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Zhao M, Hou CR, Bai J, Post F, Walsleben J, Herold N, Yu J, Zhang Z, Yu J. Effect of congestive heart failure on safety and efficacy of left atrial appendage closure in patients with non-valvular atrial fibrillation. Expert Rev Med Devices 2022; 19:805-814. [DOI: 10.1080/17434440.2022.2141112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Mingzhong Zhao
- Heart Center, Zhengzhou Ninth People’s Hospital, Zhengzhou, China
- Department of Cardiology, Helmut-G.-Walther-Klinikum, Lichtenfels, Germany
| | - Cody R. Hou
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Jianlin Bai
- Department of Surgery, Zhengzhou Ninth People’s Hospital, Zhengzhou, China
| | - Felix Post
- Clinic for General Internal Medicine and Cardiology, Catholic Medical Center Koblenz-Montabaur, Germany
| | - Jens Walsleben
- Clinic for General Internal Medicine and Cardiology, Catholic Medical Center Koblenz-Montabaur, Germany
| | - Nora Herold
- Clinic for General Internal Medicine and Cardiology, Catholic Medical Center Koblenz-Montabaur, Germany
| | - Juan Yu
- Heart Center, Zhengzhou Ninth People’s Hospital, Zhengzhou, China
| | - Zufeng Zhang
- Heart Center, Zhengzhou Ninth People’s Hospital, Zhengzhou, China
| | - Jiangtao Yu
- Department of Cardiology, Helmut-G.-Walther-Klinikum, Lichtenfels, Germany
- Clinic for General Internal Medicine and Cardiology, Catholic Medical Center Koblenz-Montabaur, Germany
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2
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Reinhardt SW, Chouairi F, Miller PE, Clark KAA, Kay B, Fuery M, Guha A, Freeman JV, Ahmad T, Desai NR, Friedman DJ. National Trends in the Burden of Atrial Fibrillation During Hospital Admissions for Heart Failure. J Am Heart Assoc 2021; 10:e019412. [PMID: 34013736 PMCID: PMC8483517 DOI: 10.1161/jaha.120.019412] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Heart failure (HF) and atrial fibrillation (AF) frequently coexist and may be associated with worse HF outcomes, but there is limited contemporary evidence describing their combined prevalence. We examined current trends in AF among hospitalizations for HF with preserved (HFpEF) ejection fraction or HF with reduced ejection fraction (HFrEF) in the United States, including outcomes and costs. Methods and Results Using the National Inpatient Sample, we identified 10 392 189 hospitalizations for HF between 2008 and 2017, including 4 250 698 with comorbid AF (40.9%). HF hospitalizations with AF involved patients who were older (average age, 76.9 versus 68.8 years) and more likely White individuals (77.8% versus 59.1%; P<0.001 for both). HF with preserved ejection fraction hospitalizations had more comorbid AF than HF with reduced ejection fraction (44.9% versus 40.8%). Over time, the proportion of comorbid AF increased from 35.4% in 2008 to 45.4% in 2017, and patients were younger, more commonly men, and Black or Hispanic individuals. Comorbid hypertension, diabetes mellitus, and vascular disease all increased over time. HF hospitalizations with AF had higher in‐hospital mortality than those without AF (3.6% versus 2.6%); mortality decreased over time for all HF (from 3.6% to 3.4%) but increased for HF with reduced ejection fraction (from 3.0% to 3.7%; P<0.001 for all). Median hospital charges were higher for HF admissions with AF and increased 40% over time (from $22 204 to $31 145; P<0.001). Conclusions AF is increasingly common among hospitalizations for HF and is associated with higher costs and in‐hospital mortality. Over time, patients with HF and AF were younger, less likely to be White individuals, and had more comorbidities; in‐hospital mortality decreased. Future research will need to address unique aspects of changing patient demographics and rising costs.
