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Gao P, Gao X, Xie B, Tse G, Liu T. Aging and atrial fibrillation: A vicious circle. Int J Cardiol 2024; 395:131445. [PMID: 37848123 DOI: 10.1016/j.ijcard.2023.131445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/17/2023] [Accepted: 10/12/2023] [Indexed: 10/19/2023]
Abstract
Atrial fibrillation (AF) is the commonest sustained cardiac arrhythmia observed in clinical practice. Its prevalence increases dramatically with advancing age. This review article discusses the recent advances in studies investigating the relationship between aging and AF and the possible underlying mechanisms.
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Affiliation(s)
- Pan Gao
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xinyi Gao
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Bingxin Xie
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.
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Mitchell A, Elmasry Y, van Poelgeest E, Welsh TJ. Anticoagulant use in older persons at risk for falls: therapeutic dilemmas-a clinical review. Eur Geriatr Med 2023; 14:683-696. [PMID: 37392359 PMCID: PMC10447288 DOI: 10.1007/s41999-023-00811-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/02/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE The aim of this clinical narrative review was to summarise the existing knowledge on the use of anticoagulants and potential adverse events in older people at risk of falls with a history of atrial fibrillation or venous thromboembolism. The review also offers practical steps prescribers can take when (de-)prescribing anticoagulants to maximise safety. METHODS Literature searches were conducted using PubMed, Embase and Scopus. Additional articles were identified by searching reference lists. RESULTS Anticoagulants are often underused in older people due to concerns about the risk of falls and intracranial haemorrhage. However, evidence suggests that the absolute risk is low and outweighed by the reduction in stroke risk. DOACs are now recommended first line for most patients due to their favourable safety profile. Off-label dose reduction of DOACs is not recommended due to reduced efficacy with limited reduction in bleeding risk. Medication review and falls prevention strategies should be implemented before prescribing anticoagulation. Deprescribing should be considered in severe frailty, limited life expectancy and increased bleeding risk (e.g., cerebral microbleeds). CONCLUSION When considering whether to (de-)prescribe anticoagulants, it is important to consider the risks associated with stopping therapy in addition to potential adverse events. Shared decision-making with the patient and their carers is crucial as patient and prescriber views often differ.
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Affiliation(s)
- Anneka Mitchell
- Research Institute for the Care of Older People (RICE), Bath, UK.
- Pharmacy Department, University Hospitals Plymouth NHS Trust, Plymouth, UK.
- Life Sciences Department, University of Bath, Bath, UK.
| | - Yasmin Elmasry
- Pharmacy Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - Tomas J Welsh
- Research Institute for the Care of Older People (RICE), Bath, UK
- Bristol Medical School, University of Bristol, Bristol, UK
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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Kılıç R, Güzel T, Aktan A, Demir M, Arslan B, Ertaş F. The effect of treatment strategy on long-term follow-up results in patients with nonvalvular atrial fibrillation in Turkey: AFTER-2 subgroup analysis. Aging Clin Exp Res 2023:10.1007/s40520-023-02467-y. [PMID: 37329474 DOI: 10.1007/s40520-023-02467-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/02/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND We performed a subanalysis of the data from the AFTER-2 registry. In our study, we aimed to compare the long-term follow-up results of nonvalvular atrial fibrillation (NVAF) patients in Turkey according to their treatment strategies. METHODS All consecutive patients older than 18 years of age who presented to cardiology outpatient clinics, had at least one AF attack and did not have rheumatic mitral valve stenosis or prosthetic heart valve disease were included in our prospective study. The patients were divided into two groups as rhythm control and rate control. Stroke, hospitalization and death rates were compared between the groups. RESULTS A total of 2592 patients from 35 centers were included in the study. Of these patients, 628 (24.2%) were in the rhythm control group and 1964 (75.8%) in the rate control group. New-onset ischemic cerebrovascular disease or transient ischemic attack (CVD/TIA) was detected at a lower rate in the rhythm control group (3.2% vs. 6.2% p = 0.004). However, there was no significant difference in one-year and five-year mortality rates (9.6% versus 9.0%, p = 0.682 and 31.8% versus 28.6%, p = 0.116, respectively). Hospitalization were found to be significantly higher in patients with rhythm control group (18% vs. 13%, p = 0.002). CONCLUSION It was found that rhythm control strategy is preferred in AF patients in Turkey. We found a lower rate of ischemic CVD/TIA in patients in the rhythm control group. Although no difference was observed in mortality rates, we found a higher rate of hospitalization in the rhythm control group.
