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Long B, Brady WJ, Gottlieb M. Emergency medicine updates: Atrial fibrillation with rapid ventricular response. Am J Emerg Med 2023; 74:57-64. [PMID: 37776840 DOI: 10.1016/j.ajem.2023.09.012] [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: 08/08/2023] [Revised: 09/03/2023] [Accepted: 09/14/2023] [Indexed: 10/02/2023] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) may lead to stroke, heart failure, and death. When AF occurs in the context of a rapid ventricular rate/response (RVR), this can lead to complications, including hypoperfusion and cardiac ischemia. Emergency physicians play a key role in the diagnosis and management of this dysrhythmia. OBJECTIVE This paper evaluates key evidence-based updates concerning AF with RVR for the emergency clinician. DISCUSSION Differentiating primary and secondary AF with RVR and evaluating hemodynamic stability are vital components of ED assessment and management. Troponin can assist in determining the risk of adverse outcomes, but universal troponin testing is not required in patients at low risk of acute coronary syndrome or coronary artery disease - especially patients with recurrent episodes of paroxysmal AF that are similar to their prior events. Emergent cardioversion is indicated in hemodynamically unstable patients. Rate or rhythm control should be pursued in hemodynamically stable patients. Elective cardioversion is a safe option for select patients and may reduce AF symptoms and risk of AF recurrence. Rate control using beta blockers or calcium channel blockers should be pursued in those with AF with RVR who do not undergo cardioversion. Anticoagulation is an important component of management, and several tools (e.g., CHA2DS2-VASc) are available to assist with this decision. Direct oral anticoagulants are the first-line medication class for anticoagulation. Disposition can be challenging, and several risk assessment tools (e.g., RED-AF, AFFORD, and the AFTER (complex, modified, and pragmatic) scores) are available to assist with disposition decisions. CONCLUSION An understanding of the recent updates in the literature concerning AF with RVR can assist emergency clinicians in the care of these patients.
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Affiliation(s)
- Brit Long
- SAUSHEC, Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - William J Brady
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
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Abolghasem Gorji H, Khosravi M, Mahmoodi R, Hasoumi M, Souresrafil A, Alipour V, Rezapour A, Hajahmadi M, Azari S. Cost-Effectiveness of Atrial Fibrillation Screening Strategies: A Systematic Review. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:672-682. [PMID: 37551181 PMCID: PMC10404313 DOI: 10.18502/ijph.v52i4.12435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/19/2022] [Indexed: 08/09/2023]
Abstract
Background Atrial fibrillation (AF) is the most common cardiac arrhythmia. AF is associated with an increased risk of stroke. We aimed to review systematically the cost-effectiveness of screening strategies for patients with AF. Methods To find related research and articles, articles published in Iranian and international databases by using a combination of MeSH (Medical Subject Headings) terms and based on inclusion and exclusion criteria were searched and reviewed until Dec 2020. The main outcome measures of the final articles were incremental cost-effectiveness ratios (ICER) per gained or additional quality-adjusted life years (QALYs), additional case detected, and avoided stroke. Results Out of 3,360 studies found, finally, fifteen studies were included in the research. The lowest ICER numerical value was 78.39 for AF screening using ECG for 65-85 yr old Japanese women. The highest value of this index is equal to 70864.31 for performing ECG monitoring for more than 60 d for Canadians over 80 yr without AF history. In two studies, the results were expressed with the years of life gained (YLG measure. Of course, in one study, the results were not reported with this measure, and in one study, the results were reported with ICER. Conclusion Most of the studies acknowledged the cost-effectiveness of different AF screening strategies. However, studies that confirmed the cost-effectiveness of population-based screening were more than studies that confirmed the cost-effectiveness of other screening strategies.
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Affiliation(s)
- Hassan Abolghasem Gorji
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Khosravi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Razieh Mahmoodi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Hasoumi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Aghdas Souresrafil
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Alipour
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Marjan Hajahmadi
- Cardiovascular Department, Rasoul Akram General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Samad Azari
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
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3
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Kawakami S, Ogawa E, Fukaya H, Matsuura G, Aiga S, Kumagai H. Estimation of mechanical properties by transcatheter monitoring using local impedance and contact force. J Med Eng Technol 2023; 47:141-146. [PMID: 36426804 DOI: 10.1080/03091902.2022.2134479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The mechanical properties of the myocardium in the left ventricle and right atrium were estimated by simultaneously measuring the local impedance (LI) and contact force (CF) using an ablation catheter. Radiofrequency catheter ablation (RFCA) is a well-established arrhythmia treatment. Monitoring the RF power, CF and properties of myocardium during RFCA are necessary to estimate the effect of ablation. Indices, such as CF, lesion size index and ablation index, do not include the myocardium mechanical properties. Therefore, there is the risk of side effects, such as cardiac tamponade, by excessive catheter indentation into vulnerable areas. We propose the simultaneous measurement of LI and CF for estimating the myocardial mechanical properties to reduce the side effects. In this study, an in vitro experimental system was constructed to measure LI and CF via the catheter. The relationship between the porcine myocardial tissue thickness and CF-LI curve was investigated using the left ventricle and right atrium. Power function coefficients approximating the CF-LI curve increased with thicker left ventricle. The thickness of the myocardium can be estimated by simultaneously measuring LI and CF. Intraoperative measurement of the myocardial mechanical properties can be used to determine the ablation conditions at each site.
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Affiliation(s)
- Sota Kawakami
- Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Emiyu Ogawa
- Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan.,Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University Hospital, Kanagawa, Japan
| | - Gen Matsuura
- Department of Cardiovascular Medicine, Kitasato University Hospital, Kanagawa, Japan
| | - Sumire Aiga
- Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Hiroshi Kumagai
- Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan.,Allied Health Sciences, Kitasato University, Kanagawa, Japan
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Gender Differences in Atrial Fibrillation: From the Thromboembolic Risk to the Anticoagulant Treatment Response. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020254. [PMID: 36837457 PMCID: PMC9963174 DOI: 10.3390/medicina59020254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/11/2023] [Accepted: 01/19/2023] [Indexed: 01/31/2023]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia associated with an increased thromboembolic risk. The impact of the female sex as an independent risk factor for thromboembolic events in AF is still debated. Background and Objectives: The aim of this review is to evaluate the gender-related differences in cardioembolic risk and response to anticoagulants among AF patients. Materials and Methods: The PubMed database is used to review the reports about gender differences and thromboembolic risk in atrial fibrillation. Results: Non-vitamin K oral anticoagulants (NOACs) represent the gold standard for thromboembolic risk prevention in patients with non-valvular atrial fibrillation (NVAF). Despite a similar rate of stroke and systemic embolism (SE) among men and women in NOACs or vitamin K antagonists (VKAs) treatment, the use of NOACs in AF women is associated with a lower risk of intracranial bleeding, major bleeding, and all-cause mortality than in men. Conclusions: The female sex can be defined as a stroke risk modifier rather than a stroke risk factor since it mainly increases the thromboembolic risk in the presence of other risk factors. Further studies about the efficacy and safety profile of NOACs according to sex are needed to support clinicians in performing the most appropriate and tailored anticoagulant therapy, either in male or female AF patients.
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Abstract
INTRODUCTION Stroke is one of the leading causes of mortality and morbidity globally. Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. It is set to reach epidemic proportions. AF is associated with a five-fold increase in risk of stroke. Strokes caused by AF more often are fatal or result in severe disability. Even though the incidence of stroke has been significantly reduced by oral anticoagulation, AF is thought to account for a significant proportion of cryptogenic strokes where no etiology is identified. AREAS COVERED This article reviews the literature related to AF and stroke, pathophysiological insights, diagnosis of AF in stroke patients, and its management (Graphical Abstract). EXPERT OPINION The pathophysiology of thrombogenesis that links AF and stroke is not well understood and is an area of active research to identify new therapeutic targets to prevent AF and stroke. As the nature of AF and stroke is multifaceted, an integrated care approach to managing AF and stroke is increasingly essential.
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Affiliation(s)
- Sylvia E Choi
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Dimitrios Sagris
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Andrew Hill
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.,Stroke Division, Department of Medicine for Older People, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Azmil H Abdul-Rahim
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Stroke Division, Department of Medicine for Older People, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, UK
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Mining of Potential Biomarkers and Pathway in Valvular Atrial Fibrillation (VAF) via Systematic Screening of Gene Coexpression Network. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3645402. [PMID: 36226239 PMCID: PMC9550484 DOI: 10.1155/2022/3645402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/06/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022]
Abstract
Purpose. We apply the bioinformatics method to excavate the potential genes and therapeutic targets associated with valvular atrial fibrillation (VAF). Methods. The downloaded gene expression files from the gene expression omnibus (GEO) included patients with primary severe mitral regurgitation complicated with sinus or atrial fibrillation rhythm. Subsequently, the differential gene expression in left and right atrium was analyzed by R software. Additionally, weighted correlation network analysis (WGCNA), principal component analysis (PCA), and linear model for microarray data (LIMMA) algorithm were used to determine hub genes. Then, Metascape database, DAVID database, and STRING database were used to annotate and visualize the gene ontology (GO) analysis, KEGG pathway enrichment analysis, and PPI network analysis of differentially expressed genes (DEGs). Finally, the TFs and miRNAs were predicted by using online tools, such as PASTAA and miRDB. Results. 20,484 differentially expressed genes related to atrial fibrillation were obtained through the analysis of left and right atrial tissue samples of GSE115574 gene chip, and 1,009 were with statistical significance, including 45 upregulated genes and 964 downregulated genes. And the hub genes implicated in AF of NPC2, ODC1, SNAP29, LAPTM5, ST8SIA5, and FCGR3B were screened. Finally, the main regulators of targeted candidate biomarkers and microRNAs, EIF5A2, HIF1A, ZIC2, ELF1, and STAT2, were found in this study. Conclusion. These hub genes, NPC2, ODC1, SNAP29, LAPTM5, ST8SIA5, and FCGR3B, are important for the development of VAF, and their enrichment pathways and TFs elucidate the involved molecular mechanisms and assist in the validation of drug targets.