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Affiliation(s)
| | | | - P Elliott Miller
- Section of Cardiovascular Medicine Yale School of Medicine New Haven CT
| | | | - Bradley Kay
- Section of Cardiovascular Medicine Yale School of Medicine New Haven CT
| | - Michael Fuery
- Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Avirup Guha
- Harrington Heart and Vascular InstituteCase Western Reserve University Cleveland OH
| | - James V Freeman
- Section of Cardiovascular Medicine Yale School of Medicine New Haven CT
| | - Tariq Ahmad
- Section of Cardiovascular Medicine Yale School of Medicine New Haven CT
| | - Nihar R Desai
- Section of Cardiovascular Medicine Yale School of Medicine New Haven CT.,Center for Outcomes Research and Evaluation New Haven CT
| | - Daniel J Friedman
- Section of Cardiovascular Medicine Yale School of Medicine New Haven CT
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3
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Liao MT, Wu CK, Juang JMJ, Lin TT, Wu CC, Lin LY. Atrial fibrillation and the risk of sudden cardiac arrest in patients with hypertrophic cardiomyopathy - A nationwide cohort study. EClinicalMedicine 2021; 34:100802. [PMID: 33997728 PMCID: PMC8102675 DOI: 10.1016/j.eclinm.2021.100802] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM), affecting 0.2% of the population, is the leading cause of sudden cardiac arrest (SCA). Incident atrial fibrillation (AF) is associated with an increased risk of SCA in general population. To determine whether AF is associated with an increased risk of SCA in patients with HCM. METHODS This nationwide cohort study analyzed data from Registry for Catastrophic Illness, which encompassed almost 100% of the patients with HCM in Taiwan from 1996 to 2013. Follow-up and data analysis ended December 31, 2013. The main outcome was physician-adjudicated SCA, defined as death from a sudden, pulseless condition presumed due to a ventricular tachyarrhythmia. The secondary outcome was non-sudden cardiac death (NSCD), which was heart failure death, stroke death and non-HCM related death. We used Cox proportional hazards models to assess the association between AF and SCA/NSCD, adjusting for baseline demographic and cardiovascular risk factors. FINDINGS A total 10,910 subjects participated in this study with mean age of 62 years. Among enrolled subjects, 1,169 (10.7%) developed AF, which was independently associated with elder age, female sex, and history of heart failure (HF) hospitalization. During follow-up (median, 8.5 years and 2th to 7th interquartile range, 3.6 to 16.5 years), 371 SCA (166 in AF and 205 in non-AF group) and 797 NSCD (417 in AF and 380 in non-AF group) events occurred. The crude incidence rates of SCA were 12.45/1000 person-years (with AF) and 3.57/1000 person-years (without AF). The crude incidence rates for NSCD were 31.29/1000 person-years (with AF) and 6.63/1000 person-years (without AF). The multivariable hazard ratios (HRs) (95% CI) of AF for SCA and NSCD were 3.633 (2.756-4.791) and 2.086 (1.799-2.418), respectively. Furthermore, among the etiologies of NSCD, subjects with AF was at most risk of stroke-related death (HR, 6.609; 95% CI, 3.794-9.725). INTERPRETATION Incident AF is associated with an increased risk of SCA and NSCD in the HCM population. Early detection of AF may provide more comprehensive risk stratification of SCD in HCM population. Because of underuse of oral anticoagulants and the absence of primary prevention ICD therapy in our cohort, the application of our findings was limited for the general HCM population in the current clinical practice. FUNDING None.
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Affiliation(s)
- Min-Tsun Liao
- Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu City 300, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Cho-Kai Wu
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jyh-Ming Jimmy Juang
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ting-Tse Lin
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsinchu Biomedical Park Branch, No. 25, Lane 442, Sec. 1, Jingguo Rd, Hsinchu County 300, Taiwan
- Corresponding author at: Cardiovascular Center, National Taiwan University Hospital, Hsinchu Biomedical Park Branch, No. 25, Lane 442, Sec. 1, Jingguo Rd, Hsinchu City 300, Taiwan.
