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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 簡國龍(Kuo-Liong Chien) | |
dc.contributor.author | Cheng Chun Wei | en |
dc.contributor.author | 魏丞駿 | zh_TW |
dc.date.accessioned | 2021-06-07T17:33:04Z | - |
dc.date.copyright | 2020-08-27 | |
dc.date.issued | 2020 | |
dc.date.submitted | 2020-07-01 | |
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/15343 | - |
dc.description.abstract | 背景與目標:根據流行病學的資料,心跳過快已被證實是臨床上不良預後的重要預測因子。本研究的目的是針對社區中的一般大眾和有急性心臟衰竭的病人,統合多個時間點的心跳資料,進而把心跳軌跡變化類似的個體進行分組,討論心跳軌跡和臨床上不良預後的關聯。 方法:在第一個研究以社區族群為主的世代研究,在1990年到2002年間,共有3434個受試者接受了最多4次的心跳測量,研究的主要目標是全死因死亡,次要目標是心血管疾病。第二個研究是以急性心衰竭病患為主,台灣心臟學會於2013年二月到2015年十月,共收錄了1509位病人,在住院,出院,出院後第六和第十二個月分別追蹤病人的心跳,研究的主要目標是全死因死亡,次要目標是心衰竭再住院。利用群組化軌跡模式把心跳變化型態類似的個體分組,再針對不同的臨床結果進行存活分析。同時也使用之前文獻中使用過的心跳參數,包含單點的心跳數值,或是兩點間心跳變化等,來和群組化軌跡模式做對照。 結果:以群組化軌跡模式所得到的組別,在社區研究中,可以見到心跳較快會隨時間增加的組別相比心跳穩定的組別,全死因死亡率明顯較高,其風險比為1.8,95%信賴區間為1.18-2.76。至於急性心臟衰竭的病人,出院後的六個月內心跳趨勢持續上升者,相較於心跳穩定的病人,全死因死亡和心衰竭再住院率會較高,其風險比為3.32 (95%信賴區間為1.31-8.40)和1.29 (95%信賴區間為1.05-1.57)。 結論:對於重複測量心跳的研究,心跳的趨勢變化研究展現了其實用性,在我們的研究中闡明了心跳趨勢和不良預後之間的相關性。 | zh_TW |
dc.description.abstract | Background and Objectives: Epidemiologic studies have demonstrated the elevated heart rate to be an indicator of adverse clinical outcomes. We tried to study the association of different heart rate trajectories with the adverse outcomes in community-based population and in patients with acute heart failure. Methods: For community-based population, 3434 participants were recruited with four repeated heart rate measurement between 1990 and 2002. The primary outcome was all-cause mortality, and the secondary outcome was the cardiovascular disease. For patients with acute heart failure, a total of 1509 patients were enrolled in Taiwan Society of Cardiology-the heart failure with reduced ejection fraction registry, beginning in Feb, 2013 to Oct, 2015. Heart rate was measured at admission, at discharge, 6 and 12 months post-discharge. The primary outcome was all-cause mortality and secondary outcome was heart failure re-admission. Group-based trajectory modeling analysis was conducted to stratify participants with repeated heart rate measurements. Results: In community based cohort study, those with markedly increased heart rate pattern would have higher risk of all-cause mortality than participants with stable pattern. The adjusted hazard ratios of all-cause mortality for participants with a markedly increased trajectory pattern were 1.80 (95% CI, 1.18-2.76) compared with those with a stable trajectory pattern. In patients with acute heart failure, patients with high-increasing trajectory pattern in 6 months had a higher risks of all-cause mortality and heart failure re-admission with adjusted hazard ratio 3.32 (95% CI, 1.31-8.40) and 1.29 (95% CI, 1.05-1.57) compared with those with low-stable trajectory. Conclusions: Trajectory patterns demonstrated the utility of repeated heart rate measurements and elucidated their associations with adverse outcomes. | en |
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dc.description.tableofcontents | 口試委員會審定書 i 致謝 ii Abstract iii 摘要 iv Chapter 1 Background 1 Section 1 The role of heart rate and biological postulated mechanisms on community based individuals and patients with acute heart failure 1 1.1 Introduction of heart rate as the basis of living 1 1.2 The role of heart rate on primary prevention 2 1.3 The role of heart rate on secondary prevention for acute heart failure patients 4 1.4 Heart rate change and adverse outcomes in community based individuals 8 1.5 Heart rate change and adverse outcomes in patients with cardiovascular diseases 9 Section 2 Important predictors for adverse outcomes in heart rate study 13 Section 3 Reviews of heart rate measurement parameters and methods in longitudinal studies 17 3.1 Conventional heart rate measurement parameters 17 3.2 Group based trajectory model for repetitive heart rate measurement 19 Chapter 2 The research gap and hypothesis of the study 26 Chapter 3 Methods 28 Section 1 study design of Chin-Shan community based cohort study 28 1.1 Clinical settings, inclusion and exclusion criteria 28 1.2 Definitions of outcomes and heart rate parameters 30 1.3 Statistical analysis in Chin-Shan Community Cohort Study 31 Section 2 study design of Taiwan Society of Cardiology Acute Heart Failure cohort 34 2.1 Study design and participants 34 2.2 Definitions of outcomes and heart rate parameters 36 2.3 Statistical analysis in TSOC acute heart failure cohort study 37 Chapter 4 Results 42 Section 1 Results of Chin-Shan Community Cohort Study 42 Section 2 Results of Taiwan Society of Cardiology Acute Heart Failure Cohort Study 45 Chapter 5 Discussion 50 Section 1 Heart rate parameters, trajectories and adverse outcomes 50 1.1 Main findings in community based population 50 1.2 Main findings in acute heart failure patients 53 Section 2 Comparison with previous articles 55 2.1 For community based cohort population 55 2.2 For acute heart failure patients 56 Section 3 The postulated mechanism of heart rate on adverse outcomes 58 3.1 For community based population 58 3.2 For acute heart failure patients 58 Section 4 Implications for clinical management 59 4.1 Implications on community based population 60 4.2 Implications on acute heart failure patients 60 Sections 5 Study strengths and limitations 61 5.1 Community based cohort study 61 5.2 Acute heart failure cohort study 62 References 64 Supplement 118 1. Codes of group based trajectory modeling 118 2. Galley proof of the article published in PeerJ 120 3. ACS 2020. Editorial Official Acceptation Note 138 | |
dc.language.iso | zh-TW | |
dc.title | 以健康族群和急性心衰竭病患為樣本的心跳軌跡與不良預後研究 | zh_TW |
dc.title | Association of heart rate trajectories with the risk of adverse outcomes in healthy individuals and in patients with acute heart failure | en |
dc.type | Thesis | |
dc.date.schoolyear | 108-2 | |
dc.description.degree | 博士 | |
dc.contributor.oralexamcommittee | 杜裕康(Yu-Kang Tu), 李文宗(Wen-Chung Lee), 季瑋珠(Wei-Chu Chie),葉宏一(Hung-I Yeh),陳文鐘(Wen-Jone Chen) | |
dc.subject.keyword | 心跳軌跡,急性心衰竭, | zh_TW |
dc.subject.keyword | heart rate trajectory,acute heart failure, | en |
dc.relation.page | 140 | |
dc.identifier.doi | 10.6342/NTU202001216 | |
dc.rights.note | 未授權 | |
dc.date.accepted | 2020-07-02 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 流行病學與預防醫學研究所 | zh_TW |
顯示於系所單位: | 流行病學與預防醫學研究所 |
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