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Long B, Keim SM, Gottlieb M, Stiell IG. What is the Best Agent for Rate Control of Atrial Fibrillation With Rapid Ventricular Response? J Emerg Med 2022; 63:467-476. [DOI: 10.1016/j.jemermed.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/10/2022] [Accepted: 07/10/2022] [Indexed: 11/06/2022]
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Can I Send This Patient With Atrial Fibrillation Home From the Emergency Department? J Emerg Med 2022; 63:600-612. [DOI: 10.1016/j.jemermed.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/10/2022] [Accepted: 07/10/2022] [Indexed: 11/06/2022]
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Verberk WJ. Atrial fibrillation and 24-h ambulatory blood pressure pattern. J Clin Hypertens (Greenwich) 2022; 24:848-850. [PMID: 35702949 PMCID: PMC9278569 DOI: 10.1111/jch.14522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Willem J Verberk
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
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10
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Bezabhe WM, Bereznicki LR, Radford J, Wimmer BC, Salahudeen MS, Garrahy E, Bindoff I, Peterson GM. Stroke risk reassessment and oral anticoagulant initiation in primary care patients with atrial fibrillation: A ten-year follow-up. Eur J Clin Invest 2021; 51:e13489. [PMID: 33426646 DOI: 10.1111/eci.13489] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/21/2020] [Accepted: 01/07/2021] [Indexed: 12/25/2022]
Abstract
AIM To examine the change in stroke risk over time and determine the proportion of patients with atrial fibrillation (AF) who were initiated on an oral anticoagulant (OAC) as their stroke risk increased from low/moderate to high, using the Australian general practice data set, MedicineInsight. METHODS A total of 2296 patients diagnosed with AF between 1 January 2007 and 31 December 2008, aged 18 years or older and not initiated on an OAC before 2009, were included. We assessed the change in stroke risk and the proportion of patients who had a recorded prescription of an OAC, each year from 1 January 2009 to 31 December 2018. RESULTS At baseline, 23.9%, 22.9% and 53.2% were categorised as being at low (score = 0), moderate (score = 1) and high stroke risk (score ≥ 2), respectively, using the sexless CHA2 DS2 -VASc (CHA2 DS2 -VA) score. Overall, the CHA2 DS2 -VA score increased by a mean of 1.34 (95% confidence interval, 1.29-1.39) points over the study period. Nearly two-thirds of patients (65%, 412/632) whose stroke risk changed from baseline low/moderate to high were subsequently prescribed an OAC. The median (interquartile range) lag time from becoming high stroke risk to having OAC initiation was 2 (5) years. CONCLUSIONS Nearly one-third of patients reclassified as being at high risk of stroke during the study period were not prescribed OAC therapy. Furthermore, the delay in OAC initiation following classification as being at high risk was a median of 2 years, suggesting that more frequent stroke reassessment is needed.
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Affiliation(s)
| | - Luke R Bereznicki
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Jan Radford
- Launceston Clinical School, Tasmanian School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Barbara C Wimmer
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Mohammed S Salahudeen
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Edward Garrahy
- Launceston Clinical School, Tasmanian School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Ivan Bindoff
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Gregory M Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
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11
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Nashimoto S, Morishita S, Iida S, Hotta K, Tsubaki A. Relationship between the face scale for rating of perceived exertion and physiological parameters in older adults and patients with atrial fibrillation. Physiol Rep 2021; 9:e14759. [PMID: 33650814 PMCID: PMC7923560 DOI: 10.14814/phy2.14759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Borg scale is used to determine exercise intensity in rehabilitation but can be difficult for older adults to understand. By contrast, face scale that are used to evaluate pain are much easier to understand thanks to the inclusion of illustrations. On the other hand, the prevalence of atrial fibrillation (AF) increases with age. This study aimed to determine the validity of the face scale for rating perceived exertion (RPE-face scale) in older adults and patients with AF during cardiopulmonary exercise test. Furthermore, the relationship between face scale and anaerobic threshold (AT) was also investigated. METHODS A total of 90 patients with sinus rhythm (SR) (74 men, 16 women) and 22 with AF were enrolled. Participants' responses were recorded using the RPE-face scale and compared with exercise intensity, heart rate, oxygen uptake, and minute ventilation during the exercise test. We determined the AT by the V-slope method. RESULTS Correlations between RPE-face scale and physiological parameters were significantly positive for men with SR and women with SR and AF. However, differences in the correlation coefficient between age and SR or AF were not statistically significant. The cutoff value for AT of the RPE-face scale was "4," showing high sensitivity and specificity. CONCLUSIONS The RPE-face scale can be used to determine the intensity of physical exercise, unaffected by age, gender, SR, or AF.
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Affiliation(s)
- Satoshi Nashimoto
- Department of RehabilitationNiigata Medical CenterNiigata‐city, NiigataJapan
| | - Shinichiro Morishita
- Institute for Human Movement and Medical SciencesNiigata University of Health and WelfareNiigata‐city, NiigataJapan
| | - Susumu Iida
- Department of RehabilitationNiigata Medical CenterNiigata‐city, NiigataJapan
| | - Kazuki Hotta
- Institute for Human Movement and Medical SciencesNiigata University of Health and WelfareNiigata‐city, NiigataJapan
| | - Atsuhiro Tsubaki
- Institute for Human Movement and Medical SciencesNiigata University of Health and WelfareNiigata‐city, NiigataJapan
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12
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Shiyovich A, Chodick G, Azani L, Tirosh M, Shuvy M, Pereg D, Katz A, Minha S. Sex-specific contemporary trends in incidence, prevalence and survival of patients with non-valvular atrial fibrillation: A long-term real-world data analysis. PLoS One 2021; 16:e0247097. [PMID: 33600504 PMCID: PMC7891766 DOI: 10.1371/journal.pone.0247097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/29/2021] [Indexed: 12/19/2022] Open
Abstract
Introduction Atrial fibrillation (AF) is a major increasing public health problem worldwide, with clinical and epidemiological differences between men and women. However, contemporary population-level data on incidence and survival are scarce. Aim To evaluate sex-specific contemporary trends in the incidence, prevalence, and long-term survival of non-valvular AF in a real-world setting Methods AF patients diagnosed between 2007–2015, insured by a large, state-mandated health organization in Israel (Maccabi Healthcare Services) were included. AF was diagnosed based on registered diagnoses. Patients with valvular disease, active malignancy, cardiac surgery ≤ 6 months, or recent pregnancy, were excluded. Annual incidence rate, period prevalence, and 5-year survival for each calendar year during the study period, were calculated. Results A total of 15,409 eligible patients (8,288 males, 7,121 females) were identified. Males were more likely to be younger, have higher rates of underlying diseases (ischemic heart disease, heart failure, and chronic obstructive pulmonary disease), but with lower rates of hypertension and chronic kidney diseases as compared to female patients. During the study period, age-adjusted incidence decreased both in men: (-0.020/1,000-person year, p-for trend = 0.033) and, women (-0.025/1,000 person-year p = 0.009). The five-year survival rate was significantly higher among men vs. women (77.1% vs. 71.5%, respectively, p<0.001). Age-adjusted prevalence increased significantly among men (+0.102 per year, p-for trend<0.001) yet decreased among women (-0.082 per year, p-for trend = 0.005). A significant trend toward improved long-term survival was observed in women and not in men. Conclusions The current study shows significant sex-related disparities in the incidence, prevalence, and survival of AF patients between 2007–2015; while the adjusted incidence of both has decreased over-time, prevalence and mortality decreased significantly only in women.
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Affiliation(s)
- Arthur Shiyovich
- Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- * E-mail:
| | - Gabriel Chodick
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Liat Azani
- Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | | | - Mony Shuvy
- Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - David Pereg
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Cardiology, Meir Medical Center, Kfar-Saba, Israel
| | - Amos Katz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sa’ar Minha
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Cardiology, Shamir Medical Center, Zerifin, Israel
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13
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Rowan CJ, Eskander MA, Seabright E, Rodriguez DE, Linares EC, Gutierrez RQ, Adrian JC, Cummings D, Beheim B, Tolstrup K, Achrekar A, Kraft T, Michalik DE, Miyamoto MI, Allam AH, Wann LS, Narula J, Trumble BC, Stieglitz J, Thompson RC, Thomas GS, Kaplan HS, Gurven MD. Very Low Prevalence and Incidence of Atrial Fibrillation among Bolivian Forager-Farmers. Ann Glob Health 2021; 87:18. [PMID: 33633929 PMCID: PMC7894370 DOI: 10.5334/aogh.3252] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Atrial fibrillation is the most common arrhythmia in post-industrialized populations. Older age, hypertension, obesity, chronic inflammation, and diabetes are significant atrial fibrillation risk factors, suggesting that modern urban environments may promote atrial fibrillation. Objective Here we assess atrial fibrillation prevalence and incidence among tropical horticulturalists of the Bolivian Amazon with high levels of physical activity, a lean diet, and minimal coronary atherosclerosis, but also high infectious disease burden and associated inflammation. Methods Between 2005-2019, 1314 Tsimane aged 40-94 years (52% female) and 534 Moseten Amerindians aged 40-89 years (50% female) underwent resting 12-lead electrocardiograms to assess atrial fibrillation prevalence. For atrial fibrillation incidence assessment, 1059 (81% of original sample) Tsimane and 310 Moseten (58%) underwent additional ECGs (mean time to follow up 7.0, 1.8 years, respectively). Findings Only one (male) of 1314 Tsimane (0.076%) and one (male) of 534 Moseten (0.187%) demonstrated atrial fibrillation at baseline. There was one new (female) Tsimane case in 7395 risk years for the 1059 participants with >1 ECG (incidence rate = 0.14 per 1,000 risk years). No new cases were detected among Moseten, based on 542 risk years. Conclusion Tsimane and Moseten show the lowest levels of atrial fibrillation ever reported, 1/20 to ~1/6 of rates in high-income countries. These findings provide additional evidence that a subsistence lifestyle with high levels of physical activity, and a diet low in processed carbohydrates and fat is cardioprotective, despite frequent infection-induced inflammation. Findings suggest that atrial fibrillation is a modifiable lifestyle disease rather than an inevitable feature of cardiovascular aging.