| | - Chih-Cheng Wu
- Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu City 300, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsinchu Biomedical Park Branch, No. 25, Lane 442, Sec. 1, Jingguo Rd, Hsinchu County 300, Taiwan
- Corresponding author at: College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Lian-Yu Lin
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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4
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Straw S, McGinlay M, Relton SD, Koshy AO, Gierula J, Paton MF, Drozd M, Lowry JE, Cole C, Cubbon RM, Witte KK, Kearney MT. Effect of disease-modifying agents and their association with mortality in multi-morbid patients with heart failure with reduced ejection fraction. ESC Heart Fail 2020; 7:3859-3870. [PMID: 32924331 PMCID: PMC7754757 DOI: 10.1002/ehf2.12978] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/30/2020] [Accepted: 08/10/2020] [Indexed: 12/26/2022] Open
Abstract
AIMS An increasing proportion of patients with heart failure with reduced ejection fraction (HFrEF) have co-morbidities. The effect of these co-morbidities on modes of death and the effect of disease-modifying agents in multi-morbid patients is unknown. METHODS AND RESULTS We performed a prospective cohort study of ambulatory patients with HFrEF to assess predictors of outcomes. We identified four key co-morbidities-ischaemic aetiology of heart failure, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and chronic kidney disease (CKD)-that were highly prevalent and associated with an increased risk of all-cause mortality. We used these data to explore modes of death and the utilization of disease-modifying agents in patients with and without these co-morbidities. The cohort included 1789 consecutively recruited patients who had an average age of 69.6 ± 12.5 years, and 1307 (73%) were male. Ischaemic aetiology of heart failure was the most common co-morbidity, occurring in 1061 (59%) patients; 503 (28%) patients had diabetes mellitus, 283 (16%) had COPD, and 140 (8%) had CKD stage IV/V. During mean follow-up of 3.8 ± 1.6 years, 737 (41.5%) patients died, classified as progressive heart failure (n = 227, 32%), sudden (n = 112, 16%), and non-cardiovascular deaths (n = 314, 44%). Multi-morbid patients were older (P < 0.001), more likely to be male (P < 0.001), and had higher New York Heart Association class (P < 0.001), despite having higher left ventricular (LV) ejection fraction (P = 0.001) and lower LV end-diastolic diameter (P = 0.001). Multi-morbid patients were prescribed lower doses of disease-modifying agents, especially patients with COPD who received lower doses of beta-adrenoceptor antagonists (2.7 ± 3.0 vs. 4.1 ± 3.4 mg, P < 0.001) and were less likely to be implanted with internal cardioverter defibrillators (7% vs. 13%, P < 0.001). In multivariate analysis, COPD and diabetes mellitus conferred a >2.5-fold and 1.5-fold increased risk of sudden death, whilst higher doses of beta-adrenoceptor antagonists were protective (hazard ratio per milligram 0.92, 95% confidence interval 0.86-0.98, P = 0.009). Each milligram of bisoprolol-equivalent beta-adrenoceptor antagonist was associated with 9% (P = 0.001) and 11% (P = 0.023) reduction of sudden deaths in patients with <2 and ≥2 co-morbidities, respectively. CONCLUSIONS Higher doses of beta-adrenoceptor antagonist are associated with greater protection from sudden death, most evident in multi-morbid patients. Patients with COPD who appear to be at the highest risk of sudden death are prescribed the lowest doses and less likely to be implanted with implantable cardioverter defibrillators, which might represent a missed opportunity to optimize safe and proven therapies for these patients.
