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Paixão GMM, Silva LGS, Gomes PR, Lima EM, Ferreira MPF, Oliveira DM, Ribeiro MH, Ribeiro AH, Nascimento JS, Canazart JA, Ribeiro LB, Benjamin EJ, Macfarlane PW, Marcolino MS, Ribeiro AL. Evaluation of Mortality in Atrial Fibrillation: Clinical Outcomes in Digital Electrocardiography (CODE) Study. Glob Heart 2020; 15:48. [PMID: 32923342 PMCID: PMC7413140 DOI: 10.5334/gh.772] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/25/2020] [Indexed: 02/07/2023] Open
Abstract
Aims Atrial fibrillation (AF) is a public health problem and its prevalence is increasing worldwide. Electronic cohorts, with large electrocardiogram (ECG) databases linked to mortality data, can be useful in determining prognostic value of ECG abnormalities. Our aim is to evaluate the risk of mortality in patients with AF from Brazil. Methods This observational retrospective study of primary care patients was developed with the digital ECG database from the Telehealth Network of Minas Gerais, Brazil. ECGs performed from 2010 to 2017 were interpreted by cardiologists and the University of Glasgow automated analysis software. An electronic cohort was obtained linking data from ECG exams and those from a national mortality information system, using standard probabilistic linkage methods. We considered only the first ECG of each patient. Patients under 16 years were excluded. Hazard ratios (HR) for mortality were adjusted for demographic and self-reported clinical factors and estimated with Cox regression. Results From a dataset of 1,773,689 patients, 1,558,421 were included, mean age 51.6 years; 40.2% male. There were 3.34% deaths from all causes in 3.68 years of median follow up. The prevalence of AF was 1.33%. AF was an independent risk factor for all-cause mortality (HR 2.10, 95%CI 2.03-2.17) and cardiovascular mortality (HR 2.06, 95%CI 1.86-2.29). Females with AF had a higher risk of overall and cardiovascular mortality compared with males (p < 0.001). Conclusions AF was a strong predictor of cardiovascular and all-cause mortality in a primary care population, with increased risk in women. Condensed abstract To assess risk of mortality in AF patients, an electronic cohort was obtained linking data from ECG exams of Brazilian primary care patients and a national mortality information system. From 1,558,421 patients, AF (prevalence 1.33%) carried a higher risk of overall and cardiovascular mortality, with increased risk in women. What’s New This is the first study with a large Brazilian electronic cohort to evaluate the risk of mortality linked to AF in primary care patients.AF patients from a Brazilian primary care population had a higher risk of death for all causes (HR 2.10, 95%CI 2.03-2.17) and cardiovascular mortality (HR 2.06, 95%CI 1.86-2.29).Female patients with AF had an increased risk of overall and cardiovascular mortality compared with male patients (p < 0.001).
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Affiliation(s)
- Gabriela M. M. Paixão
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BR
| | - Luis Gustavo S. Silva
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BR
| | - Paulo R. Gomes
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BR
| | - Emilly M. Lima
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BR
| | - Milton P. F. Ferreira
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BR
| | - Derick M. Oliveira
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BR
| | - Manoel H. Ribeiro
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BR
| | - Antonio H. Ribeiro
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BR
| | - Jamil S. Nascimento
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BR
| | - Jéssica A. Canazart
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BR
| | - Leonardo B. Ribeiro
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BR
| | - Emelia J. Benjamin
- Department of Medicine, Boston University School of Medicine, Department of Public Health, Boston University School of Public Health, Boston, MA, US
| | | | - Milena S. Marcolino
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BR
| | - Antonio L. Ribeiro
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BR