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Affiliation(s)
| | | | - Edmond Seabright
- University of New Mexico, Department of Anthropology, New Mexico, USA
| | - Daniel Eid Rodriguez
- Universidad de San Simon, Bolivia
- Tsimane Health and Life History Project, San Borja, Beni, Bolivia
| | | | | | | | - Daniel Cummings
- University of New Mexico, Department of Anthropology, New Mexico, USA
| | - Bret Beheim
- Max Plank Institute of Evolutionary Anthropology, Department of Human Behavior, Culture and Ecology, Leipzig, Germany
| | - Kirsten Tolstrup
- Cardiology, Dept. of Medicine, University of California, San Francisco, CA, USA
| | - Abinash Achrekar
- University of New Mexico, Division of Cardiology, Albuquerque, New Mexico, USA
| | - Thomas Kraft
- University of California, Santa Barbara, Department of Anthropology, USA
| | - David E. Michalik
- Miller Children’s and Women’s Hospital Long Beach, CA, USA
- Division of Pediatric Infectious Diseases, University of California, Irvine, CA, USA
| | | | | | | | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, Department of Cardiology, NY, USA
| | - Benjamin C. Trumble
- Arizona State University, School of Human Evolution and Social Change, Center for Evolution and Medicine, Arizona State University, Tempe, AZ, USA
| | | | - Randall C. Thompson
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
- University of Missouri–Kansas City, USA
| | - Gregory S. Thomas
- MemorialCare, Southern California, USA
- Division of Cardiology, University of California, Irvine, Orange, California, USA
| | - Hillard S. Kaplan
- Chapman University, Department of Health Economics and Anthropology, Economic Science Institute, Argyros School of Business and Economics, Orange, California, USA
| | - Michael D. Gurven
- University of California, Santa Barbara, Department of Anthropology, USA
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Katsumata Y, Kohsaka S, Ikemura N, Ueda I, Hashimoto K, Yamashita T, Miyama H, Fujisawa T, Kimura T, Tanimoto K, Momiyama Y, Suzuki M, Fukuda K, Takatsuki S. Symptom Under-Recognition of Atrial Fibrillation Patients in Consideration for Catheter Ablation: A Report From the KiCS-AF Registry. JACC Clin Electrophysiol 2020; 7:565-574. [PMID: 33358669 DOI: 10.1016/j.jacep.2020.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/14/2020] [Accepted: 10/18/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study sought to investigate whether symptom under-recognition is associated with the application of catheter ablation. BACKGROUND Atrial fibrillation (AF) symptom burden is frequently under-recognized and may affect the choice of treatment strategies. METHODS A total of 3,276 patients with AF consecutively registered in a Japanese multicenter database from 2012 to 2017 were analyzed. All patients underwent AF symptom burden assessment via the symptom and daily activities domain within the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire. For the present analysis, 1,173 symptomatic patients (AFEQT score ≤80) with a clinical indication for catheter ablation were included. Under-recognition of symptom burden was defined as no subjective complaints checked by physicians despite self-reported AFEQT scores ≤80. Logistic regression analysis identified the predictors associated with receiving catheter ablation. RESULTS Of the 1,173 patients (age: 68 ± 12 years, men: 61%) analyzed, 459 underwent catheter ablation (ablation group); they had lower overall AFEQT scores (p < 0.01 for all domains) compared with the nonablation group. At the 1-year follow-up, greater improvement in the AFEQT scores was noted in the ablation group, even after adjusting for clinically relevant factors (+20.0 ± 1.2, +14.2 ± 0.9, respectively; p < 0.001). Notably, 306 (28%) patients met the criteria for symptom under-recognition, which was associated with the nonuse of catheter ablation during follow-up (odds ratio: 0.41; 95% confidence interval: 0.28 to 0.60; p < 0.001). CONCLUSIONS Under-recognition of AF symptom burden was frequently noted and was associated with less use of catheter ablation. Standardized recognition of symptoms using the application of validated questionnaires may facilitate outcome improvement.
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Affiliation(s)
- Yoshinori Katsumata
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Nobuhiro Ikemura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kenji Hashimoto
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Terumasa Yamashita
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Miyama
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Taishi Fujisawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Takehiro Kimura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kojiro Tanimoto
- Department of Cardiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yukihiko Momiyama
- Department of Cardiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Masahiro Suzuki
- Department of Cardiology, National Hospital Organization Saitama National Hospital, Saitama, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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15
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Kodani E, Akao M. Atrial fibrillation and stroke prevention: state of the art-epidemiology and pathophysiology: new risk factors, concepts and controversies. Eur Heart J Suppl 2020; 22:O1-O13. [PMID: 33380940 PMCID: PMC7753870 DOI: 10.1093/eurheartj/suaa176] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Atrial fibrillation (AF) increases the risk of thromboembolism, and risk assessment for thromboembolism is necessary for the management of AF patients. CHADS2 and CHA2DS2-VASc scores have been adopted in international guidelines for AF management, but the significance of each risk factor included in these risk scores are sometimes controversial, and the performance of these scores is only modest. There are several other risk factors not included in the scores such as renal dysfunction, low body weight, type of AF (paroxysmal or non-paroxysmal) as well as echocardiographic parameters and blood biomarkers, and physicians should assess patients risk in an integrated manner.
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Affiliation(s)
- Eitaro Kodani
- Department of Cardiovascular Medicine, Nippon Medical School Tama-Nagayama Hospital, 1-7-1, Nagayama, Tama-shi, Tokyo 206-8512, Japan
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
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16
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Katsumata Y, Kimura T, Kohsaka S, Ikemura N, Ueda I, Fujisawa T, Nakajima K, Nishiyama T, Aizawa Y, Oki T, Suzuki M, Heidenreich PA, Fukuda K, Takatsuki S. Discrepancy in recognition of symptom burden among patients with atrial fibrillation. Am Heart J 2020; 226:240-249. [PMID: 32517853 DOI: 10.1016/j.ahj.2020.03.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 03/11/2020] [Indexed: 11/19/2022]
Abstract
Our aim was to investigate the variability in physician recognition of atrial fibrillation (AF)-related symptoms, which greatly contributes to the management of AF patients. METHODS AND RESULTS: A total of 1493 newly-referredAF patients (67 ± 11 y/o, 1057 men) consecutively registered in an outpatient-based Japanese multicenter database (KiCS-AF) from September 2012 to December 2016 were analyzed. Self-reportedAF symptom burden was assessed via symptom and daily activities domains within the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire. Physician symptom under-recognition (UR) was defined as no subjective complaints recorded in the medical records despite AFEQT score of <80; and physician's apparent over-recognition (OvR) was defined as documentation of subjective complaints despite total AFEQT score of ≥80. There was poor agreement between patient-reported and physicians-estimated symptom burden (kappa 0.28, 95% CI 0.23 to 0.33). In the logistic regression analysis, age> 75 (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.13-2.62), male sex (OR, 1.82; 95% CI, 1.22-2.74), and persistent/permanent AF (OR 2.54/3.36; CI, 1.63-3.99/1.91-5.89, respectively) were predictors of UR. Conversely, heart failure (OR, 2.46; 95% CI, 1.44-4.25) and treatment in an ablation facility (OR, 1.43; 95% CI, 1.02-2.02) were associated with greater odds of OvR in addition to age, sex, and type of AF. CONCLUSIONS: Discordance in recognition of AF symptom burden by physicians was frequent in AF patients seen in outpatient management and involved both patient- and physician-related factors.
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Affiliation(s)
- Yoshinori Katsumata
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Takehiro Kimura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Nobuhiro Ikemura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Taishi Fujisawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuaki Nakajima
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Takahiko Nishiyama
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiyasu Aizawa
- Department of Cardiology, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Takahiro Oki
- Department of Cardiology, Tokyo Dental College Ichikawa General Hospital, Tiba, Japan
| | - Masahiro Suzuki
- Department of Cardiology, National Hospital Organization Saitama National Hospital, Japan
| | - Paul A Heidenreich
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Anzai T, Grandinetti A, Katz AR, Hurwitz EL, Wu YY, Masaki K. Association between central sleep apnea and atrial fibrillation/flutter in Japanese-American men: The Kuakini Honolulu Heart Program (HHP) and Honolulu-Asia Aging Study (HAAS). J Electrocardiol 2020; 61:10-17. [PMID: 32464488 DOI: 10.1016/j.jelectrocard.2020.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/18/2020] [Accepted: 05/09/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION While several studies have indicated that central sleep apnea (CSA) is associated with atrial fibrillation and atrial flutter (AF) in older populations, few studies have focused on older Asian populations. METHODS We conducted a cross- sectional analysis using data from the 1999-2000, 7th exam cycle of the Kuakini Honolulu-Asia Aging Study. Participants were 718 Japanese-American men between 79 and 97 years old, who had overnight polysomnography. Obstructive Apnea-Hypopnea Index (OAHI) was the measure of the number of obstructive apneas and hypopneas with >4% oxygen desaturation. Additionally, the Central Apnea Index (CAI) was the measure of the number of central apneas. Obstructive sleep apnea (OSA) was categorized as none (OAHI <5), mild (OAHI 5-14), moderate (OAHI 15-29) and severe (OAHI ≥30). CSA was defined by CAI of 5 or more. Cheyne-Stokes Breathing (CSB) was defined as a minimum consecutive 5-minute period of a crescendo-decrescendo respiratory pattern associated with CSA. RESULTS AF prevalence was 5.5% (39 of 709). The prevalence proportions of severe OSA, CSA, and CSB were 20.2% (143 of 709), 6.4% (43 of 673) and 3.2% (22 of 673), respectively. In multivariable-adjusted logistic regression models, CSA and CSB were significantly associated with AF prevalence: odds ratio (OR) 5.15, 95% confidential interval (CI), 2.21-12.52 and OR 6.26, 95% CI, 2.05-19.14, respectively. However, OSA was not significantly associated with AF prevalence. CONCLUSION AF prevalence is associated with CSA and CSB but not OSA in older Japanese-American men. This information could help target AF prevention strategies in this population.
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Affiliation(s)
- Tagayasu Anzai
- University of Hawai'i at Mānoa, Office of Public Health Studies, 1960 East-West Road, Honolulu, HI, USA.
| | - Andrew Grandinetti
- University of Hawai'i at Mānoa, Office of Public Health Studies, 1960 East-West Road, Honolulu, HI, USA.
| | - Alan R Katz
- University of Hawai'i at Mānoa, Office of Public Health Studies, 1960 East-West Road, Honolulu, HI, USA.
| | - Eric L Hurwitz
- University of Hawai'i at Mānoa, Office of Public Health Studies, 1960 East-West Road, Honolulu, HI, USA.
| | - Yan Yan Wu
- University of Hawai'i at Mānoa, Office of Public Health Studies, 1960 East-West Road, Honolulu, HI, USA.
| | - Kamal Masaki
- University of Hawai'i at Mānoa, Department of Geriatric Medicine, John A. Burns School of Medicine, 347 N Kuakini St, Honolulu, HI, USA; Kuakini Medical Center, 347 N Kuakini St, Honolulu, HI, USA.