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Affiliation(s)
- Sam Straw
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | | | | | - Aaron O. Koshy
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - John Gierula
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | | | - Michael Drozd
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | | | | | - Richard M Cubbon
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Klaus K. Witte
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - Mark T. Kearney
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
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5
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Burkman G, Naccarelli GV. Rhythm Control of Atrial Fibrillation in Heart Failure with Reduced Ejection Fraction. Curr Cardiol Rep 2020; 22:83. [DOI: 10.1007/s11886-020-01336-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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6
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Grubb A, Mentz RJ. Pharmacological management of atrial fibrillation in patients with heart failure with reduced ejection fraction: review of current knowledge and future directions. Expert Rev Cardiovasc Ther 2020; 18:85-101. [PMID: 32066285 DOI: 10.1080/14779072.2020.1732210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Both heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation (AF) independently cause significant morbidity and mortality. The two conditions commonly coexist and AF in the setting of HFrEF is associated with worse mortality, hospitalizations, and quality of life compared to HFrEF without AF. Despite the large burden of these conditions, there is no clear optimal management strategy for when they occur together.Areas covered: This review focuses on the pharmacological management of AF in HFrEF. Studies were identified through PubMed search of relevant keywords. The authors review key clinical trials that have influenced management strategies and guidelines. The authors focus on the classes of drugs used to treat AF for both rate and rhythm control strategies including beta-blockers, digoxin, amiodarone, and dofetilide. Additionally, the authors discuss select non-antiarrhythmic medications that affect AF in HFrEF. The authors highlight the strengths and weakness of the data supporting the use of these medications and suggest future directions.Expert opinion: The pharmacological treatment of AF in HFrEF will need further refinement alongside the emerging role of catheter ablation. Novel HF medications and antiarrhythmics offer new tools to prevent the development of AF, as well as for rate and rhythm control strategies.
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Affiliation(s)
- Alex Grubb
- Department of Medicine, Duke University Hospital, Durham, NC, USA
| | - Robert J Mentz
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham NC, USA.,Duke Clinical Research Institute, Durham NC, USA
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7
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Mercer BN, Koshy A, Drozd M, Walker AMN, Patel PA, Kearney L, Gierula J, Paton MF, Lowry JE, Kearney MT, Cubbon RM, Witte KK. Ischemic Heart Disease Modifies the Association of Atrial Fibrillation With Mortality in Heart Failure With Reduced Ejection Fraction. J Am Heart Assoc 2019; 7:e009770. [PMID: 30371286 PMCID: PMC6474978 DOI: 10.1161/jaha.118.009770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background The CASTLE‐AF (Catheter Ablation versus Standard Conventional Therapy in Patients With Left Ventricular Dysfunction and Atrial Fibrillation) trial recently reported that catheter ablation of atrial fibrillation (AF) improves survival in heart failure (HF) with reduced ejection fraction (HFrEF). However, established AF was not associated with mortality in trials of contemporary HFrEF pharmacotherapies. We investigated whether HFrEF pathogenesis may influence the conclusions of studies evaluating the prognostic impact of AF. Methods and Results Using a prospective cohort study of 791 patients with HFrEF, with AF determined using 24‐hour ambulatory ECG monitoring, univariable and multivariable Cox regression analyses were used to define the association between AF and mode‐specific mortality (mean follow‐up of 5.4 years). One‐year HF‐related hospitalization was assessed with binary logistic regression analysis. One‐year cardiac remodeling was assessed in a subgroup (n=378) using echocardiography. AF was present in 28.2% of patients, with 9.4% of these being paroxysmal. While AF was associated with increased risk of all‐cause mortality (hazard ratio, 1.27; 95% confidence interval 1.03–1.57), with diverging survival curves after 1 year of follow‐up, this association was lost in age‐sex–adjusted analyses. However, AF was associated with increased risk of age‐sex–adjusted all‐cause mortality in people with ischemic pathogenesis, with a statistically significant interaction between pathogenesis and AF. This was predominantly attributed to progressive HF deaths. After 1 year, HF hospitalization and cardiac remodeling were not associated with AF, even in people with ischemic pathogenesis. Conclusions AF is associated with increased risk of death in HFrEF of ischemic pathogenesis, predominantly due to progressive HF deaths during long‐term follow‐up. HFrEF pathogenesis should be considered in trial design and interpretation.
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Affiliation(s)
- Ben N Mercer
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
| | - Aaron Koshy
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
| | - Michael Drozd
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
| | - Andrew M N Walker
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
| | - Peysh A Patel
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
| | - Lorraine Kearney
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
| | - John Gierula
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
| | - Maria F Paton
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
| | - Judith E Lowry
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
| | - Mark T Kearney
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
| | - Richard M Cubbon
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
| | - Klaus K Witte
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories The University of Leeds United Kingdom
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