1
|
Zhang C, Liu W, Wang L, Wang F, Li J, Liu Z, Zhao Y, Zhou M, Yin P, Hao J. Prevalence and Burden of Multiple Sclerosis in China, 1990-2019: Findings From the Global Burden of Disease Study 2019. Neurology 2024; 102:e209351. [PMID: 38759127 DOI: 10.1212/wnl.0000000000209351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Multiple sclerosis (MS) is the leading cause of neurologic disability in young adults, but the burden caused by MS in China is lacking. We aimed to comprehensively describe the prevalence and health loss due to MS by demographic and geographical variables from 1990 to 2019 across China. METHODS Data were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019). We used GBD methodology to systematically analyze the prevalence, disability-adjusted life-years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) due to MS by age, sex, and location from 1990 to 2019 in mainland China and its provinces. We also compared the MS burden in China with the world and other Group of 20 (G20) countries. RESULTS In 2019, 42,571 (95% uncertainty interval [UI] 33,001-53,329) individuals in China had MS, which doubled from 1990. The age-standardized prevalence rate of MS was 2.32 per 100,000 (95% UI 1.78-2.91), which increased by 23.31% (95% UI 20.50-25.89) from 1990, with most of the growth occurring after 2010. There was a positive latitudinal gradient with the increasing prevalence from south to north across China. The total DALYs caused by MS were 71,439 (95% UI 58,360-92,254) in 2019, ranking China third among G20 countries. Most of the MS burden in China derived from premature mortality, with the higher fraction of YLLs than that at the global level and most other G20 countries. From 1990 to 2019, the age-standardized DALY and YLL rate had nonsignificant changes; however, the age-standardized YLD rate substantially increased by 23.33% (95% UI 20.50-25.89). The geographic distribution of MS burden varied at the provincial level in China, with a slight downward trend in the age-standardized DALY rates along with increasing Socio-Demographic Index over the study period. DISCUSSION Although China has a low risk of MS, the substantial and increasing prevalent cases should not be underestimated. The high burden due to premature death and geographic disparity of MS burden reveals insufficient management of MS in China, highlighting the needs for increased awareness and effective intervention.
Collapse
Affiliation(s)
- Chen Zhang
- From the Department of Neurology (C.Z., F.W., J.L., Z.L., Y.Z., J.H.), Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing; Department of Neurology (C.Z.), PLA Rocket Force Characteristic Medical Center, Beijing; Department of Environmental Health (W.L.), Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (W.L., L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing; Key Laboratory for Neurodegenerative Diseases of Ministry of Education (J.H.), Beijing; and Beijing Municipal Geriatric Medical Research Center (J.H.), China
| | - Wei Liu
- From the Department of Neurology (C.Z., F.W., J.L., Z.L., Y.Z., J.H.), Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing; Department of Neurology (C.Z.), PLA Rocket Force Characteristic Medical Center, Beijing; Department of Environmental Health (W.L.), Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (W.L., L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing; Key Laboratory for Neurodegenerative Diseases of Ministry of Education (J.H.), Beijing; and Beijing Municipal Geriatric Medical Research Center (J.H.), China
| | - Lijun Wang
- From the Department of Neurology (C.Z., F.W., J.L., Z.L., Y.Z., J.H.), Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing; Department of Neurology (C.Z.), PLA Rocket Force Characteristic Medical Center, Beijing; Department of Environmental Health (W.L.), Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (W.L., L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing; Key Laboratory for Neurodegenerative Diseases of Ministry of Education (J.H.), Beijing; and Beijing Municipal Geriatric Medical Research Center (J.H.), China
| | - Fei Wang
- From the Department of Neurology (C.Z., F.W., J.L., Z.L., Y.Z., J.H.), Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing; Department of Neurology (C.Z.), PLA Rocket Force Characteristic Medical Center, Beijing; Department of Environmental Health (W.L.), Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (W.L., L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing; Key Laboratory for Neurodegenerative Diseases of Ministry of Education (J.H.), Beijing; and Beijing Municipal Geriatric Medical Research Center (J.H.), China
| | - Jiao Li