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Affiliation(s)
- Raif Kılıç
- Department of Cardiology, Memorial Diyarbakır Hospital, Diyarbakır, Turkey.
| | - Tuncay Güzel
- Department of Cardiology, Health Science University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Adem Aktan
- Department of Cardiology, Mardin Training and Research Hospital, Mardin, Turkey
| | - Muhammed Demir
- Department of Cardiology, Dicle University, Faculty of Medicine, Diyarbakır, Turkey
| | - Bayram Arslan
- Department of Cardiology, Ergani State Hospital, Diyarbakır, Turkey
| | - Faruk Ertaş
- Department of Cardiology, Dicle University, Faculty of Medicine, Diyarbakır, Turkey
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Lin HC, Chen MJ, Lee CH, Kung LC, Huang JT. Fall Recognition Based on an IMU Wearable Device and Fall Verification through a Smart Speaker and the IoT. Sensors (Basel) 2023; 23:5472. [PMID: 37420638 DOI: 10.3390/s23125472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 07/09/2023]
Abstract
A fall is one of the most devastating events that aging people can experience. Fall-related physical injuries, hospital admission, or even mortality among the elderly are all critical health issues. As the population continues to age worldwide, there is an imperative need to develop fall detection systems. We propose a system for the recognition and verification of falls based on a chest-worn wearable device, which can be used for elderly health institutions or home care. The wearable device utilizes a built-in three-axis accelerometer and gyroscope in the nine-axis inertial sensor to determine the user's postures, such as standing, sitting, and lying down. The resultant force was obtained by calculation with three-axis acceleration. Integration of three-axis acceleration and a three-axis gyroscope can obtain a pitch angle through the gradient descent algorithm. The height value was converted from a barometer. Integration of the pitch angle with the height value can determine the behavior state including sitting down, standing up, walking, lying down, and falling. In our study, we can clearly determine the direction of the fall. Acceleration changes during the fall can determine the force of the impact. Furthermore, with the IoT (Internet of Things) and smart speakers, we can verify whether the user has fallen by asking from smart speakers. In this study, posture determination is operated directly on the wearable device through the state machine. The ability to recognize and report a fall event in real-time can help to lessen the response time of a caregiver. The family members or care provider monitor, in real-time, the user's current posture via a mobile device app or internet webpage. All collected data supports subsequent medical evaluation and further intervention.
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Affiliation(s)
- Hsin-Chang Lin
- Graduate Institute of Mechanical and Electrical Engineering, National Taipei University of Technology, Taipei City 10608, Taiwan
- Division of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City 10449, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
- Department of Nursing, MacKay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan
| | - Ming-Jen Chen
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
- Department of Nursing, MacKay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei City 10449, Taiwan
| | - Chao-Hsiung Lee
- Graduate Institute of Mechanical and Electrical Engineering, National Taipei University of Technology, Taipei City 10608, Taiwan
| | - Lu-Chih Kung
- Graduate Institute of Mechanical and Electrical Engineering, National Taipei University of Technology, Taipei City 10608, Taiwan
| | - Jung-Tang Huang
- Graduate Institute of Mechanical and Electrical Engineering, National Taipei University of Technology, Taipei City 10608, Taiwan
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Spichler-Moffarah A, Rubin LE, Bernstein JA, O'Bryan J, McDonald E, Golden M. Prosthetic Joint Infections of the Hip and Knee Among the Elderly: A Retrospective Study. Am J Med 2023; 136:100-107. [PMID: 36063860 DOI: 10.1016/j.amjmed.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND As the population ages and demand for total joint arthroplasty increases, rates of periprosthetic joint infection are expected to increase in the geriatric population. Studies comparing prevalence of risk factors, etiology, management, and mortality of prosthetic joint infection in older patients are lacking. METHODS We compared clinical characteristics, management, and mortality of patients <75 vs ≥75 years of age with first prosthetic joint infection of the hip or knee admitted to a tertiary medical center between September 2017 and December 2019. RESULTS Ninety-eight patients (<75 years of age [n = 63]; ≥75 years of age (n = 35) were studied. Groups were similar in terms of etiology, culture-directed therapy, antibiotic suppression, and length of stay. There was no difference in surgical management, performed in almost 97% of cases in both groups. Arrhythmia and heart failure were more prevalent in those aged ≥75 years. Readmission related to prosthetic joint infection occurred less often in older individuals (P = .005). Deaths within 1 year of diagnosis were rare (n = 4; 4.1%), occurring in older patients and resulting mostly from sepsis. CONCLUSION In our single-center study, patients with first prosthetic joint infection had similar management, regardless of age. We identified cardiac history as one of the host factors for prosthetic joint infection most seen in patients ≥75 years of age. Although deaths were rare, 1-year mortality was higher in patients aged ≥75. Prospective, multicenter studies are needed to explore risk factors and management strategies of prosthetic joint infection among elderly populations.