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18
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Predictors of localization, outcome, and etiology of spontaneous intracerebral hemorrhages: focus on cerebral amyloid angiopathy. J Neural Transm (Vienna) 2020; 127:963-972. [PMID: 32193732 PMCID: PMC7248013 DOI: 10.1007/s00702-020-02174-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/09/2020] [Indexed: 12/29/2022]
Abstract
Despite its clinical relevance, cerebral amyloid angiopathy (CAA) is underdiagnosed worldwide. This retrospective study aimed to assess the incidence, etiology, predictors, and outcome of intracerebral hemorrhages (ICHs) in this region, with special focus on possible underlying CAA. Database screening of acute cares with intracranial hemorrhage diagnosis within 01/07/2014–01/07/2018 were conducted analyzing medical records and imaging. Spontaneous ICHs were classified as deep (basal ganglionic/thalamic/brainstem) and lobar/cerebellar (i.e., CAA-compatible) ICHs. Probable/definite CAA was established using the modified Boston criteria in a subgroup with ‘complete’ radiological/neuropathological work-up. The ability of several factors to discriminate between deep and lobar/cerebellar ICHs, between probable/definite CAA and non-probable CAA cases, and to predict 1-month case fatality was assessed. Of the 213 ICHs identified, 121 were in deep and 92 in lobar/cerebellar localization. Sub-analysis of 47 lobar/cerebellar ICHs with ‘complete’ work-up identified 16 probable/definite CAA patients, yielding an estimated 14.7% prevalence of CAA-related ICHs. Chronic hypertension was the most prevalent risk factor for all types of ICHs (including CAA-related), with hypertensive excess and younger age being independent predictors of deep whereas antiplatelet use of lobar/cerebellar localization. The 1-month case fatality was 33.8%, driven predominantly by age and INR > 1.4. Probable/definite CAA diagnosis was independently predicted by age, prior intracranial hemorrhage, and antiplatelet use. First in this region and among the few in the literature, this study reports a remarkable prevalence of CAA-related ICHs, emphasizing the need for an increased awareness of CAA and its therapeutic implications, especially regarding antiplatelets among the elderly.
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19
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Maeda T, Nishi T, Funakoshi S, Tada K, Tsuji M, Satoh A, Kawazoe M, Yoshimura C, Arima H. Risks of Bleeding and Stroke Based on CHA2DS2-VASc Scores in Japanese Patients With Atrial Fibrillation: A Large-Scale Observational Study Using Real-World Data. J Am Heart Assoc 2020; 9:e014574. [PMID: 32106743 PMCID: PMC7335551 DOI: 10.1161/jaha.119.014574] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background This large-scale observational study on negative events in a real-world setting investigated Japanese patients with atrial fibrillation who were not on anticoagulants. This study aims to evaluate the incidence of ischemic stroke and bleeding events (intracranial hemorrhage, gastrointestinal bleeding, others) based on CHA2DS2-VASc scores in Japanese patients with atrial fibrillation who were not anticoagulated. Methods and Results We used health checkups and insurance claim data from a Japanese insurance organization. Altogether, 9733 atrial fibrillation patients were not prescribed anticoagulation during their follow-up periods. Patients' risk levels were defined by their CHA2DS2-VASc scores (range 0-≥3): Men with scores of 0, 1, or ≥2 and women with scores of 1, 2, or ≥3 were considered at low, intermediate, or high risk, respectively. Cox proportional hazards model was used to assess the association between the CHA2DS2-VASc-determined risk and the incidence of ischemic stroke and intracranial, gastrointestinal, and other bleeding. The mean 2.5-year follow-up revealed 143 ischemic strokes and 332 bleeding events. Annual event rates were 0.58% for ischemic stroke and 1.17% for total bleeding events. Annual incidence of ischemic stroke increased with elevated predicted risks based on CHA2DS2-VASc scores: 0.18% for low-risk, 0.44% intermediate-risk, and 1.29% high-risk groups (P<0.001 for trend). Annual incidences of total bleeding also increased with elevated predicted risks: 0.51% for low-risk, 1.28% intermediate-risk, and 2.02% high-risk groups (P<0.001 for trend). Conclusions Risks of ischemic stroke and bleeding events were high, particularly among those with high CHA2DS2-VASc scores.
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Affiliation(s)
- Toshiki Maeda
- Department of Preventive Medicine and Public Health Faculty of Medicine Fukuoka University Fukuoka Japan
| | - Takumi Nishi
- Department of Preventive Medicine and Public Health Faculty of Medicine Fukuoka University Fukuoka Japan.,Department of Research Planning and Information Management Fukuoka Institute of Health and Environmental Sciences Fukuoka Japan
| | - Shunsuke Funakoshi
- Department of Preventive Medicine and Public Health Faculty of Medicine Fukuoka University Fukuoka Japan
| | - Kazuhiro Tada
- Division of Nephrology and Rheumatology Department of Internal Medicine Faculty of Medicine Fukuoka University Fukuoka Japan
| | | | - Atsushi Satoh
- Department of Preventive Medicine and Public Health Faculty of Medicine Fukuoka University Fukuoka Japan
| | - Miki Kawazoe
- Department of Preventive Medicine and Public Health Faculty of Medicine Fukuoka University Fukuoka Japan
| | - Chikara Yoshimura
- Department of Preventive Medicine and Public Health Faculty of Medicine Fukuoka University Fukuoka Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health Faculty of Medicine Fukuoka University Fukuoka Japan
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20
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Tiwari P, Colborn KL, Smith DE, Xing F, Ghosh D, Rosenberg MA. Assessment of a Machine Learning Model Applied to Harmonized Electronic Health Record Data for the Prediction of Incident Atrial Fibrillation. JAMA Netw Open 2020; 3:e1919396. [PMID: 31951272 PMCID: PMC6991266 DOI: 10.1001/jamanetworkopen.2019.19396] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
IMPORTANCE Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and its early detection could lead to significant improvements in outcomes through the appropriate prescription of anticoagulation medication. Although a variety of methods exist for screening for AF, a targeted approach, which requires an efficient method for identifying patients at risk, would be preferred. OBJECTIVE To examine machine learning approaches applied to electronic health record data that have been harmonized to the Observational Medical Outcomes Partnership Common Data Model for identifying risk of AF. DESIGN, SETTING, AND PARTICIPANTS This diagnostic study used data from 2 252 219 individuals cared for in the UCHealth hospital system, which comprises 3 large hospitals in Colorado, from January 1, 2011, to October 1, 2018. Initial analysis was performed in December 2018; follow-up analysis was performed in July 2019. EXPOSURES All Observational Medical Outcomes Partnership Common Data Model-harmonized electronic health record features, including diagnoses, procedures, medications, age, and sex. MAIN OUTCOMES AND MEASURES Classification of incident AF in designated 6-month intervals, adjudicated retrospectively, based on area under the receiver operating characteristic curve and F1 statistic. RESULTS Of 2 252 219 individuals (1 225 533 [54.4%] women; mean [SD] age, 42.9 [22.3] years), 28 036 (1.2%) developed incident AF during a designated 6-month interval. The machine learning model that used the 200 most common electronic health record features, including age and sex, and random oversampling with a single-layer, fully connected neural network provided the optimal prediction of 6-month incident AF, with an area under the receiver operating characteristic curve of 0.800 and an F1 score of 0.110. This model performed only slightly better than a more basic logistic regression model composed of known clinical risk factors for AF, which had an area under the receiver operating characteristic curve of 0.794 and an F1 score of 0.079. CONCLUSIONS AND RELEVANCE Machine learning approaches to electronic health record data offer a promising method for improving risk prediction for incident AF, but more work is needed to show improvement beyond standard risk factors.
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Affiliation(s)
- Premanand Tiwari
- Colorado Center for Personalized Medicine, University of Colorado School of Medicine, Aurora
| | - Kathryn L. Colborn
- Colorado School of Public Health, Department of Biostatics and Informatics, University of Colorado Denver, Aurora
| | - Derek E. Smith
- Children’s Hospital Colorado, Cancer Center Biostatistics Core, Department of Pediatrics, University of Colorado, Aurora
| | - Fuyong Xing
- Colorado School of Public Health, Department of Biostatics and Informatics, University of Colorado Denver, Aurora
| | - Debashis Ghosh
- Colorado School of Public Health, Department of Biostatics and Informatics, University of Colorado Denver, Aurora
| | - Michael A. Rosenberg
- Colorado Center for Personalized Medicine, University of Colorado School of Medicine, Aurora
- Division of Cardiology and Cardiac Electrophysiology, University of Colorado School of Medicine, Aurora
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21
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Edling C, Fazmin I, Saadeh K, Chadda K, Ahmad S, Valli H, Huang CH, Jeevaratnam K. Molecular basis of arrhythmic substrate in ageing murine peroxisome proliferator-activated receptor γ co-activator deficient hearts modelling mitochondrial dysfunction. Biosci Rep 2019; 39:BSR20190403. [PMID: 31778152 PMCID: PMC6911157 DOI: 10.1042/bsr20190403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 11/19/2019] [Accepted: 11/26/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Ageing and chronic metabolic disorders are associated with mitochondrial dysfunction and cardiac pro-arrhythmic phenotypes which were recently attributed to slowed atrial and ventricular action potential (AP) conduction in peroxisome proliferator-activated receptor γ co-activator deficient (Pgc-1β-/-) mice. METHODS We compared expression levels of voltage-gated Na+ channel (NaV1.5) and gap junction channels, Connexins 40 and 43 (Cx40 and Cx43) in the hearts of young and old, and wild-type (WT) and Pgc-1β-/- mice. This employed Western blotting (WB) for NaV1.5, Cx40 and Cx43 in atrial/ventricular tissue lysates, and immunofluorescence (IF) from Cx43 was explored in tissue sections. Results were analysed using two-way analysis of variance (ANOVA) for independent/interacting effects of age and genotype. RESULTS In atria, increased age and Pgc-1β-/- genotype each independently decreased both Cx40 and Cx43 expression without interacting effects. In IF experiments, both age and Pgc-1β deletion independently reduced Cx43 expression. In ventricles, age and genotype exerted interacting effects in WB studies of NaV1.5 expression. Young Pgc-1β-/- then showed greater NaV1.5 expression than young WT ventricles. However, neither age nor Pgc-1β deletion affected Cx43 expression, independently or through interacting effects in both WB and IF studies. CONCLUSION Similar pro-arrhythmic atrial/ventricular phenotypes arise in aged/Pgc-1β-/- from differing contributions of altered protein expression and functional effects that may arise from multiple acute mechanisms.