- From the Department of Neurology (C.Z., F.W., J.L., Z.L., Y.Z., J.H.), Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing; Department of Neurology (C.Z.), PLA Rocket Force Characteristic Medical Center, Beijing; Department of Environmental Health (W.L.), Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (W.L., L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing; Key Laboratory for Neurodegenerative Diseases of Ministry of Education (J.H.), Beijing; and Beijing Municipal Geriatric Medical Research Center (J.H.), China
| | - Zheng Liu
- From the Department of Neurology (C.Z., F.W., J.L., Z.L., Y.Z., J.H.), Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing; Department of Neurology (C.Z.), PLA Rocket Force Characteristic Medical Center, Beijing; Department of Environmental Health (W.L.), Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (W.L., L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing; Key Laboratory for Neurodegenerative Diseases of Ministry of Education (J.H.), Beijing; and Beijing Municipal Geriatric Medical Research Center (J.H.), China
| | - Yinan Zhao
- From the Department of Neurology (C.Z., F.W., J.L., Z.L., Y.Z., J.H.), Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing; Department of Neurology (C.Z.), PLA Rocket Force Characteristic Medical Center, Beijing; Department of Environmental Health (W.L.), Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (W.L., L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing; Key Laboratory for Neurodegenerative Diseases of Ministry of Education (J.H.), Beijing; and Beijing Municipal Geriatric Medical Research Center (J.H.), China
| | - Maigeng Zhou
- From the Department of Neurology (C.Z., F.W., J.L., Z.L., Y.Z., J.H.), Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing; Department of Neurology (C.Z.), PLA Rocket Force Characteristic Medical Center, Beijing; Department of Environmental Health (W.L.), Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (W.L., L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing; Key Laboratory for Neurodegenerative Diseases of Ministry of Education (J.H.), Beijing; and Beijing Municipal Geriatric Medical Research Center (J.H.), China
| | - Peng Yin
- From the Department of Neurology (C.Z., F.W., J.L., Z.L., Y.Z., J.H.), Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing; Department of Neurology (C.Z.), PLA Rocket Force Characteristic Medical Center, Beijing; Department of Environmental Health (W.L.), Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (W.L., L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing; Key Laboratory for Neurodegenerative Diseases of Ministry of Education (J.H.), Beijing; and Beijing Municipal Geriatric Medical Research Center (J.H.), China
| | - Junwei Hao
- From the Department of Neurology (C.Z., F.W., J.L., Z.L., Y.Z., J.H.), Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, Beijing; Department of Neurology (C.Z.), PLA Rocket Force Characteristic Medical Center, Beijing; Department of Environmental Health (W.L.), Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou; National Center for Chronic and Non-communicable Disease Control and Prevention (W.L., L.W., M.Z., P.Y.), Chinese Center for Disease Control and Prevention, Beijing; Key Laboratory for Neurodegenerative Diseases of Ministry of Education (J.H.), Beijing; and Beijing Municipal Geriatric Medical Research Center (J.H.), China
| |
Collapse
|
2
|
Chen M, Yao PC, Fei ZT, Wang QS, Yu YC, Zhang PP, Li W, Zhang R, Mo BF, Zhao MZ, Yu Y, Yang M, Zhao Y, Gong CQ, Sun J, Li YG. Prognostic Impact of Left Atrial Appendage Patency After Device Closure. Circ Cardiovasc Interv 2024; 17:e013579. [PMID: 38629273 PMCID: PMC11097947 DOI: 10.1161/circinterventions.123.013579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/02/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND The prognostic impact of left atrial appendage (LAA) patency, including those with and without visible peri-device leak (PDL), post-LAA closure in patients with atrial fibrillation, remains elusive. METHODS Patients with atrial fibrillation implanted with the WATCHMAN 2.5 device were prospectively enrolled. The device surveillance by cardiac computed tomography angiography was performed at 3 months post-procedure. Adverse events, including stroke/transient ischemic attack (TIA), major bleeding, cardiovascular death, all-cause death, and the combined major adverse events (MAEs), were compared between patients with complete closure and LAA patency. RESULTS Among 519 patients with cardiac computed tomography angiography surveillance at 3 months post-LAA closure, 271 (52.2%) showed complete closure, and LAA patency was detected in 248 (47.8%) patients, including 196 (37.8%) with visible PDL and 52 (10.0%) without visible PDL. During a median of 1193 (787-1543) days