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Affiliation(s)
- Anne Spichler-Moffarah
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn.
| | - Lee E Rubin
- Division of Adult Reconstruction, Department of Orthopedics & Rehabilitation, Yale University School of Medicine, Yale New Haven Health, New Haven, Conn
| | - Jenna A Bernstein
- Division of Adult Reconstruction, Department of Orthopedics & Rehabilitation, Yale University School of Medicine, Yale New Haven Health, New Haven, Conn
| | - Jane O'Bryan
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Conn; Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Conn
| | - Erik McDonald
- Division of Adult Reconstruction, Department of Orthopedics & Rehabilitation, Yale University School of Medicine, Yale New Haven Health, New Haven, Conn
| | - Marjorie Golden
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
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Yamashita T, Akao M, Atarashi H, Ikeda T, Koretsune Y, Okumura K, Shimizu W, Suzuki S, Tsutsui H, Toyoda K, Hirayama A, Yasaka M, Yamaguchi T, Teramukai S, Kimura T, Morishima Y, Takita A, Inoue H. Effect of Polypharmacy on Clinical Outcomes in Elderly Patients With Non-Valvular Atrial Fibrillation - A Sub-Analysis of the ANAFIE Registry. Circ J 2022; 87:6-16. [PMID: 35858804 DOI: 10.1253/circj.cj-22-0170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND This All Nippon AF in the Elderly (ANAFIE) Registry sub-analysis evaluated the impact of polypharmacy on 2-year outcomes in a large, elderly (aged ≥75 years) Japanese population with non-valvular atrial fibrillation (NVAF).Methods and Results: The ANAFIE Registry was a multicenter, prospective, observational study with a 24-month follow-up period. Of 32,275 enrolled NVAF patients, 31,419 were grouped by the number of prescribed concomitant medications (other than oral anticoagulants [OACs]): 0-4 [38.8%], 5-8 [43.3%], and ≥9 [17.9%]). Patients receiving more concomitant medications were older, had poor renal function, and suffered more comorbidities than those receiving fewer concomitant medications. Several patient background factors, including diabetes mellitus, myocardial infarction, and chronic kidney disease, were significantly correlated with an increased number of concomitant medications. With increasing medications, OAC prescription rates decreased, but the warfarin prescription rate increased, and the cumulative incidence rates of stroke/systemic embolic events (SEE), major bleeding, gastrointestinal bleeding, fracture/falls, cardiovascular events, cardiovascular death, and all-cause death significantly increased (each, P<0.05). In multivariate analysis, increasing medications was independently associated with increases in these events, except for stroke/SEE. There were no significant interactions between the number of medications and anticoagulant treatment with direct OAC or warfarin concerning the incidence of these events. CONCLUSIONS Polypharmacy was frequent among elderly patients with NVAF who were older with more comorbidities, and was independently associated with a higher incidence of extracranial events.