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Affiliation(s)
- Charlotte E. Edling
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, United Kingdom
| | - Ibrahim T. Fazmin
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, United Kingdom
- Physiological Laboratory, University of Cambridge, Downing Street, Cambridge CB2 3EG, United Kingdom
| | - Khalil Saadeh
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, United Kingdom
- Physiological Laboratory, University of Cambridge, Downing Street, Cambridge CB2 3EG, United Kingdom
| | - Karan R. Chadda
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, United Kingdom
- Physiological Laboratory, University of Cambridge, Downing Street, Cambridge CB2 3EG, United Kingdom
| | - Shiraz Ahmad
- Physiological Laboratory, University of Cambridge, Downing Street, Cambridge CB2 3EG, United Kingdom
| | - Haseeb Valli
- Physiological Laboratory, University of Cambridge, Downing Street, Cambridge CB2 3EG, United Kingdom
| | - Christopher L.-H. Huang
- Physiological Laboratory, University of Cambridge, Downing Street, Cambridge CB2 3EG, United Kingdom
- Department of Biochemistry, Hopkins Building, University of Cambridge, Cambridge CB2 1QW, United Kingdom
| | - Kamalan Jeevaratnam
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7AL, United Kingdom
- Department of Biochemistry, Hopkins Building, University of Cambridge, Cambridge CB2 1QW, United Kingdom
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Noubiap JJ, Nyaga UF. A review of the epidemiology of atrial fibrillation in sub-Saharan Africa. J Cardiovasc Electrophysiol 2019; 30:3006-3016. [PMID: 31596016 DOI: 10.1111/jce.14222] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/05/2019] [Accepted: 09/09/2019] [Indexed: 01/05/2023]
Abstract
This systematic review summarizes the data on the prevalence, risk factors, complications, and management of atrial fibrillation (AF) in sub-Saharan Africa (SSA). Bibliographic databases were searched from inception to 31 May 2019, to identify all published studies providing data on AF in populations living in SSA. A total of 72 studies were included. The community-based prevalence of AF was 4.3% and 0.7% in individuals aged ≥40 years and aged ≥70 years, respectively. The prevalence of AF ranged between 6.7% and 34.8% in patients with ischemic stroke, between 9.5% and 46.8% in those with rheumatic heart disease (RHD), between 5% and 31.5% in patients with dilated cardiomyopathy. The main risk factors for AF were hypertension, affecting at least one-third of patients with AF, and valvular heart disease (12.3%-44.4%) and cardiomyopathy (~20%). Complications of AF included heart failure in about two thirds and stroke in 10% to 15% of cases. The use of anticoagulation for stroke prevention was suboptimal. Rate control was the most frequent therapeutic strategy, used in approximately 65% to 95% of AF patients, with approximately 80% of them achieving rate control. The management of AF was associated with exorbitant cost. In conclusion, AF seems to have a higher prevalence in the general population than previously thought and is mostly associated with hypertension, cardiomyopathy, and RHD in SSA. It is associated with a high incidence of heart failure and stroke. The management of AF is suboptimal in SSA, especially with a low uptake of oral anticoagulation.
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Affiliation(s)
- Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Ulrich Flore Nyaga
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon
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Bedford JP, Harford M, Petrinic T, Young JD, Watkinson PJ. Risk factors for new-onset atrial fibrillation on the general adult ICU: A systematic review. J Crit Care 2019; 53:169-175. [DOI: 10.1016/j.jcrc.2019.06.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/10/2019] [Accepted: 06/17/2019] [Indexed: 11/24/2022]
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Abstract
Optical mapping of electrical activity in the heart is based on voltage-sensitive and lipophilic fluorescence dyes. Optical signals recorded from cardiac cells correlate well with their transmembrane potentials. High spatiotemporal resolution, wide field mapping, and high sensitivity to transmembrane potential enable detailed characterization of action potential initiation and propagation. Optical mapping is used to study complex patterns of excitation propagation, including propagation across the sinoatrial and atrioventricular nodes and during atrial and ventricular arrhythmias.Optical mapping is used to study the role of reentrant activity in atrial and ventricular fibrillation.
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25
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Kabutoya T, Takahashi S, Watanabe T, Imai Y, Uemoto K, Yasui N, Kario K. Diagnostic accuracy of an algorithm for detecting atrial fibrillation in a wrist-type pulse wave monitor. J Clin Hypertens (Greenwich) 2019; 21:1393-1398. [PMID: 31420946 DOI: 10.1111/jch.13648] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/20/2019] [Accepted: 03/26/2019] [Indexed: 11/27/2022]
Abstract
We evaluated the diagnostic value of atrial fibrillation (AF) measured by a wrist-type pulse wave monitor in this case-control study. Six serial pulse wave values (three in the left and three in the right wrist) were measured using a wrist-type monitor in 29 AF patients and 30 subjects with sinus rhythm. We defined "monitor AF in irregular pulse peak (IPP) 15/20/25" as follows: (a) IPP: |interval of pulse peak - the average of the interval of the pulse peak| ≥ the average of the interval of the pulse peak × 15/20/25%; (b) irregular heartbeat (IHB): beats of IPP ≥ total pulse × 20%; and (c) monitor AF: ≥4 IHBs of the six pulse wave measurements. In IPP 15, the sensitivity and specificity were 0.97 and 1.00, respectively. Pulse wave analysis by a wrist-type monitor was shown to have high sensitivity and specificity for the diagnosis of AF.
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Affiliation(s)
- Tomoyuki Kabutoya
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | | | - Tomonori Watanabe
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yasushi Imai
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | | | | | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
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Kodani E, Kaneko T, Fujii H, Nakamura H, Sasabe H, Tamura Y, Shimizu W. Prevalence and Incidence of Atrial Fibrillation in the General Population Based on National Health Insurance Special Health Checkups ― TAMA MED Project-AF ―. Circ J 2019; 83:524-531. [DOI: 10.1253/circj.cj-18-1038] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Eitaro Kodani
- Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital
- TAMA CITY Medical Association
| | - Tomohiro Kaneko
- Department of Nephrology, Nippon Medical School Tama-Nagayama Hospital
| | - Hitomi Fujii
- Tama-center Mirai Clinic
- TAMA CITY Medical Association
| | | | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
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Accuracy of automated blood pressure measurements in the presence of atrial fibrillation: systematic review and meta-analysis. J Hum Hypertens 2019; 33:352-364. [PMID: 30631126 DOI: 10.1038/s41371-018-0153-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/30/2018] [Accepted: 11/26/2018] [Indexed: 01/19/2023]
Abstract
Atrial fibrillation (AF) affects ~3% of the general population and is twice as common with hypertension. Validation protocols for automated sphygmomanometers exclude people with AF, raising concerns over accuracy of hypertension diagnosis or management, using out-of-office blood pressure (BP) monitoring, in the presence of AF. Some devices include algorithms to detect AF; a feature open to misinterpretation as offering accurate BP measurement with AF. We undertook this review to explore accuracy of automated devices, with or without AF detection, for measuring BP. We searched Medline and Embase to October 2018 for studies comparing automated BP measurement devices to a standard mercury sphygmomanometer contemporaneously. Data were extracted by two reviewers. Mean BP differences between devices and mercury were calculated, where not reported and compared; meta-analyses were undertaken where possible. We included 13 studies reporting 14 devices. Mean systolic and diastolic BP differences from mercury ranged from -3.1 to + 6.1/-4.6 to +9.0 mmHg. Considerable heterogeneity existed between devices (I2: 80 to 90%). Devices with AF detection algorithms appeared no more accurate for BP measurement with AF than other devices. A previous review concluded that oscillometric devices are accurate for systolic but not diastolic BP measurement in AF. The present findings do not support that conclusion. Due to heterogeneity between devices, they should be evaluated on individual performance. We found no evidence that devices with AF detection measure BP more accurately in AF than other devices. More home or ambulatory automated BP monitors require validation in populations with AF.
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Lahoz C, Cardenas J, Salinero-Fort MÁ, Mostaza JM. Prevalence of atrial fibrillation and associated anticoagulant therapy in the nonagenarian population of the Community of Madrid, Spain. Geriatr Gerontol Int 2018; 19:203-207. [DOI: 10.1111/ggi.13587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/18/2018] [Accepted: 11/06/2018] [Indexed: 01/30/2023]
Affiliation(s)
- Carlos Lahoz
- Lipids and Arteriosclerosis Unit, Internal Medicine Department; Hospital Carlos III - La Paz; Madrid Spain
| | - Juan Cardenas
- Health Information Systems Technical Management, Adjunct Healthcare Processes Management; Primary Care Management; Madrid Spain
| | | | - José M Mostaza
- Lipids and Arteriosclerosis Unit, Internal Medicine Department; Hospital Carlos III - La Paz; Madrid Spain
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Arslani K, Roffler N, Zurek M, Greutmann M, Schwerzmann M, Bouchardy J, Rutz T, Ehl NF, Jost CA, Tobler D. Patterns of Incidence Rates of Cardiac Complications in Patients With Congenital Heart Disease. Can J Cardiol 2018; 34:1624-1630. [DOI: 10.1016/j.cjca.2018.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/28/2018] [Accepted: 09/19/2018] [Indexed: 10/28/2022] Open
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Liu X, Kong D, Liu Y, Fu J, Gao P, Chen T, Fang Q, Cheng K, Fan Z. Effects of the short-term exposure to ambient air pollution on atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1441-1446. [PMID: 30225893 DOI: 10.1111/pace.13500] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 07/25/2018] [Accepted: 09/05/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Xiaole Liu
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College; Chinese Academy of Medical Sciences; Beijing China
| | - Dehui Kong
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College; Chinese Academy of Medical Sciences; Beijing China
| | - Yanbo Liu
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College; Chinese Academy of Medical Sciences; Beijing China
| | - Jia Fu
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College; Chinese Academy of Medical Sciences; Beijing China
| | - Peng Gao
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College; Chinese Academy of Medical Sciences; Beijing China
| | - Taibo Chen
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College; Chinese Academy of Medical Sciences; Beijing China
| | - Quan Fang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College; Chinese Academy of Medical Sciences; Beijing China
| | - Kang'an Cheng
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College; Chinese Academy of Medical Sciences; Beijing China
| | - Zhongjie Fan
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College; Chinese Academy of Medical Sciences; Beijing China
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Affiliation(s)
- Roopinder K Sandhu
- Department of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Justin A Ezekowitz
- Department of Cardiology, University of Alberta, Edmonton, Alberta, Canada
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Marott JL, Skielboe AK, Dixen U, Friberg JB, Schnohr P, Jensen GB. Increasing population height and risk of incident atrial fibrillation: the Copenhagen City Heart Study. Eur Heart J 2018; 39:4012-4019. [DOI: 10.1093/eurheartj/ehy367] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 06/12/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
- Jacob Louis Marott
- The Copenhagen City Heart Study, Copenhagen University Hospital Frederiksberg, Nordre Fasanvej 57, Frederiksberg, Denmark
| | - Ane Katrine Skielboe
- Department of Cardiology, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Hvidovre, Denmark
| | - Ulrik Dixen
- Department of Cardiology, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Hvidovre, Denmark
| | - Jens Birkedal Friberg
- Department of Cardiology, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Hvidovre, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Copenhagen University Hospital Frederiksberg, Nordre Fasanvej 57, Frederiksberg, Denmark
| | - Gorm Boje Jensen
- The Copenhagen City Heart Study, Copenhagen University Hospital Frederiksberg, Nordre Fasanvej 57, Frederiksberg, Denmark
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Copenhagen, Denmark
- Section of Cardiology, Department of Medicine, Holbæk Hospital, Smedelundsgade 60, Holbæk, Denmark
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Higuchi S, Kabeya Y, Matsushita K, Tachibana K, Kawachi R, Takei H, Suzuki Y, Abe N, Imanishi Y, Moriyama K, Yorozu T, Saito K, Sugiyama M, Kondo H, Yoshino H. The study protocol for PREDICT AF RECURRENCE: a PRospEctive cohort stuDy of surveIllanCe for perioperaTive Atrial Fibrillation RECURRENCE in major non-cardiac surgery for malignancy. BMC Cardiovasc Disord 2018; 18:127. [PMID: 29940875 PMCID: PMC6019832 DOI: 10.1186/s12872-018-0862-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/11/2018] [Indexed: 12/24/2022] Open
Abstract
Background A previous retrospective cohort study established the relationship between perioperative atrial fibrillation (POAF) and subsequent mortality and stroke. However, the details regarding the cause of death and etiology of stroke remain unclear. Methods The prospective cohort study of surveillance for perioperative atrial fibrillation recurrence in major non-cardiac surgery for malignancy (PREDICT AF RECURRENCE) registry is an ongoing prospective cohort study to elucidate the long-term recurrence rate and the clinical impact of new-onset POAF in the setting of head and neck, non-cardiac thoracic, and abdominal surgery for malignancy. In this study, cardiologists collaborate with a surgical team during the perioperative period, carefully observe the electrocardiogram (ECG) monitor, and treat arrhythmia as required. Furthermore, patients who develop new-onset POAF are followed up using a long-term Holter ECG monitor, SPIDER FLASH-t AFib®, to assess POAF recurrence. Discussion Even if patients with malignancy survive by overcoming the disease, they may die from any preventable cardiovascular diseases. In particular, those with POAF may develop cardiogenic stroke in the future. Because details of the natural history of patients with POAF remain unclear, investigating the need to continue anticoagulation therapy for such patients is necessary. This study will provide essential information on the recurrence rate of POAF and new insights into the prediction and treatment of POAF. Trial registration University Hospital Medical Information Network Clinical Trial Registry (UMIN-CTR): UMIN000016146; Data of Registration: January 7, 2015. Electronic supplementary material The online version of this article (10.1186/s12872-018-0862-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Satoshi Higuchi
- Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, Tokyo, Japan. .,Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan.