follow-up, the presence of LAA patency was associated with increased risks of stroke/TIA (adjusted hazard ratio for baseline differences, 3.22 [95% CI, 1.17-8.83]; P=0.023) and MAEs (adjusted hazard ratio, 1.12 [95% CI, 1.06-1.17]; P=0.003). Specifically, LAA patency with visible PDL was associated with increased risks of stroke/TIA (hazard ratio, 3.66 [95% CI, 1.29-10.42]; P=0.015) and MAEs (hazard ratio, 3.71 [95% CI, 1.71-8.07]; P=0.001), although LAA patency without visible PDL showed higher risks of MAEs (hazard ratio, 3.59 [95% CI, 1.28-10.09]; P=0.015). Incidences of stroke/TIA (2.8% versus 3.0% versus 6.7% versus 22.2%; P=0.010), cardiovascular death (0.9% versus 0% versus 1.7% versus 11.1%; P=0.005), and MAEs (4.6% versus 9.0% versus 11.7% versus 22.2%; P=0.017) increased with larger PDL (0, >0 to ≤3, >3 to ≤5, or >5 mm). Older age and discontinuing antiplatelet therapy at 6 months were independent predictors of stroke/TIA and MAEs in patients with LAA patency. CONCLUSIONS LAA patency detected by cardiac computed tomography angiography at 3 months post-LAA closure is associated with unfavorable prognosis in patients with atrial fibrillation implanted with WATCHMAN 2.5 device. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03788941.
Collapse
Affiliation(s)
- Mu Chen
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Peng-Cheng Yao
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Zhen-Tao Fei
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Qun-Shan Wang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Yi-Chi Yu
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Peng-Pai Zhang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Wei Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Rui Zhang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Bin-Feng Mo
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Ming-Zhe Zhao
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Yi Yu
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Mei Yang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Yan Zhao
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Chang-Qi Gong
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Jian Sun
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| |
Collapse
|
3
|
Sun J, Zhang R, Yang M, Li W, Zhang PP, Mo BF, Wang QS, Chen M, Li YG. Combined Radiofrequency Ablation and Left Atrial Appendage Closure in Atrial Fibrillation and Systolic Heart Failure. Diagnostics (Basel) 2023; 13:3325. [PMID: 37958221 PMCID: PMC10647617 DOI: 10.3390/diagnostics13213325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Managing patients with atrial fibrillation (AF) and comorbid heart failure (HF) with reduced (HFrEF) or mildly reduced ejection fraction (HFmrEF) is of clinical importance but a great challenge. This study aimed to evaluate the clinical benefit of the combined radiofrequency catheter ablation (RFCA) and left atrial appendage closure (LAAC) procedure in AF patients complicated with systolic HF. METHODS AF patients with HFrEF or HFmrEF who underwent the combined RFCA and LAAC procedure were prospectively enrolled in the LAACablation registry. The procedural complications and long-term outcomes were evaluated. Another cohort of AF patients with systolic HF who did not undergo either RFCA or LAAC were used for prognosis comparison. RESULTS Among 802 AF patients who underwent the combined procedure, 65 patients were comorbid with systolic HF (25 with HFrEF and 40 with HFmrEF). The overall procedural complication rate was 9.2%, which was mainly attributed to acute decompensated HF (6.2%). Accompanied with markedly reduced AF burden (from median [25th, 75th percentile]: 100 [100, 100] to 0 [0, 1.2]%, p < 0.001), upward trajectories of cardiac function were observed in 51 (78.4%) patients, showing improvement in New York Heart Classification (p < 0.01), natriuretic peptide levels (from 1492 [809, 3259] to 413 [163, 880] pg/mL, p < 0.001) and left ventricular EF (from 42.6 ± 5.3 to 53.8 ± 8.2%, p < 0.001). During the 27-month follow-up period, death, thromboembolism, major bleeding, and HF rehospitalization were observed in three, one, one, and four patients, respectively. The observed event rates showed a significant reduction compared with the non-procedure AF-HF cohort (n = 138; for composite endpoint: hazard ratio: 2.509, 95% confidence interval: 1.415-4.449, p = 0.002) and with the respective rates predicted by risk scores. CONCLUSIONS Combining RFCA and LAAC achieves acceptable safety and credible long-term efficacy in AF patients with systolic HF. Further randomized studies are warranted in a larger patient cohort.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Mu Chen
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Yi-Gang Li