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Affiliation(s)
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | | | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | | | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | | | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, Cerebrovascular Center, National Hospital Organization Kyushu Medical Center
| | - Takenori Yamaguchi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Teramukai
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Tetsuya Kimura
- Primary Medical Science Department, Daiichi Sankyo Co., Ltd
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Karnik AA, Saczynski JS, Chung JJ, Gurwitz JH, Bamgbade BA, Paul TJ, Lessard DM, McManus DD, Helm RH. Cognitive impairment, age, quality of life, and treatment strategy for atrial fibrillation in older adults: The SAGE-AF study. J Am Geriatr Soc 2022; 70:2818-2826. [PMID: 35735210 PMCID: PMC10719956 DOI: 10.1111/jgs.17886] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/18/2022] [Accepted: 04/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) treatment includes anticoagulation for high stroke risk individuals and either rate or rhythm control strategies. We aimed to investigate the impact of age, geriatric factors, and medical comorbidities on choice of rhythm versus rate control strategy in older adults. METHODS Patients with AF aged ≥65 years with CHA2 DS2 VASc score ≥2 and eligible for anticoagulation were recruited for the Systematic Assessment of Geriatric Elements-AF (SAGE-AF) prospective cohort study. An interview that included measures of HRQoL, cognitive function, vision, hearing, and frailty was performed. The association between these elements and AF treatment strategy was examined by multivariable logistic regression models. RESULTS One thousand two hundred forty-four participants (mean age 76 years; 49% female; 85% non-Hispanic white) were enrolled. Rate and rhythm control were used in 534 and 710 participants, respectively. Compared to participants <75 years, those ≥75 were more likely to be treated with a rate control strategy (age 75-84 adjusted odds ratio [aOR] 1.37 [95% CI 0.99, 1.88]; age 85+ aOR = 2.05, 95% CI 1.30, 3.21). Those treated with a rate control strategy were more likely to have cognitive impairment (aOR = 1.50, 95% CI 1.13, 1.99), and peripheral vascular disease (PVD) (aOR = 1.82, 95% CI 1.22, 2.72) but less likely to have visual impairment (aOR 0.73 [0.55, 0.98]), congestive heart failure (CHF; aOR 0.68 [0.49, 0.94]) or receive anticoagulation (aOR 0.53, 95% CI 0.36, 0.78). CONCLUSION Older age, cognitive impairment, and PVD were associated with use of rate control strategy. Visual impairment, CHF, and anticoagulation use were associated with a rhythm control strategy. There was no difference in HRQoL between the rate and rhythm control groups. This study suggests that certain geriatric elements may be associated with AF treatment strategies. Further study is needed to evaluate how these decisions affect outcomes.
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Affiliation(s)
- Ankur A. Karnik
- Evans Department of Medicine, Cardiovascular Medicine Section, Arrhythmia Service, Boston University School of Medicine, Boston, MA
| | - Jane S. Saczynski
- Bouvé College of Health Sciences, Department of Pharmacy and Health System Sciences, Northeastern University, Boston, MA
| | - Joseph J. Chung
- Evans Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Jerry H. Gurwitz
- Meyers Primary Care Institute and Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Benita A. Bamgbade
- Bouvé College of Health Sciences, Department of Pharmacy and Health System Sciences, Northeastern University, Boston, MA
| | - Tenes J. Paul
- Meyers Primary Care Institute and Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Darleen M. Lessard
- Division of Epidemiology of Chronic Diseases, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - David D. McManus
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Robert H. Helm
- Evans Department of Medicine, Cardiovascular Medicine Section, Arrhythmia Service, Boston University School of Medicine, Boston, MA
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Volgman AS, Nair G, Lyubarova R, Merchant FM, Mason P, Curtis AB, Wenger NK, Aggarwal NT, Kirkpatrick JN, Benjamin EJ. Management of Atrial Fibrillation in Patients 75 Years and Older: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 79:166-179. [PMID: 35027110 DOI: 10.1016/j.jacc.2021.10.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/18/2021] [Indexed: 12/11/2022]
Abstract
The prevalence of atrial fibrillation (AF) is increasing as the population ages. AF treatment-related complications also increase markedly in older adults (defined as ≥75 years of age for this review). The older AF population has a high risk of stroke, bleeding, and death. Syncope and fall-related injuries are the most common reasons for nonprescription of oral anticoagulation (OAC), and are more common in older adults when OACs are used with antiarrhythmic drugs. Digoxin may be useful for rate control, but associations with increased mortality limit its use. Beyond rate and rhythm control considerations, stroke prophylaxis is critical to AF management, and the benefits of direct OACs, compared with warfarin, extend to older adults. Invasive procedures such as AF catheter ablation, pacemaker implantation/atrioventricular junction ablation, and left atrial appendage occlusion may be useful in appropriately selected cases. However, older adults have generally been under-represented in clinical trials.