| | - Yusuke Kabeya
- Division of General Internal Medicine, Department of Internal Medicine, Tokai University, Isehara, Kanagawa, Japan.,Department of Home Care Medicine, Saiyu Clinic, Saitama, Japan
| | - Kenichi Matsushita
- Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, Tokyo, Japan
| | - Keisei Tachibana
- Department of General Thoracic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Riken Kawachi
- Department of General Thoracic Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hidefumi Takei
- Department of General Thoracic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Yutaka Suzuki
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Nobutsugu Abe
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Yorihisa Imanishi
- Department of Otorhinolaryngology, Head and Neck Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Kanagawa, Japan
| | - Kiyoshi Moriyama
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Tomoko Yorozu
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Koichiro Saito
- Department of Otolaryngology-Head and Neck Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Masanori Sugiyama
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Haruhiko Kondo
- Department of General Thoracic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Hideaki Yoshino
- Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, Tokyo, Japan
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Jain N, Thompson P, Ferrajoli A, Nabhan C, Mato AR, O'Brien S. Approaches to Chronic Lymphocytic Leukemia Therapy in the Era of New Agents: The Conundrum of Many Options. Am Soc Clin Oncol Educ Book 2018; 38:580-591. [PMID: 30231393 DOI: 10.1200/edbk_200691] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Three small molecule inhibitors have been approved for the treatment of chronic lymphocytic leukemia (CLL) in the last 4 years. Ibrutinib, idelalisib, and venetoclax are oral agents with excellent efficacy and different toxicity profiles. Issues discussed herein include the current role for chemoimmunotherapy in CLL, the use of oral inhibitors in older patients, and the sequencing of these molecules in daily practice.
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Affiliation(s)
- Nitin Jain
- From the Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Cardinal Health Specialty Solutions, Chicago, IL; Chronic Lymphocytic Leukemia Program, Memorial Sloan Kettering Cancer Center, New York, NY; Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA
| | - Philip Thompson
- From the Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Cardinal Health Specialty Solutions, Chicago, IL; Chronic Lymphocytic Leukemia Program, Memorial Sloan Kettering Cancer Center, New York, NY; Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA
| | - Alessandra Ferrajoli
- From the Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Cardinal Health Specialty Solutions, Chicago, IL; Chronic Lymphocytic Leukemia Program, Memorial Sloan Kettering Cancer Center, New York, NY; Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA
| | - Chadi Nabhan
- From the Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Cardinal Health Specialty Solutions, Chicago, IL; Chronic Lymphocytic Leukemia Program, Memorial Sloan Kettering Cancer Center, New York, NY; Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA
| | - Anthony R Mato
- From the Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Cardinal Health Specialty Solutions, Chicago, IL; Chronic Lymphocytic Leukemia Program, Memorial Sloan Kettering Cancer Center, New York, NY; Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA
| | - Susan O'Brien
- From the Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Cardinal Health Specialty Solutions, Chicago, IL; Chronic Lymphocytic Leukemia Program, Memorial Sloan Kettering Cancer Center, New York, NY; Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA
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Kamioka M, Hijioka N, Matsumoto Y, Nodera M, Kaneshiro T, Suzuki H, Takeishi Y. Uncontrolled blood pressure affects atrial remodeling and adverse clinical outcome in paroxysmal atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:402-410. [DOI: 10.1111/pace.13311] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 01/21/2018] [Accepted: 01/29/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Masashi Kamioka
- Department of Cardiovascular Medicine; Fukushima Medical University; Fukushima Japan
| | - Naoko Hijioka
- Department of Cardiovascular Medicine; Fukushima Medical University; Fukushima Japan
| | - Yoshiyuki Matsumoto
- Department of Cardiovascular Medicine; Fukushima Medical University; Fukushima Japan
| | - Minoru Nodera
- Department of Cardiovascular Medicine; Fukushima Medical University; Fukushima Japan
| | - Takashi Kaneshiro
- Department of Cardiovascular Medicine; Fukushima Medical University; Fukushima Japan
| | - Hitoshi Suzuki
- Department of Cardiovascular Medicine; Fukushima Medical University; Fukushima Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine; Fukushima Medical University; Fukushima Japan
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Alharbi AM, Alsuhaibani MA. Atrial fibrillation among adult Saudi patients with chronic heart failure: Tertiary center experience. Int J Health Sci (Qassim) 2018; 12:64-68. [PMID: 29623020 PMCID: PMC5870318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To estimate the rate of atrial fibrillation (AF) among adult patients with chronic heart failure (HF) from Saudi Arabia, and to identify the clinical and the demographic characteristics. METHODS This study was performed using all medical records of patients registered in Prince Sultan Cardiac Center in Qassim, Saudi Arabia, and diagnosed with HF during the period from January 1, 2010 to June 30, 2014. The review process included patients diagnosed with chronic HF who were registered for follow-up during the study period. The rate of AF was calculated, and the associated risk factors were determined. RESULTS The rate of AF among chronic HF (n = 70) patients was 14.9%. The rate of AF was higher among males (15.7%) than females (12.5%). In both genders, the rate of AF rose with advancing age, and in each age stratum, it was higher in males than females. The rate of AF was higher if chronic HF was associated with chronic diseases, such as diabetes mellitus (DM, 14.3%), hypertension (HTN, 20%), and none of the patients had a history of chronic kidney disease. CONCLUSION The rate of AF with chronic HF is high among Saudi Arabia patients. It is higher among male patients and HTN and DM patients.
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Affiliation(s)
- Amjad Mohammad Alharbi
- Qassim University, Heart Function Clinic at Prince Sultan Cardiac Center, Qassim, Buraidah, An Naziyah, Kingdom of Saudi Arabia,Address for correspondence: Medical Graduate, College of Medicine, Qassim University, Qassim, Kingdom of Saudi Arabia P.O. Box: 52378, ZIP code: 2558. E-mail:
| | - Marya Abdullah Alsuhaibani
- Qassim University, Heart Function Clinic at Prince Sultan Cardiac Center, Qassim, Buraidah, An Naziyah, Kingdom of Saudi Arabia
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Atrial fibrillation and use of antithrombotic medications in older people: A population-based study. Int J Cardiol 2017; 249:173-178. [DOI: 10.1016/j.ijcard.2017.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/30/2017] [Accepted: 07/06/2017] [Indexed: 01/05/2023]
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Azoulay L, Dell’Aniello S, Simon T, Renoux C, Suissa S. The concurrent use of antithrombotic therapies and the risk of bleeding in patients with atrial fibrillation. Thromb Haemost 2017; 109:431-9. [DOI: 10.1160/th12-08-0542] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 11/17/2012] [Indexed: 01/06/2023]
Abstract
SummaryPatients with atrial fibrillation (AF) often receive, in addition to warfarin, antithrombotic drugs to manage other comorbid conditions. To date, few population-based studies have quantified the bleeding risk associated with the concurrent use of these therapies. The United Kingdom General Practice Research Database was used to identify a cohort of 70,760 patients newly-diagnosed with AF between 1993 and 2008. A nested case-control analysis was conducted within that cohort, and conditional logistic regression was used to estimate adjusted rate ratios (RRs) of bleeding associated with current use of warfarin, aspirin, and clopidogrel in single therapy, as well as in dual and triple therapy, as compared with non-use of any therapy. A total of 10,850 patients experienced a bleeding event during follow-up. In single therapy, warfarin was associated with the highest increased risk (RR: 2.08, 95% confidence interval [CI]: 1.95–2.23), followed by clopidogrel (RR: 1.57, 95% CI: 1.37–1.81) and aspirin (RR: 1.25, 95% CI: 1.17–1.34). In dual therapy, combinations containing warfarin were associated with a higher increased risk (warfarin-aspirin: RR: 2.87, 95% CI: 2.58–3.19, and warfarin-clopidogrel: RR: 2.74, 95% CI: 2.14–3.51), than those not containing warfarin (aspirin-clopidogrel: RR: 1.68, 95% CI: 1.44–1.97). Triple therapy of warfarin-aspirin-clopidogrel was associated with the highest increased risk (RR: 3.75, 95% CI: 2.71–5.19). This large population-based study suggests that while all antithrombotic therapies are associated with an elevated risk of bleeding, the risks increase in an additive fashion with dual and triple therapy, particularly in combinations containing warfarin.