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| |
Collapse
|
4
|
Chen C, Cai J, Song B, Zhang L, Wang W, Luo R, Zhang Y, Ling Y, Wu C, Wang Z, Liu H, Wu Y, Qu X. Relationship between the Ratio of Red Cell Distribution Width to Albumin and 28-Day Mortality among Chinese Patients over 80 Years with Atrial Fibrillation. Gerontology 2023; 69:1471-1481. [PMID: 37793355 DOI: 10.1159/000534259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is a prevalent heart arrhythmia in elderly adults aged 80 years or older. The red cell distribution width (RDW) to albumin ratio has been acknowledged as a reliable prognostic marker for poor outcomes in a variety of disorders. However, there exists limited scientific evidence on the association of RDW to albumin (RAR) with mortality in geriatric individuals with AF. METHODS From January 2015 to June 2020, a retrospective study was conducted in a tertiary academic institution that diagnosed 1,141 elderly adults with AF. The RAR value was calculated as the ratio of RDW (%) to albumin (g/dL). The potential association between RAR and cardiovascular mortality and the risk of all-cause mortality within 28 days was evaluated by means of multivariable Cox regression analysis. RESULTS The 28-day all-cause and cardiovascular mortality rates were 8.7% and 3.3%, respectively. Increased RAR tertiles were found to be significantly associated with greater all-cause mortality (T1: 1.6%; T2: 6.2%; T3: 18.1%, p < 0.001) and cardiovascular mortality (T1: 0.8%; T2: 2.9%; T3: 6.3%, p < 0.001) using Kaplan-Meier analysis. Continuous RAR had a positive association with all-cause mortality (hazard ratios [HR] = 1.42, 95% confidence interval [CI] 1.23-1.65) and cardiovascular mortality (HR = 1.31, 95% CI: 1.05-1.64), even after accounting for numerous confounding variables. In comparison to the T1 group, individuals with the highest RAR levels displayed a greater risk of all-cause mortality (HR = 2.73, 95% CI: 1.11-6.74) and cardiovascular mortality (HR = 2.59, 95% CI: 0.69-9.78). Increased RAR levels were related to higher rates of cardiovascular and all-cause mortality across almost all subgroups. CONCLUSION RAR is independently correlated with 28-day all-cause mortality and cardiovascular mortality in AF-affected individuals aged ≥80.
Collapse
Affiliation(s)
- Conggai Chen
- Department of Emergency, Ningbo No.2 Hospital, Ningbo, China,
| | - Jiasheng Cai
- QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Bin Song
- Department of Chronic Diseases Management, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Lingyun Zhang
- Department of Nephrology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Wang
- QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Rong Luo
- QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yi Zhang
- QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yunhao Ling
- Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Chuntao Wu
- QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Zilong Wang
- QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Haibo Liu
- QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yumei Wu
- Department of Hematology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Xinkai Qu
- Departments of Cardiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| |
Collapse
|
5
|
Tsiartas E, Samaras A, Papazoglou AS, Kartas A, Moysidis DV, Gemousakakis E, Kamzolas O, Bekiaridou A, Doundoulakis I, Tzikas A, Giannakoulas G. Changes in CHA 2DS 2-VASc score and risk of ischemic stroke among patients with atrial fibrillation. Heart Vessels 2023; 38:1267-1276. [PMID: 37311823 PMCID: PMC10465382 DOI: 10.1007/s00380-023-02278-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/01/2023] [Indexed: 06/15/2023]
Abstract
AIMS The CHA2DS2-VASc score is fundamental to stroke risk assessment in atrial fibrillation. However, stroke-related risk factors can be modified later in life. This study aimed to assess the association of changes in CHA2DS2-VASc score over time (Delta CHA2DS2-VASc score) with the risk of ischemic stroke. MATERIALS AND METHODS This is an observational analysis of 1127 atrial fibrillation patients previously enrolled in the MISOAC-AF trial. After a median 2.6-year follow-up period, baseline and follow-up CHA2DS2-VASc scores were used to extract the Delta CHA2DS2-VASc score. The stroke predicting accuracies of the baseline, follow-up, and Delta CHA2DS2-VASc scores were assessed through regression analyses. RESULTS The mean baseline, follow-up, and Delta CHA2DS2-VASc scores were 4.2, 4.8, and 0.6 respectively. Ischemic stroke occurred in 54 (4.4%) patients, of which 83.3% had a Delta CHA2DS2-VASc score ≥1, contrary to 40.1% of the stroke-free group. The stroke risk per 1-point increase of the