事件全因痴呆诊断。使用线性和三次样条项的Cox比例风险模型来评估相关性。

结果

共有49841名老年人（平均年龄67.19[SD，4.29]岁；）女性占54.7%，平均随访6.72年，（标准差，）0.95年。在此期间，有414人被诊断为偶发性全因痴呆。在完全调整的模型中，久坐行为时间与痴呆事件之间存在显著的非线性关联。相对于静坐行为的中位数9.27小时/天，痴呆的风险比（HR）在10小时/天时为1.08（95%CI，1.04-1.12，P<.001），在12小时/天时为1.63（95%CI，1.35-1.97，P<.001），在15小时/天时为3.21（959.27小时/d的静坐行为每1000人-年的校正痴呆发病率为7.49（95%CI，7.48-7.49），10小时/d为8.06（95%CI，7.76-8.36），12小时/d为12.00（95%可信区间，10.00-14.36），15小时/天为22.74（95%可信区间，14.92-34.11）。平均每日久坐发作时间（HR，1.53[95%CI，1.03-2.27]，P=0.04和0.65[95%CI，0.04-1.57]每1000人-年比平均0.48小时增加1小时的痴呆病例）和最大每日久坐发作时间（HR，1.15[95%可信区间1.02-1.31]，P=0.02-0.38]每1000人-年更多的痴呆病例，比）的平均值1.95小时增加1小时，与发生痴呆的高风险显著相关。每天久坐的次数与较高的痴呆发病风险无关（HR，1.00[95%CI，0.99-1.01]，P=.89）。在敏感性分析中，在对久坐行为的时间进行调整后，平均每日久坐时间和最大每日久坐时间不再与痴呆事件显著相关。

结论和相关性

在老年人中，久坐时间越长，全因痴呆的发病率越高。未来的研究需要确定久坐行为和痴呆风险之间的联系是否是因果关系。

英文原文如下：

Key Points

Question  Does atrial fibrillation catheter ablation have an impact on mental health?

Findings  In this randomized clinical trial of 100 patients with symptomatic atrial fibrillation, catheter ablation with reduction in arrhythmia burden and antiarrhythmic drug use was associated with improvement in markers of psychological distress compared with medical therapy alone.

Meaning  Improvement of severe psychological distress may be an additional benefit of catheter ablation treatment for atrial fibrillation.

Abstract

Importance  The impact of atrial fibrillation (AF) catheter ablation on mental health outcomes is not well understood.

Objective  To determine whether AF catheter ablation is associated with greater improvements in markers of psychological distress compared with medical therapy alone.

Design, Setting, and Participants  The Randomized Evaluation of the Impact of Catheter Ablation on Psychological Distress in Atrial Fibrillation (REMEDIAL) study was a randomized trial of symptomatic participants conducted in 2 AF centers in Australia between June 2018 and March 2021.

Interventions  Participants were randomized to receive AF catheter ablation (n = 52) or medical therapy (n = 48).

Main Outcomes and Measures  The primary outcome was Hospital Anxiety and Depression Scale (HADS) score at 12 months. Secondary outcomes included follow-up assessments of prevalence of severe psychological distress (HADS score >15), anxiety HADS score, depression HADS score, and Beck Depression Inventory-II (BDI-II) score. Arrhythmia recurrence and AF burden data were also analyzed.

Results  A total of 100 participants were randomized (mean age, 59 [12] years; 31 [32%] women; 54% with paroxysmal AF). Successful pulmonary vein isolation was achieved in all participants in the ablation group. The combined HADS score was lower in the ablation group vs the medical group at 6 months (8.2 [5.4] vs 11.9 [7.2]; P = .006) and at 12 months (7.6 [5.3] vs 11.8 [8.6]; between-group difference, −4.17 [95% CI, −7.04 to −1.31]; P = .005). Similarly, the prevalence of severe psychological distress was lower in the ablation group vs the medical therapy group at 6 months (14.2% vs 34%; P = .02) and at 12 months (10.2% vs 31.9%; P = .01), as was the anxiety HADS score at 6 months (4.7 [3.2] vs 6.4 [3.9]; P = .02) and 12 months (4.5 [3.3] vs 6.6 [4.8]; P = .02); the depression HADS score at 3 months (3.7 [2.6] vs 5.2 [4.0]; P = .047), 6 months (3.4 [2.7] vs 5.5 [3.9]; P = .004), and 12 months (3.1 [2.6] vs 5.2 [3.9]; P = .004); and the BDI-II score at 6 months (7.2 [6.1] vs 11.5 [9.0]; P = .01) and 12 months (6.6 [7.2] vs 10.9 [8.2]; P = .01). The median (IQR) AF burden in the ablation group was lower than in the medical therapy group (0% [0%-3.22%] vs 15.5% [1.0%-45.9%]; P < .001).

Conclusion and Relevance  In this trial of participants with symptomatic AF, improvement in psychological symptoms of anxiety and depression was observed with catheter ablation, but not medical therapy.

医咖会员已正式上线，点击链接https://new.mediecogroup.com/user/vip/categories/，查看会员12项权益！