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Valli H, Ahmad S, Chadda KR, Al-Hadithi ABAK, Grace AA, Jeevaratnam K, Huang CLH. Age-dependent atrial arrhythmic phenotype secondary to mitochondrial dysfunction in Pgc-1β deficient murine hearts. Mech Ageing Dev 2017; 167:30-45. [PMID: 28919427 PMCID: PMC5652526 DOI: 10.1016/j.mad.2017.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/24/2017] [Accepted: 09/13/2017] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Ageing and several age-related chronic conditions including obesity, insulin resistance and hypertension are associated with mitochondrial dysfunction and represent independent risk factors for atrial fibrillation (AF). MATERIALS AND METHODS Atrial arrhythmogenesis was investigated in Langendorff-perfused young (3-4 month) and aged (>12 month), wild type (WT) and peroxisome proliferator activated receptor-γ coactivator-1β deficient (Pgc-1β-/-) murine hearts modeling age-dependent chronic mitochondrial dysfunction during regular pacing and programmed electrical stimulation (PES). RESULTS AND DISCUSSION The Pgc-1β-/- genotype was associated with a pro-arrhythmic phenotype progressing with age. Young and aged Pgc-1β-/- hearts showed compromised maximum action potential (AP) depolarization rates, (dV/dt)max, prolonged AP latencies reflecting slowed action potential (AP) conduction, similar effective refractory periods and baseline action potential durations (APD90) but shortened APD90 in APs in response to extrasystolic stimuli at short stimulation intervals. Electrical properties of APs triggering arrhythmia were similar in WT and Pgc-1β-/- hearts. Pgc-1β-/- hearts showed accelerated age-dependent fibrotic change relative to WT, with young Pgc-1β-/- hearts displaying similar fibrotic change as aged WT, and aged Pgc-1β-/- hearts the greatest fibrotic change. Mitochondrial deficits thus result in an arrhythmic substrate, through slowed AP conduction and altered repolarisation characteristics, arising from alterations in electrophysiological properties and accelerated structural change.
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Affiliation(s)
- Haseeb Valli
- Physiological Laboratory, University of Cambridge, Downing Street, Cambridge, CB2 3EG, United Kingdom
| | - Shiraz Ahmad
- Physiological Laboratory, University of Cambridge, Downing Street, Cambridge, CB2 3EG, United Kingdom
| | - Karan R Chadda
- Physiological Laboratory, University of Cambridge, Downing Street, Cambridge, CB2 3EG, United Kingdom; Faculty of Health and Medical Sciences, University of Surrey, GU2 7AL, Guildford, Surrey, United Kingdom
| | - Ali B A K Al-Hadithi
- Physiological Laboratory, University of Cambridge, Downing Street, Cambridge, CB2 3EG, United Kingdom
| | - Andrew A Grace
- Department of Biochemistry, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QW, United Kingdom
| | - Kamalan Jeevaratnam
- Physiological Laboratory, University of Cambridge, Downing Street, Cambridge, CB2 3EG, United Kingdom; Faculty of Health and Medical Sciences, University of Surrey, GU2 7AL, Guildford, Surrey, United Kingdom; PU-RCSI School of Medicine, Perdana University, 43400, Serdang, Selangor Darul Ehsan, Malaysia
| | - Christopher L-H Huang
- Physiological Laboratory, University of Cambridge, Downing Street, Cambridge, CB2 3EG, United Kingdom; Department of Biochemistry, University of Cambridge, Tennis Court Road, Cambridge, CB2 1QW, United Kingdom.
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Lacoin L, Lumley M, Ridha E, Pereira M, McDonald L, Ramagopalan S, Lefèvre C, Evans D, Halcox JP. Evolving landscape of stroke prevention in atrial fibrillation within the UK between 2012 and 2016: a cross-sectional analysis study using CPRD. BMJ Open 2017; 7:e015363. [PMID: 28951401 PMCID: PMC5623501 DOI: 10.1136/bmjopen-2016-015363] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe the changes in prescribing of oral anticoagulant (AC) and antiplatelet (AP) agents in patients with non-valvular atrial fibrillation (NVAF) in the UK and to identify the characteristics associated with deviation from guideline-based recommendations. DESIGN Five cross-sectional analyses in a large retrospective population-based cohort study. SETTING General practices contributing data to the UK Clinical Practice Research Datalink. PARTICIPANTS The study included patients with a diagnosis of NVAF and eligible for anticoagulation (CHA2DS2-VASc score ≥2) on 1 April of 2012, 2013, 2014, 2015 and 1st January 2016. RESULTS The proportion of patients being treated with AC increased at each index date, showing an absolute rise of 16.7% over the study period. At the same time, the proportion of patients treated with an AP alone was reduced by half, showing an absolute decrease of 16.8%. The proportion of patients not receiving any antithrombotic (AT) treatment remained the same across the study period. A number of predictors were identified for AP alone or no treatment compared with AC treatment. CONCLUSION Major improvements in the AT management of patients with NVAF for stroke prevention in the UK were observed between April 2012 and January 2016. Despite this, nearly 20% of at-risk patients still received AP alone and over 15% were on no AT agents in January 2016.
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Affiliation(s)
- Laure Lacoin
- UK Medical Department, Bristol-Myers Squibb, Uxbridge, UK
| | | | - Essra Ridha
- UK Medical Department, Bristol-Myers Squibb, Uxbridge, UK
| | | | | | | | - Cinira Lefèvre
- Center of Observational Research and Data Sciences, Business Insights and Analytics, Bristol-Myers Squibb, Rueil Malmaison, France
- Worldwide Health Economics & Outcomes Research, Bristol-Myers Squibb, Rueil Malmaison, France
| | - David Evans
- Worldwide Health Economics & Outcomes Research, Bristol-Myers Squibb, Rueil Malmaison, France
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Kabutoya T, Imai Y, Hoshide S, Kario K. Diagnostic accuracy of a new algorithm to detect atrial fibrillation in a home blood pressure monitor. J Clin Hypertens (Greenwich) 2017; 19:1143-1147. [DOI: 10.1111/jch.13076] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/18/2017] [Accepted: 04/30/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Tomoyuki Kabutoya
- Division of Cardiovascular Medicine; Department of Medicine; Jichi Medical University School of Medicine; Tochigi Japan
| | - Yasushi Imai
- Division of Cardiovascular Medicine; Department of Medicine; Jichi Medical University School of Medicine; Tochigi Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine; Department of Medicine; Jichi Medical University School of Medicine; Tochigi Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine; Department of Medicine; Jichi Medical University School of Medicine; Tochigi Japan
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Ghannam M, Chugh A. Indications and appropriate selection of novel oral anticoagulants in patients with atrial fibrillation. Heart 2017. [DOI: 10.1136/heartjnl-2014-307030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Mechanism of atrial functional mitral regurgitation in patients with atrial fibrillation: A study using three-dimensional transesophageal echocardiography. J Cardiol 2017; 70:584-590. [PMID: 28527865 DOI: 10.1016/j.jjcc.2017.03.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/27/2017] [Accepted: 03/27/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Functional mitral regurgitation (MR) can occur in patients with atrial fibrillation (AF) despite having preserved left ventricular (LV) systolic function. This MR is known as atrial functional MR. The aim of this study was to clarify the mechanism of atrial functional MR using real-time three-dimensional transesophageal echocardiography (3DTEE). METHODS Sixty patients underwent transthoracic echocardiography and 3DTEE: 16 patients with AF and significant non-organic MR and preserved LV ejection fraction (>50%) constituted the AF-MR group, 20 patients with AF and no significant MR formed the AF-NSMR group, and 24 normal subjects comprised the control group. RESULTS The left atrial volume index was significantly larger in the AF-MR group (95±41ml/m2) than in the AF-NSMR group (38±13ml/m2, p<0.05) or the control group (21±7ml/m2, p<0.05). The 3D annular circumference was significantly longer in the AF-MR group than in the AF-NSMR group. The annular-anterior leaflet coaptation angle was smaller in the AF-MR group than in the AF-NSMR group (11±6° vs. 18±9°, p<0.05). The annular-posterior leaflet coaptation angle was comparable between the two AF groups (26±12° vs. 28±10°), whereas the annular-posterior leaflet tip angle was larger in the AF-MR group than in the AF-NSMR group (59±13° vs. 44±11°, p<0.05). The posterior leaflet bending toward LV cavity was therefore significantly larger in the AF-MR group than in the AF-NSMR group (32±10° vs. 18±15°, p<0.05). CONCLUSIONS In patients with AF and significant functional MR occurring despite their preserved LV systolic function, the left atrium and mitral annulus were dilated and the anterior leaflet was flattened along the mitral annular plane, whereas the posterior leaflet was bent toward the LV cavity.
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Rationale and design of ASSAF-K (A study of the safety and efficacy of anticoagulant therapy in the treatment of atrial fibrillation in Kanagawa). J Arrhythm 2017; 33:111-116. [PMID: 28416976 PMCID: PMC5388051 DOI: 10.1016/j.joa.2016.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 07/02/2016] [Accepted: 07/13/2016] [Indexed: 01/19/2023] Open
Abstract
Background Atrial fibrillation (AF) is one of the most prevalent cardiac arrhythmias associated with substantially increased risks of ischemic stroke and thromboembolism. Oral anticoagulants (OACs) are the cornerstone of AF management and effectively prevent AF-related stroke. As new non-vitamin K antagonist OACs (NOACs) have become available, the landscape of stroke prevention in AF has changed. However, there are considerable gaps between daily clinical practice and current guideline-based recommendations for anticoagulant therapy in Japan. Consequently, little is known about the real-world setting and the current use of NOACs, especially by practitioners in Japan. Methods We conducted a prospective, observational study in 3847 patients with AF who were enrolled in clinics and hospitals located in Kanagawa Prefecture from September 2013 through March 2015. The participating centers included practitioners (small clinics), medium-sized hospitals, and university hospitals. The primary endpoints were epidemiologic characteristics, status of treatment with anticoagulants and antiplatelet agents, outcomes, and adverse events, including cerebrovascular disease, bleeding, and death. Results The mean CHADS2 score was 1.81±1.27, the mean CHADS2-Vasc score was 3.02±1.58, and the mean HAS-BLED score was 2.23±1.06, respectively. The usage rate of warfarin was 44.2% overall, and the usage rate of NOACs was 33.5%. Conclusions The results of the study are expected to serve as the basis for providing clinical practice guidance to healthcare institutions in Japan, with the ultimate goals of better characterizing the appropriate use of OACs and providing clinical decision support to physicians to facilitate the design of appropriate therapeutic strategies and the selection of anticoagulants for the management of AF.