CHA2DS2-VASc score was not significantly associated with the baseline score (aHR=1.14; 95%CI: 0.93-1.41; p=0.201), whereas a significant association was observed with the follow-up (aHR=2.58; 95% CI: 2.07-3.21; p<0.001) and Delta (aHR=4.56; 95%CI: 3.50-5.94; p<0.001) scores. C-index assessment indicated that follow-up and Delta CHA2DS2-VASc scores were more potent predictors of ischemic stroke compared to baseline. CONCLUSION In atrial fibrillation patients, changes in CHA2DS2-VASc score over time were associated with the incidence of stroke. The improved predictability of follow-up and Delta CHA2DS2-VASc scores indicates that stroke risk is not a static parameter. TRIAL REGISTRATION This is an observational, post-hoc analysis of the MISOAC-AF randomized controlled trial, registered on ClinicalTrials.gov (identifier: NCT02941978; registered: October 21, 2016).
Collapse
Affiliation(s)
- Eirinaios Tsiartas
- First Cardiology Department, School of Medicine, Faculty of Health Sciences, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kiriakidi, Thessaloniki, 546 36, Greece
| | - Athanasios Samaras
- First Cardiology Department, School of Medicine, Faculty of Health Sciences, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kiriakidi, Thessaloniki, 546 36, Greece
| | - Andreas S Papazoglou
- First Cardiology Department, School of Medicine, Faculty of Health Sciences, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kiriakidi, Thessaloniki, 546 36, Greece
| | - Anastasios Kartas
- First Cardiology Department, School of Medicine, Faculty of Health Sciences, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kiriakidi, Thessaloniki, 546 36, Greece
| | - Dimitrios V Moysidis
- First Cardiology Department, School of Medicine, Faculty of Health Sciences, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kiriakidi, Thessaloniki, 546 36, Greece
| | - Eleftherios Gemousakakis
- First Cardiology Department, School of Medicine, Faculty of Health Sciences, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kiriakidi, Thessaloniki, 546 36, Greece
| | - Odysseas Kamzolas
- First Cardiology Department, School of Medicine, Faculty of Health Sciences, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kiriakidi, Thessaloniki, 546 36, Greece
| | - Alexandra Bekiaridou
- First Cardiology Department, School of Medicine, Faculty of Health Sciences, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kiriakidi, Thessaloniki, 546 36, Greece
| | - Ioannis Doundoulakis
- First Cardiology Department, School of Medicine, Faculty of Health Sciences, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kiriakidi, Thessaloniki, 546 36, Greece
| | - Apostolos Tzikas
- First Cardiology Department, School of Medicine, Faculty of Health Sciences, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kiriakidi, Thessaloniki, 546 36, Greece
| | - George Giannakoulas
- First Cardiology Department, School of Medicine, Faculty of Health Sciences, AHEPA University Hospital, Aristotle University of Thessaloniki, 1 Kiriakidi, Thessaloniki, 546 36, Greece.
| |
Collapse
|
6
|
Tamirisa KP, Calvert P, Dye C, Mares AC, Gupta D, Al-Ahmad A, Russo AM. Sex Differences in Atrial Fibrillation. Curr Cardiol Rep 2023; 25:1075-1082. [PMID: 37505398 DOI: 10.1007/s11886-023-01927-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE OF REVIEW Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. The estimated lifetime risk of developing AF is higher in men; however, due to differences in life expectancy, the overall prevalence is higher among women, particularly in the older age group. Sex differences play an important role in the pathophysiology, presentation, and clinical outcomes of AF. Awareness of these differences minimizes the potential for disparities in AF management. Our review summarizes the current literature on sex differences in AF, including the epidemiology, pathophysiology, risk factors, clinical symptomatology, mechanisms, treatment, and outcomes. We also explore the implications of these differences for clinical practice and future research. RECENT FINDINGS Women are more likely to present with atypical symptoms, have a higher stroke risk, and have a worse quality of life with AF when compared to men. Despite this, they are less likely to receive rhythm control strategies and anticoagulants. The sex-based differences in AF pathology and management might be a combination of inherent biological and hormonal differences, and implicit bias of the research entities and treating clinicians. Our review stresses the need for further sex-specific research in the pathophysiology of AF and opens a dialogue on personalized medicine, where management strategies can be tailored to individual patient characteristics, including sex.