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Affiliation(s)
| | - Gatha Nair
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Radmila Lyubarova
- Division of Cardiology, Albany Medical Center, Albany, New York, USA
| | - Faisal M Merchant
- Department of Medicine, Section of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Pamela Mason
- Department of Cardiology, University of Virginia, Charlottesville, Virginia, USA
| | - Anne B Curtis
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Nanette K Wenger
- Department of Medicine, Section of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Neelum T Aggarwal
- Departments of Neurological Sciences, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Emelia J Benjamin
- Boston Medical Center, and Boston University School of Medicine and School of Public Health, Boston, Massachusetts, USA
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Zhang Q, Ding Q, Yan S, Yue QY. Fatal Adverse Events of Dabigatran Combined With Aspirin in Elderly Patients: An Analysis Using Data From VigiBase. Front Pharmacol 2021; 12:769251. [PMID: 35002709 PMCID: PMC8727914 DOI: 10.3389/fphar.2021.769251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: The elderly are vulnerable to cardiovascular diseases and the incidence of atrial fibrillation (AF) and venous thromboembolism (VTE) increases significantly with age. Dabigatran is a commonly used new oral anticoagulant approved by the FDA for stroke prevention in patients with non-valvular AF and VTE treatment and prevention. Aspirin is commonly used as a preventive drug for cardiovascular diseases. AF and coronary heart disease share many risk factors, so these two diseases often coexist and thus dabigatran and aspirin are often combined in those people. The aim of this study was to analyze the clinical characteristics of fatal adverse events of dabigatran combined with aspirin in elderly patients, and to provide references for clinical rational use of drugs.Materials and Methods: Fatal adverse events related to the combined use of dabigatran and aspirin in elderly patients aged over 75 were extracted from the WHO global database of individual case safety reports (VigiBase). Well-documented reports, vigiGrade completeness score ≥0.80, or with an informative narrative, were analyzed with a focus on the clinical features of the cases.Results: From 1968 up to January 19, 2020, there were 112 eligible reports in VigiBase from 13 countries, of which 33 were identified as well-documented. Of these 33, 19 were male (58%) and 14 were female (42%), the average age of the patients was 84 (75–95 years), with five cases of extreme weights (>100 kg in one case, <50 kg in four cases). There were 31 cases of death by internal bleeding (mainly 15 of gastrointestinal hemorrhage and 12 of intracranial hemorrhage) and two cases of the sudden death of unknown cause. Medication errors existed in 15 patients. The times to onset (TTO) was provided in 24 cases, ranging from 2 days to 4 years, and in 12 patients occurred within a month. Of the 31 patients with fatal bleeding events, 29 were associated with other factors that increase the risk of bleeding, such as diseases (hypertension, renal impairment, stroke, gastrointestinal related diseases, hypothyroidism, and cancer), drugs (antiplatelets, anticoagulants, thrombolytics, P glycoprotein substrates, non-steroidal anti-inflammatory drugs, hormones, selective serotonin reuptake inhibitors, and acetaminophen) and other factors (low body weights and alcohol consumption), and 21 of these contained two or more risk factors.Conclusion: The fatal adverse events associated with the combined use of dabigatran and aspirin in elderly patients were mainly serious bleeding events, which often occurred within 1 month. Most of these cases had medication errors and most of the patients had multiple diseases, medications, or other conditions at the same time that increase the risk of bleeding. It is suggested that prescription of dabigatran and aspirin in elderly patients should go along with alertness for medication errors, care for correct dose or control of other bleeding risk factors, and the combined medication time should be as short as possible to minimise serious adverse events.
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Affiliation(s)
- Qingxia Zhang
- Department of Pharmacy, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Disease, Beijing, China
- *Correspondence: Qingxia Zhang, ; Qun-Ying Yue,
| | - Qian Ding
- School of Pharmaceutical Science, Capital Medical University, Beijing, China
| | - Suying Yan
- Department of Pharmacy, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Disease, Beijing, China
| | - Qun-Ying Yue
- Uppsala Monitoring Centre, Uppsala, Sweden
- *Correspondence: Qingxia Zhang, ; Qun-Ying Yue,
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Klamer TA, Bots SH, Neefs J, Tulevski II, Ruijter HMD, Somsen GA, de Groot JR. Rate and Rhythm Control Treatment in the Elderly and Very Elderly Patients With Atrial Fibrillation: An Observational Cohort Study of 1497 Patients. Curr Probl Cardiol 2021; 47:100996. [PMID: 34610350 DOI: 10.1016/j.cpcardiol.2021.100996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/14/2021] [Indexed: 11/19/2022]
Abstract
Stroke prevention and rate or rhythm control are crucial in the management of atrial fibrillation (AF). There is recent evidence for benefit of early rhythm control, yet rate control is the first choice in elderly patients. However, the efficacy and safety of rate and rhythm control in the elderly population remains largely unexplored. Therefore, we analyzed electronic health record data and investigated prescribing patterns and mortality of both strategies in elderly patients with AF. Data from patients with AF who were aged ≥75 years, used a pharmacological rate or rhythm control strategy, and visited Cardiology Centers of the Netherlands between 2007 and 2018 were extracted. Of the 1497 patients (54% female), 316 (21%) were prescribed rhythm control and 1181 (79%) rate control. Patients aged >85 years (OR: 2.28; 95% CI: 1.51-3.44, P< 0.001) and those with permanent AF (OR: 2.71; 95% CI: 1.67-4.41, P< 0.001) were more likely to receive rate control, whereas those with paroxysmal AF were less likely to receive rate control (OR: 0.42; 95% CI: 0.32-0.56, P< 0.001). After correction for relevant confounders, the mortality risk for patients using rhythm control and patients using rate control was similar (HR: 0.89; 95% CI: 0.70-1.12, P = 0.31). A more liberal approach towards prescribing a rhythm control strategy to the elderly patients with AF may be warranted and seems safe. Our data underscore the need for prospective studies to provide definite answers on efficacy and safety of rhythm control in elderly patients with AF.