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Yamauchi T, Sakata Y, Miura M, Onose T, Tsuji K, Abe R, Oikawa T, Kasahara S, Sato M, Nochioka K, Shiroto T, Takahashi J, Miyata S, Shimokawa H. Prognostic Impact of Atrial Fibrillation and New Risk Score of Its Onset in Patients at High Risk of Heart Failure - A Report From the CHART-2 Study. Circ J 2017; 81:185-194. [PMID: 28090009 DOI: 10.1253/circj.cj-16-0759] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prognostic impact of atrial fibrillation (AF) among patients at high risk for heart failure (HF) remains unclear. In addition, there is no risk estimation model for AF development in these patients.Methods and Results:The present study included 5,382 consecutive patients at high risk of HF enrolled in the CHART-2 Study (n=10,219). At enrollment, 1,217 (22.6%) had AF, and were characterized, as compared with non-AF patients, by higher age, lower estimated glomerular filtration rate, higher B-type natriuretic peptide (BNP) level and lower left ventricular ejection fraction. A total of 116 non-AF patients (2.8%) newly developed AF (new AF) during the median 3.1-year follow-up. AF at enrollment was associated with worse prognosis for both all-cause death and HF hospitalization (adjusted hazard ratio (aHR) 1.31, P=0.027 and aHR 1.74, P=0.001, for all-cause death and HF hospitalization, respectively) and new AF was associated with HF hospitalization (aHR 4.54, P<0.001). We developed a risk score with higher age, smoking, pulse pressure, lower eGFR, higher BNP, aortic valvular regurgitation, LV hypertrophy, and left atrial and ventricular dilatation on echocardiography, which effectively stratified the risk of AF development with excellent accuracy (AUC 0.76). CONCLUSIONS These results indicated that AF is associated with worse prognosis in patients at high risk of HF, and our new risk score may be useful to identify patients at high risk for AF onset.
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Affiliation(s)
- Takeshi Yamauchi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Johnson ME, Lefèvre C, Collings SL, Evans D, Kloss S, Ridha E, Maguire A. Early real-world evidence of persistence on oral anticoagulants for stroke prevention in non-valvular atrial fibrillation: a cohort study in UK primary care. BMJ Open 2016; 6:e011471. [PMID: 27678530 PMCID: PMC5051466 DOI: 10.1136/bmjopen-2016-011471] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To examine the characteristics and persistence in patients newly initiated with oral anticoagulants (OACs) for stroke prevention in non-valvular atrial fibrillation (NVAF). DESIGN Cohort study in Clinical Practice Research Datalink. SETTING UK primary care. PARTICIPANTS 15 242 patients with NVAF newly prescribed apixaban, rivaroxaban, dabigatran or vitamin K antagonists (VKAs) between 1 December 2012 and 31 October 2014. 13 089 patients were OAC naïve. OUTCOME MEASURES Patient characteristics and risk of non-persistence compared to apixaban using Cox regression models over the entire follow-up and using a time-partitioned approach to handle non-proportional hazards. RESULTS Among the OAC naïve patients, VKAs were most common (78.1%, n=10 218), followed by rivaroxaban (12.1%, n=1589), dabigatran (5.7%, n=741) and apixaban (4.1%, n=541). High baseline stroke risk (CHA2DS2VASc ≥2) ranged from 80.2% (dabigatran) to 88.4% (apixaban and rivaroxaban). History of stroke and bleeding was the highest among apixaban (23.7% and 31.6%) and lowest among VKA patients (15.9% and 27.5%). Across the entire follow-up period, adjusting for differences in characteristics, there was no evidence of a difference in non-persistence between VKA and apixaban (HR 0.92 (95% CI 0.68 to 1.23)). Non-persistence was higher with dabigatran (HR 1.67 (1.20 to 2.32)) and rivaroxaban (HR 1.41 (1.02 to 1.93)) than apixaban. Using the partitioned approach, non-persistence was lower with VKA (HR 0.33 (0.22 to 0.48)), and higher with dabigatran (HR 1.65 (1.08 to 2.52)) compared to apixaban in the first 2 months of follow-up. After 2 months, non-persistence was higher with VKA (HR 1.70 (1.08 to 2.66)) and dabigatran (HR 2.10 (1.30 to 3.41)). Pooling OAC naïve and experienced patients, non-persistence was also higher with rivaroxaban compared to apixaban after 2 months of follow-up (HR 1.69 (1.19 to 2.39)). CONCLUSIONS Observed differential prescribing of OACs can result in channelling bias in comparative effectiveness research. Persistence patterns changed over follow-up time, but there are indications of improved persistence rates with apixaban over other OACs in the UK. A larger study with longer follow-up is needed to corroborate findings. This study is registered on ClinicalTrials.gov (NCT02488421).
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Affiliation(s)
| | - Cinira Lefèvre
- Department of Worldwide Health Economics & Outcomes Research, Bristol-Myers Squibb, Paris, France
| | | | - David Evans
- Department of Worldwide Health Economics & Outcomes Research, Bristol-Myers Squibb, Paris, France
| | | | - Essra Ridha
- Medical Department UK, Bristol-Myers Squibb, London, UK
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Shinohara D, Matsushita S, Yamamoto T, Inaba H, Kuwaki K, Shimada A, Amano A. Reduction of c-kit positive cardiac stem cells in patients with atrial fibrillation. J Cardiol 2016; 69:712-718. [PMID: 27499271 DOI: 10.1016/j.jjcc.2016.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/21/2016] [Accepted: 07/11/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND We aimed to determine expression patterns of cardiac stem cells in the left atrium (LA) tissue from patients with atrial fibrillation. METHODS LA appendages were obtained during open-heart surgery and processed for explant cell culture and tissue analysis (n=319). The total number of grown cells and c-kit positive cells were analyzed by flow cytometry after 4 weeks of culture. The remaining tissue was used for Masson's trichrome staining to determine the area of the fibrosis. RESULTS The diameter of the LA, as measured by echocardiography, was significantly larger in the AF group than in the sinus rhythm group. Reverse transcription polymerase chain reaction analysis revealed higher expression of collagen in the AF group and an increase in the expression of basic fibrosis growth factor and transforming growth factor-2 and -3. Masson's trichrome staining showed progression of fibrosis in the AF tissue. In addition, the expression of apoptosis-related genes were significantly higher in AF group. There was no difference in the expression of connexin-40 between groups, while the expression of connexin-43 was decreased and that of connexin-45 was increased in the AF group. The total numbers of grown cells as well as c-kit positive cells after 4 weeks of cardiac tissue culture were significantly lower in the AF group. CONCLUSION Progression of remodeling in LA tissue was observed in AF patients. The number of c-kit positive cells cultured from LA appendages was reduced in AF patients, suggesting impairments in self-renewal.
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Affiliation(s)
- Daisuke Shinohara
- Department of Cardiovascular Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Satoshi Matsushita
- Department of Cardiovascular Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan.
| | - Taira Yamamoto
- Department of Cardiovascular Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Hirotaka Inaba
- Department of Cardiovascular Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Kenji Kuwaki
- Department of Cardiovascular Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Akie Shimada
- Department of Cardiovascular Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan
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Oyinlola JO, Campbell J, Kousoulis AA. Is real world evidence influencing practice? A systematic review of CPRD research in NICE guidances. BMC Health Serv Res 2016; 16:299. [PMID: 27456701 PMCID: PMC4960862 DOI: 10.1186/s12913-016-1562-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 07/20/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND There is currently limited evidence regarding the extent Real World Evidence (RWE) has directly impacted the health and social care systems. The aim of this review is to identify national guidelines or guidances published in England from 2000 onwards which have referenced studies using the governmental primary care data provider the Clinical Practice Research Datalink (CPRD). METHODS The methodology recommended by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed. Four databases were searched and documents of interest were identified through a search algorithm containing keywords relevant to CPRD. A search diary was maintained with the inclusion/exclusion decisions which were performed by two independent reviewers. RESULTS Twenty-five guidance documents were included in the final review (following screening and assessment for eligibility), referencing 43 different CPRD/GPRD studies, all published since 2007. The documents covered 12 disease areas, with the majority (N =7) relevant to diseases of the Central Nervous system (CNS). The 43 studies provided evidence of disease epidemiology, incidence/prevalence, pharmacoepidemiology, pharmacovigilance and health utilisation. CONCLUSIONS A slow uptake of RWE in clinical and therapeutic guidelines (as provided by UK governmental structures) was noticed. However, there seems to be an increasing trend in the use of healthcare system data to inform clinical practice, especially as the real world validity of clinical trials is being questioned. In order to accommodate this increasing demand and meet the paradigm shift expected, organisations need to work together to enable or improve data access, undertake translational and relevant research and establish sources of reliable evidence.
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Affiliation(s)
- Jessie O. Oyinlola
- Clinical Practice Research Datalink (CPRD), Medicines and Healthcare products Regulatory Agency, 151 Buckingham Palace Road, Victoria London, SW1W 9SZ UK
| | - Jennifer Campbell
- Clinical Practice Research Datalink (CPRD), Medicines and Healthcare products Regulatory Agency, 151 Buckingham Palace Road, Victoria London, SW1W 9SZ UK
| | - Antonis A. Kousoulis
- Clinical Practice Research Datalink (CPRD), Medicines and Healthcare products Regulatory Agency, 151 Buckingham Palace Road, Victoria London, SW1W 9SZ UK
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Murdoch DL, O'Neill K, Jackson J, McMahon A, Rumley A, Wallace I, Lowe GDO, Tait RC. Are Atrial Fibrillation Guidelines Altering Management? A Community Based Study. Scott Med J 2016; 50:166-9. [PMID: 16374981 DOI: 10.1177/003693300505000409] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Aims: We wanted to determine the prevalence of atrial fibrillation (AF) in a community based cross sectional study in greater Glasgow and how current anti thrombotic management compares to published guidelines. Methods: 1466 patients with AF were identified in General Practices in our community and 1008 consented to take part. Their demographic details and medical history were recorded. Results: 1466 patients (mean age 73.4; 55% female) with AF were identified, in our community, giving a prevalence of 1%. 53% of patients were on warfarin therapy. Of those not receiving warfarin, only one third had a putative contra-indication. The proportion of AF patients on warfarin increased with increasing stroke risk, and over the period of the study. Conclusions: Prevalence of AF was in keeping with previous estimates. The proportion of patients with AF receiving warfarin therapy appears to be increasing. In the moderate risk group, there was a tendency to use more warfarin in the younger age groups compared to the elderly. It was in the moderate and low risk groups that there was still evidence of deviation from published guidelines.
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Affiliation(s)
- D L Murdoch
- Department of Cardiology, Southern General Hospital, Glasgow, Scotland.
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Stewart S. Atrial Fibrillation in the 21st Century: The New Cardiac ‘Cinderella’ and New Horizons for Cardiovascular Nursing? Eur J Cardiovasc Nurs 2016. [DOI: 10.1016/s1474-51510200010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Simon Stewart
- Centre for Research into Nursing and Health Care/School of Nursing and Midwifery, 4th Floor Centenary Building, City East Campus, University of South Australia, Frome Road, Adelaide 5000, Australia
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