Collapse
Affiliation(s)
- Kamala P Tamirisa
- Texas Cardiac Arrhythmia Institute, 11970 N. Central Expressway, Suite 540, Dallas/Austin, TX, USA.
| | - Peter Calvert
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Cicely Dye
- Naval Medical Center, San Diego, CA, USA
| | | | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, 11970 N. Central Expressway, Suite 540, Dallas/Austin, TX, USA
| | - Andrea M Russo
- Cardiovascular Division, Cooper Medical School of Rowan University, Camden, NJ, USA
| |
Collapse
|
7
|
Chen Q, Toorop MMA, Tops LF, Lijfering WM, Cannegieter SC. Time Trends in Patient Characteristics, Anticoagulation Treatment, and Prognosis of Incident Nonvalvular Atrial Fibrillation in the Netherlands. JAMA Netw Open 2023; 6:e239973. [PMID: 37097630 PMCID: PMC10130953 DOI: 10.1001/jamanetworkopen.2023.9973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
Importance The temporal trend in adverse events regarding stroke prevention for nonvalvular atrial fibrillation (NVAF) in the direct oral anticoagulant (DOAC) era was rarely investigated comprehensively, especially taking into account potential changes in patient characteristics and anticoagulation treatment. Objective To investigate time trends in patient characteristics, anticoagulation treatment, and prognosis of patients with incident NVAF in the Netherlands. Design, Setting, and Participants This retrospective cohort study assessed patients with incident NVAF initially recognized within a hospitalization between 2014 and 2018, using data from Statistics Netherlands. Participants were followed-up for 1 year from the hospital admission at which the incident NVAF diagnosis was made or until death, whichever occurred first. Data were analyzed from January 15, 2021, to March 8, 2023. Exposure Calendar year of the incident NVAF diagnosis, according to which the participants were categorized into 5 cohorts. Main Outcomes and Measures Outcomes of interest were baseline patient characteristics, anticoagulation treatment, and occurrence of ischemic stroke or major bleeding within the 1-year follow-up after incident NVAF. Results Between 2014 and 2018, 301 301 patients (mean [SD] age, 74.2 [11.9] years; 169 748 [56.3%] male patients) experienced incident NVAF in the Netherlands, each of whom was categorized into 1 of 5 cohorts by calendar year. Baseline patient characteristics were broadly the same between cohorts with a mean (SD) CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years [doubled], diabetes, stroke [doubled], vascular disease, age 65 to 74 years, and sex category [female]) score of 2.9 (1.7). The median (IQR) proportion of days covered by OACs (ie, vitamin K antagonists or DOACs) within the 1-year follow-up increased from 56.99% (0%-86.30%) to 75.62% (0%-94.52%), and DOACs increased from 5102 patients (13.5%) to 32 314 patients (72.0%) among those who received OACs, gradually replacing VKAs as the first choice of OACs. Over the course of the study, there were statistically significant decreases in the 1-year cumulative incidence of ischemic stroke (from 1.63% [95% CI, 1.52%-1.73%] to 1.39% [95% CI, 1.30%-1.48%) and major bleeding (from 2.50% [95% CI, 2.37%-2.63%] to 2.07% [95% CI, 1.96%-2.19%]), and the association was consistent after adjusting for baseline patient characteristics and excluding those with preexisting chronic anticoagulation. Conclusions and Relevance This cohort study of patients with incident NVAF diagnosed between 2014 and 2018 in the Netherlands found similar baseline characteristics, increased OAC use with DOACs being favored over time, and improved 1-year prognosis. Comorbidity burden, potential underuse of anticoagulation medications, and specific subgroups of patients with NVAF remain directions for future investigations and further improvement.