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Affiliation(s)
- Thomas A Klamer
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
| | - Sophie H Bots
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jolien Neefs
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
| | - Igor I Tulevski
- Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
| | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - G Aernout Somsen
- Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
| | - Joris R de Groot
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands.
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Ayabe K, Komiyama T, Hasegawa M, Sakai T, Morise M, Sakama S, Yagishita A, Amino M, Ikari Y, Yoshioka K. Clinical Significance of the Head-Up Tilt Test in Improving Prognosis in Patients with Possible Neurally Mediated Syncope. Biology (Basel) 2021; 10:919. [PMID: 34571796 DOI: 10.3390/biology10090919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 11/20/2022]
Abstract
Simple Summary Several diseases can cause syncope, which is commonly known as fainting; however, syncope triggered by a reflex mechanism, also termed neurally mediated syncope (NMS), is one of the most common forms. While NMS is considered a benign disease, it can cause critical clinical events, such as severe trauma due to syncope. The head-up tilt test (HUTT) is one of the modalities for the diagnosis of NMS. The clinical significance of HUTT in the prognosis of NMS, such as recurrence rate of syncope and mortality, are still to be elucidated. This research aimed to clarify the value of HUTT for the diagnosis of NMS, and to investigate the prognosis of patients with NMS by analyzing the data of 101 patients with syncope and their close long-term (four years at the longest) follow-up. Furthermore, as insertable cardiac monitors (ICMs) are considered effective in patients with syncope, this study also aimed to evaluate the usefulness of ICM in patients with negative HUTT results. Finally, our research contributes to the improvement of the clinical management for patients with syncope. Abstract Syncope is commonly encountered in daily clinical practice. Depending on its etiology (benign or life-threatening conditions or environmental triggers), syncope can be neurally mediated (reflex), cardiac, or orthostatic. Furthermore, neurologic disease can cause symptoms that mimic syncope. However, there is limited research on neurally mediated syncope (NMS), which is considered a benign disorder, and close follow-ups are rarely performed. NMS can cause serious clinical events, including severe trauma and car accidents. The head-up tilt test (HUTT) is the gold standard for diagnosing NMS; however, its clinical significance remains unknown, and its relevance to NMS prognosis requires further research. This retrospective study aimed to assess the clinical significance of the HUTT for NMS. We reviewed the charts of 101 patients who underwent HUTT at Tokai University Hospital in Japan between January 2016 and March 2019. During the HUTT, 72 patients (69.2%) experienced syncope. Patients were followed up for 886.1 ± 457.7 days (interquartile range: 518–1293 days). The syncope recurrence rate was 16.9%; however, no significant difference was observed between the two groups (HUTT positive vs. negative) (13.8% vs. 18.1%, p = 0.772). Four of 29 (13.9%) and two of 72 (2.8%) patients in the negative and positive HUTT groups, respectively, experienced cardiac events (p = 0.019). Negative HUTT results may assist in anticipating unexpected clinical events within a few years. A negative HUTT result may allow us to reconsider the NMS diagnosis based on clinical information. Close outpatient follow-up of patients with negative HUTT results is warranted.