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Paixão GMM, Lima EM, Gomes PR, Ferreira MPF, Oliveira DM, Ribeiro MH, Ribeiro AH, Nascimento JS, Canazart JA, Ribeiro LB, Ribeiro AL. Evaluation of mortality in bundle branch block patients from an electronic cohort: Clinical Outcomes in Digital Electrocardiography (CODE) study. J Electrocardiol 2019; 57S:S56-S60. [PMID: 31653433 DOI: 10.1016/j.jelectrocard.2019.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/27/2019] [Accepted: 09/04/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Left bundle branch block is recognized as a marker of higher risk of death, but the prognostic value of the right bundle branch block in the general population is still controversial. Our aim is to evaluate the risk of overall and cardiovascular mortality in patients with right (RBBB) and left bundle branch block (LBBB) in a large electronic cohort of Brazilian patients. METHODS This observational retrospective study was developed with the database of digital ECGs from Telehealth Network of Minas Gerais, Brazil (TNMG). All ECGs performed from 2010 to 2017 in primary care patients over 16 years old were assessed. The electronic cohort was obtained by linking data from ECG exams (name, sex, date of birth, city of residence) and those from national mortality information system, using standard probabilistic linkage methods (FRIL: Fine-grained record linkage software, v.2.1.5, Atlanta, GA). Only the first ECG of each patient was considered. Clinical data were self-reported, and ECGs were interpreted manually by cardiologists and automatically by the Glasgow University Interpreter software. Hazard ratio (HR) for mortality was estimated using Cox regression. RESULTS From a dataset of 1,773,689 patients, 1,558,421 primary care patients over 16 years old underwent a valid ECG recording during 2010 to 2017. We excluded 17,359 patients that didn't have a valid QRS measure from the Glasgow program and 11,091 patients from the control group that had QRS equal or above 120 ms and were not RBBB or LBBB. Therefore, 1,529,971 were included (median age 52 [Q1:38; Q3:65] years; 40.2% were male). In a mean follow-up of 3.7 years, the overall mortality rate was 3.34%. RBBB was more frequent (2.42%) than LBBB (1.32%). In multivariate analysis, adjusting for sex, age and comorbidities, both patients with RBBB (HR 1.32; CI 95% 1.27-1.37) and LBBB (HR 1.69; CI 95% 1.62-1.76) had higher risk of overall mortality. Women with RBBB had an increased risk of all-cause death compared to men (p < 0.001). Cardiovascular mortality was higher in patients with LBBB (HR 1.77; CI 95% 1.55-2.01), but not for RBBB. CONCLUSIONS Patients with RBBB and LBBB had higher risk of overall mortality. Women with RBBB had more risk of all-cause death than men. LBBB was associated with higher risk of cardiovascular mortality.
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Affiliation(s)
- Gabriela M M Paixão
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Belo Horizonte, Minas Gerais 30130-100, Brazil.
| | - Emilly M Lima
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Belo Horizonte, Minas Gerais 30130-100, Brazil
| | - Paulo R Gomes
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Belo Horizonte, Minas Gerais 30130-100, Brazil
| | - Milton P F Ferreira
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Belo Horizonte, Minas Gerais 30130-100, Brazil
| | - Derick M Oliveira
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Belo Horizonte, Minas Gerais 30130-100, Brazil
| | - Manoel H Ribeiro
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Belo Horizonte, Minas Gerais 30130-100, Brazil
| | - Antonio H Ribeiro
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Belo Horizonte, Minas Gerais 30130-100, Brazil
| | - Jamil S Nascimento
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Belo Horizonte, Minas Gerais 30130-100, Brazil
| | - Jéssica A Canazart
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Belo Horizonte, Minas Gerais 30130-100, Brazil
| | - Leonardo B Ribeiro
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Belo Horizonte, Minas Gerais 30130-100, Brazil
| | - Antonio L Ribeiro
- Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Belo Horizonte, Minas Gerais 30130-100, Brazil
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Abdelhamid N, Thabtah F. Associative Classification Approaches: Review and Comparison. JOURNAL OF INFORMATION & KNOWLEDGE MANAGEMENT 2014. [DOI: 10.1142/s0219649214500270] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Associative classification (AC) is a promising data mining approach that integrates classification and association rule discovery to build classification models (classifiers). In the last decade, several AC algorithms have been proposed such as Classification based Association (CBA), Classification based on Predicted Association Rule (CPAR), Multi-class Classification using Association Rule (MCAR), Live and Let Live (L3) and others. These algorithms use different procedures for rule learning, rule sorting, rule pruning, classifier building and class allocation for test cases. This paper sheds the light and critically compares common AC algorithms with reference to the abovementioned procedures. Moreover, data representation formats in AC mining are discussed along with potential new research directions.
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Affiliation(s)
- Neda Abdelhamid
- Computing and Informatics Department, De Montfort University, Leicester, UK
| | - Fadi Thabtah
- Ebusiness Department, Canadian University of Dubai, Dubai, UAE
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