What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Atrioventricular block (n=15181402). Primary outcome: Age- and sex-standardized prevalence of all atrioventricular block (per 1000) (95% CI 7.01-7.11).

June 11, 2021Open Access

Prevalence and risk factors of atrioventricular block among 15 million Chinese health examination participants in 2018: a nation-wide cross-sectional study

Key Result

The age- and sex-standardized prevalence of atrioventricular block among 15 million Chinese adults undergoing routine health examinations was 7.06 per 1000, with older age and male sex increasing risk.

Study Design

Type

Cross-Sectional (n=15,181,402)

Multicenter

Yes

Structured PICO

Population

15,181,402 adults aged ≥ 18 years (mean age 41.5 ± 13.4 years, 53.2% men) who underwent a 12-lead electrocardiogram as a part of routine health examination in 2018 across 454 centers from 224 cities in 30 provinces in China.

Outcome

Prevalence and risk factors of all, first-, second-, and third-degree atrioventricular (AV) block

First-degree AV block is relatively common (6.84‰) while severe AV block is rare in Chinese health examination adults, with higher prevalence associated with older age, male sex, and metabolic risk factors.

Limitations

Based on a physical examination population, mostly ostensibly healthy, limiting generalizability to the general population
Cross-sectional design limits causal inference regarding potential risk factors
Information on education level, diet, and lifestyle were not available

Abstract

BACKGROUND: Nationwide data on the prevalence of atrioventricular (AV) block are currently unavailable in China. Thus, we aimed to assess the prevalence and risk factors of AV block among Chinese health examination adults. METHODS: A total of 15,181,402 participants aged ≥ 18 years (mean age 41.5 ± 13.4 years, 53.2% men) who underwent an electrocardiogram as a part of routine health examination in 2018 were analyzed. AV block was diagnosed by physicians using 12-lead electrocardiogram. Overall and stratified prevalence (by age, sex, and city size) of all, first-, second- and third-degree AV block were calculated. Multivariable logistic regression analyses were performed to explore risk factors associated with AV block. RESULTS: AV block was observed in 88,842 participants, including 86,153 with first-degree, 2249 with second-degree and 440 with third-degree AV block. The age- and sex-standardized prevalence rate 95% confidence interval (CI) of all, first-, second- and third-degree AV block were 7.06‰ (7.01-7.11), 6.84‰ (6.79-6.89), 0.18‰ (0.17-0.18) and 0.04‰ (0.03-0.04) respectively. After multivariable adjustment, the risk of AV block was positively associated with older age, being male, lower heart rate, higher body mass index, hypertension, diabetes and low high-density lipoprotein cholesterol. High total cholesterol was associated with a lower risk of AV block. CONCLUSION: First-degree AV block is relatively common while severe AV block is rare in health examination adults. Besides, AV block was highly prevalent among the elderly. The risk of AV block was associated with older age, being male and metabolic factors.

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