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12
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Gawrońska K, Lorkowski J. Smart homes for the older population: particularly important during the COVID-19 outbreak. Reumatologia 2021; 59:41-6. [PMID: 33707795 DOI: 10.5114/reum.2021.103939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/10/2021] [Indexed: 11/17/2022] Open
Abstract
Osteoporosis, one of the leading causes of disability in older adults, significantly reduces the quality of life and leads to loss of independence. Dynamic development of “smart” solutions based on artificial intelligence more and more commonly applied in older people’s houses may be an answer to the above issues. The aim of this study is to present selected “smart home” solutions for the diagnosis and prevention of falls in the older population through a literature review. The conducted meta-analysis based on a review of the scientific literature available in English and Polish in the Medline/PubMed, Embase, Scopus, and GBL databases was undertaken from 01.01.2015 to 01.10.2020 with the string search method using key words. According to the authors of this study, the development of new technology based on artificial intelligence allows older people to live independently, which contributes to a higher level of life satisfaction and quality.
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Rivera-Chávez JG, Torres-Gutiérrez JL, Regalado-Villalobos A, Moreno-Cervantes CA, Luna-Torres S. Association between falls and cardiovascular diseases in the geriatric population. Arch Cardiol Mex 2021; 91:66-72. [PMID: 33661879 PMCID: PMC8258912 DOI: 10.24875/acm.20000024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/25/2020] [Indexed: 12/30/2022] Open
Abstract
Objective To determine the association of cardiovascular diseases with falls in the geriatric population. Methods Original, Transversal and analytical study. Elderly patients who attend the external consultation of the Geriatrics service, older than 65 years, with falls history, perform comprehensive geriatric assessment to indentify causes of falls in the period from March 2018 to June 2019. We perform measures of central tendency, chi-square test X2 for qualitative variables, we performed linear regression model. Results A total of 669 patients were included, the analysis shows association with frailty [OR 1.65 (95% CI 1.37-3.77), p <0.05], Heart Failure [OR 1.02, (95% CI, 0.68 - 1.54), p < 0.05 ], the logistic regression analysis with the variables (Fragility, SAH, es: DM2, AMI, Stroke, AF, postural hypotensive syncope, Hypothyroidism, Dyslipidemia, and HF) shows that the probability of falling is 57%. Conclusion Cardiovascular diseases have a high prevalence in the population studied and increase the risk of falls. Individually analyzed cardiovascular diseases do not show an association with the syndrome of falls in the elderly, except for frailty, which proved to be an independent factor that increases the risk of falls with an OR 1.65. When analyzing them together, the risk of falling increases up to 57%. It is necessary to correctly identify and treat cardiovascular diseases in the elderly.
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Affiliation(s)
- José G. Rivera-Chávez
- Geriatrics Service, Regional Hospital of the Institute of Social Security and Services of State Workers (ISSSTE), Regional Hospital, Health Sciences Division, Leon Campus, University of Guanajuato (UG). León, Guanajuato, Mexico
| | - Jorge L. Torres-Gutiérrez
- Geriatrics Service, Regional Hospital of the Institute of Social Security and Services of State Workers (ISSSTE), Regional Hospital, Health Sciences Division, Leon Campus, University of Guanajuato (UG). León, Guanajuato, Mexico
| | - Alejandra Regalado-Villalobos
- Geriatrics Service, Regional Hospital of the Institute of Social Security and Services of State Workers (ISSSTE), Regional Hospital, Health Sciences Division, Leon Campus, University of Guanajuato (UG). León, Guanajuato, Mexico
| | - César A. Moreno-Cervantes
- Geriatrics Service, Regional Hospital of the Institute of Social Security and Services of State Workers (ISSSTE), Regional Hospital, Health Sciences Division, Leon Campus, University of Guanajuato (UG). León, Guanajuato, Mexico
| | - Sara Luna-Torres
- Geriatrics Service, Regional Hospital of the Institute of Social Security and Services of State Workers (ISSSTE), Regional Hospital, Health Sciences Division, Leon Campus, University of Guanajuato (UG). León, Guanajuato, Mexico
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Marco CA, Lynde J, Nelson B, Madden J, Schaefer A, Hardman C, McCarthy M. Predictors of new-onset atrial fibrillation in geriatric trauma patients. J Am Coll Emerg Physicians Open 2020; 1:102-106. [PMID: 33000020 PMCID: PMC7493536 DOI: 10.1002/emp2.12005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/12/2019] [Accepted: 11/20/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Geriatric patients (age >65) comprise a growing segment of the trauma population. New-onset atrial fibrillation may occur after injury, complicating clinical management and resulting in significant morbidity and mortality. This study was undertaken to identify clinical and demographic factors associated with new-onset atrial fibrillation among geriatric trauma patients. METHODS In this case control study, eligible participants included admitted trauma patients age 65 and older who developed new-onset atrial fibrillation during the hospitalization. Controls were admitted trauma patients who were matched for age and injury severity score, who did not develop atrial fibrillation. We evaluated the associations between new-onset atrial fibrillation and clinical characteristics, including patient demographics, health behaviors, chronic medical conditions, and course of care. RESULTS Data were available for 63 cases and 25 controls. Patients who developed atrial fibrillation were more likely to be male, compared to controls (49% versus 24%; odds ratio 3.0[1.0, 8.9]). Other demographic and clinical factors were not associated with new-onset atrial fibrillation, including mechanism of injury, co-morbid medical conditions, drug or alcohol use, surgical procedures, and intravenous fluid administration. CONCLUSIONS Male geriatric trauma patients were at higher risk for developing new-onset atrial fibrillation. Other demographic and clinical factors were not associated with new-onset atrial fibrillation.