Collapse
Affiliation(s)
- Qingui Chen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Myrthe M A Toorop
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Willem M Lijfering
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- The Knowledge Institute of the Federation of Medical Specialists, Utrecht, the Netherlands
| | - Suzanne C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Medicine, Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
8
|
Cai J, Li M, Wang W, Luo R, Zhang Z, Liu H. The Relationship Between the Neutrophil Percentage-to-Albumin Ratio and Rates of 28-Day Mortality in Atrial Fibrillation Patients 80 Years of Age or Older. J Inflamm Res 2023; 16:1629-1638. [PMID: 37092133 PMCID: PMC10120825 DOI: 10.2147/jir.s400924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/08/2023] [Indexed: 04/25/2023] Open
Abstract
Backgrounds and Aims Atrial fibrillation (AF) is the most common cardiac arrhythmia among the older patients (≥ 80 years) in clinical practice. The index of neutrophil percentage-to-albumin ratio (NPAR) is a reliable predictor of adverse outcomes in cardiovascular diseases. There is scarce evidence regarding the association between NPAR and mortality among the older patients with AF. Methods The research was conducted among 1141 patients with AF between January 2015 and June 2020, hospitalized at Huadong Hospital affiliated with Fudan University. The primary outcome were 28-day all-cause and cardiovascular mortality. Cox regression analysis and Kaplan-Meier survival curves were used to explore the correlation between NPAR and 28-day all-cause or cardiovascular mortality. Receiver operating characteristic (ROC) curve and the area under the curve (AUC) were performed for the predictive values of NPAR on prognosis. Results The 28-day death rate from cardiovascular disease and all-causes were 3.3% and 8.7%, respectively. Continuous NPAR levels were positively associated with all-cause (HR 1.13, 95% CI 1.09, 1.16) and cardiovascular (HR 1.16, 95% CI 1.10, 1.23) mortality after adjustment for confounding variables. Relative to patients in the T1 group, those in higher NPAR tertiles also exhibit elevated risks of all-cause (P < 0.001) and cardiovascular mortality (P < 0.001). Furthermore, both all-cause and cardiovascular mortality rates rose with increasing NPAR in all analyzed subgroups. Conclusion NPAR values are consistently positively related to 28-day all-cause and cardiovascular mortality rates in patients ≥80 years of age with AF.
Collapse
Affiliation(s)
- Jiasheng Cai
- Department of Cardiology, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, 201700, People’s Republic of China
| | - Mingxuan Li
- Department of Cardiology, Shanghai Medical College Fudan University, Huadong Hospital, Shanghai, 200040, People’s Republic of China
| | - Wei Wang
- Department of Cardiology, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, 201700, People’s Republic of China
| | - Rong Luo
- Department of Cardiology, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, 201700, People’s Republic of China
| | - Zheng Zhang
- Department of Cardiology, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, 201700, People’s Republic of China
| | - Haibo Liu
- Department of Cardiology, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, 201700, People’s Republic of China
- Correspondence: Haibo Liu; Zheng Zhang, Department of Cardiology, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, 1158 Park, Shanghai, 201700, People’s Republic of China, Email ;
| |
Collapse
|
9
|
Yang J, Song C, Ding H, Chen M, Sun J, Liu X. Numerical study of the risk of thrombosis in the left atrial appendage of chicken wing shape in atrial fibrillation. Front Cardiovasc Med 2022; 9:985674. [PMID: 36505384 PMCID: PMC9732567 DOI: 10.3389/fcvm.2022.985674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/07/2022] [Indexed: 11/26/2022] Open
Abstract
Atrial fibrillation (AF) is a common and life-threatening disease. For the patients with AF, more than 90% of the thrombi are formed in the left atrial appendage (LAA), thrombus dislodgement can cause vascular embolism, making them is becoming a high-risk group for stroke. Therefore, identifying the patients with high risk of thrombosis is crucial for advanced stroke warning. To better investigate the mechanism behind thrombus formation in the LAA, this study reconstructed the 3-D Left Atrium (LA) models of six AF volunteer patients by corresponding Computed Tomography (CT) images. Combine the advantages of Computational Fluid Dynamics (CFD), the blood flow field in LA both in AF and sinus heart rate states were studied. The risk of thrombus was evaluated based on the blood viscosity, shear rate thrombus prediction model and Time Average Wall Shear Stress (TAWSS), Oscillatory Shear Index (OSI), and Relative Residence Time (RRT) values. The results showed that the left atrium had lower blood flow velocity and TAWSS values at the LAA in both AF and sinus rhythm, thus the LAA is the most thrombogenic region in the LA. Besides, the RRT value of LAA was generally higher in AF than in sinus rhythm. Therefore, AF carries a higher risk of thrombosis.
Collapse
Affiliation(s)
- Jun Yang
- School of Energy and Power Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Chentao Song
- School of Energy and Power Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Huirong Ding
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mu Chen
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Sun
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,*Correspondence: Jian Sun,
| | - Xiaohua Liu
- School of Aeronautics and Astronautics, Shanghai Jiao Tong University, Shanghai, China,Key Laboratory (Fluid Machinery and Engineering Research Base) of Sichuan Province, Xihua University, Chengdu, China,Xiaohua Liu,
| |
Collapse
|
10
|
Hu F, Zang M, Zheng L, Chen W, Guo J, Du Z, Liang E, Shen L, Hu X, Xu X, Hu G, Li A, Huang J, Yao Y, Pu J. The Impact of COVID-19 Pandemic on the Clinical Practice Patterns in Atrial Fibrillation: A Multicenter Clinician Survey in China. J Clin Med 2022; 11:jcm11216469. [PMID: 36362695 PMCID: PMC9653826 DOI: 10.3390/jcm11216469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
The COVID-19 pandemic has severely impacted healthcare systems worldwide. This study investigated cardiologists’ opinions on how the COVID-19 pandemic impacted clinical practice patterns in atrial fibrillation (AF). A multicenter clinician survey, including demographic and clinical questions, was administered to 300 cardiologists from 22 provinces in China, in April 2022. The survey solicited information about their treatment recommendations for AF and their perceptions of how the COVID-19 pandemic has impacted their clinical practice patterns for AF. The survey was completed by 213 cardiologists (71.0%) and included employees in tertiary hospitals (82.6%) and specialists with over 10 years of clinical cardiology practice (53.5%). Most respondents stated that there were reductions in the number of inpatients and outpatients with AF in their hospital during the pandemic. A majority of participants stated that the pandemic had impacted the treatment strategies for all types of AF, although to different extents. Compared with that during the assumed non-pandemic period in the hypothetical clinical questions, the selection of invasive interventional therapies (catheter ablation, percutaneous left atrial appendage occlusion) was significantly decreased (all p < 0.05) during the pandemic. There was no significant difference in the selection of non-invasive therapeutic strategies (the management of cardiovascular risk factors and concomitant diseases, pharmacotherapy for stroke prevention, heart rate control, and rhythm control) between the pandemic and non-pandemic periods (all p > 0.05). The COVID-19 pandemic has had a profound impact on the clinical practice patterns of AF. The selection of catheter ablation and percutaneous left atrial appendage occlusion was significantly reduced, whereas pharmacotherapy was often stated as the preferred option by participating cardiologists.
Collapse
Affiliation(s)
- Feng Hu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Minhua Zang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Lihui Zheng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Wensheng Chen
- Department of Cardiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
| | - Jinrui Guo
- Department of Cardiology, Fuwai Yunnan Cardiovascular Hospital, Kunming 650102, China
| | - Zhongpeng Du
- Department of Cardiology, Zhu Jiang Hospital of Southern Medical University, Guangzhou 510280, China
| | - Erpeng Liang
- Heart Center of Henan Provincial People’s Hospital, Central China Fuwai Hospital, Zhengzhou University, Zhengzhou 451460, China
| | - Lishui Shen
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Xiaofeng Hu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xuelian Xu
- Department of Cardiology, University-Town Hospital of Chongqing Medical University, Chongqing 400042, China
| | - Gaifeng Hu
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325035, China
| | - Aihua Li
- Department of Cardiology, The Affiliated Hospital of Yangzhou University, Yangzhou 225007, China
| | - Jianfeng Huang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Yan Yao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Correspondence: (Y.Y.); (J.P.)
| | - Jun Pu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
- Correspondence: (Y.Y.); (J.P.)
| |
Collapse
|