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Affiliation(s)
- Catherine A. Marco
- Department of Emergency MedicineWright State University Boonshoft School of MedicineDaytonOhioUSA
| | - Jennifer Lynde
- Department of SurgeryWright State University Boonshoft School of MedicineDaytonOhioUSA
| | - Blake Nelson
- Wright State University Boonshoft School of MedicineDaytonOhioUSA
| | - Joshua Madden
- Wright State University Boonshoft School of MedicineDaytonOhioUSA
| | - Adam Schaefer
- Wright State University Boonshoft School of MedicineDaytonOhioUSA
| | - Claire Hardman
- Department of SurgeryWright State University Boonshoft School of MedicineDaytonOhioUSA
| | - Mary McCarthy
- Department of SurgeryWright State University Boonshoft School of MedicineDaytonOhioUSA
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Dalgaard F, Pallisgaard JL, Lindhardt TB, Gislason G, Blanche P, Torp-Pedersen C, Ruwald MH. Risk factors and a 3-month risk score for predicting pacemaker implantation in patients with atrial fibrillations. Open Heart 2020; 7:e001125. [PMID: 32257243 PMCID: PMC7103856 DOI: 10.1136/openhrt-2019-001125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 02/19/2020] [Accepted: 02/25/2020] [Indexed: 12/14/2022] Open
Abstract
Objectives To identify risk factors and to develop a predictive risk score for pacemaker implantation in patients with atrial fibrillation (AF). Methods Using Danish nationwide registries, patients with newly diagnosed AF from 2000 to 2014 were identified. Cox proportional-hazards regression computed HRs for risk factors of pacemaker implantation. A logistic regression was used to fit a prediction model for 3-month risk of pacemaker implantation and derived a risk score using 80% of the data and its predictive accuracy estimated using the remaining 20%. Results Among 155 934 AF patients included, the median age (IQR) was 75 (65–83) and 51.3% were men. During a median follow-up time of 3.4 (1.2–5.0) years, 8348 (5.4%) patients received a pacemaker implantation. Risk factors of pacemaker implantation were (in order of highest risk first) age above 60 years, congenital heart disease, heart failure at age under 60 years, prior syncope, valvular AF, hypertension, ischaemic heart disease, male sex and diabetes mellitus. The derived risk score assigns points ranging from 1 to 14 to each of these risk factors. The 3-month risk of pacemaker implantation increased from 0.4% (95% CI: 0.2 to 0.8) at 1 point to 2.6% (95% CI: 1.9 to 3.6) at 18 points. Area under the receiver operator characteristics curve was 62.9 (95% CI: 60.3 to 65.5). Conclusion We highlighted risk factors of pacemaker implantation in newly diagnosed AF patients and created a risk score. The clinical utility of the risk score needs further investigation.
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Affiliation(s)
| | | | | | | | - Paul Blanche
- Cardiology, Gentofte Hospital, Hellerup, Denmark
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Rich MW. Antiarrhythmic Drugs in Atrial Fibrillation: Is There Still a Role for Rhythm Control? J Am Geriatr Soc 2019; 67:2006-2007. [DOI: 10.1111/jgs.16061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/11/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Michael W. Rich
- Department of Medicine, Division of Cardiology Washington University School of Medicine St. Louis Missouri
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