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Ding WY, Proietti M, Romiti GF, Vitolo M, Fawzy AM, Boriani G, Marin F, Blomstrom-Lundqvist C, Potpara TS, Fauchier L, Lip GYH. Impact of ABC pathway adherence in high-risk patients with atrial fibrillation: an analysis from the ESC-EHRA EORP-AF long-term general registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The impact of Atrial Fibrillation Better Care (ABC) pathway adherence among high-risk subgroups of patients with atrial fibrillation (AF), ie. those with chronic kidney disease (CKD), advanced age and/or prior thromboembolism remains unknown. We evaluated the impact of ABC pathway adherence on clinical outcomes in these high-risk AF patients.
Methods
The EORP-AF General Long-Term Registry is a prospective, observational registry from 250 centres across 27 European countries. High-risk patients were defined as those with either CKD (eGFR <60 mL/min/1.73 m2), older age (≥75 years) and/or prior thromboembolism. The primary outcome was a composite event of all-cause death, any thromboembolism and acute coronary syndrome, evaluated according to ABC pathway adherence.
Results
A total of 6646 patients with AF were included (median age was 70 [IQR 61–77] years; 40.2% females). There were 3304 (54.2%) `high risk' patients with either CKD (n=1750), older age (n=2236) or prior thromboembolism (n=728). Among these there were 924 (28.0%) managed as adherent to ABC.
At 2-year follow-up, a total of 966 (14.5%) patients reported the primary outcome. The incidence of the primary outcome was significantly lower in high-risk patients managed as adherent to ABC pathway (IRR 0.53 [95% CI, 0.43–0.64]). Consistent results were obtained in the individual subgroups [Table]. Using multivariable Cox proportional hazards analysis, ABC adherence in the high-risk cohort was independently associated with a lower risk of primary outcome (aHR 0.64 [95% CI, 0.51–0.80]), as well as in the CKD (aHR 0.51 [95% CI, 0.37–0.70]) and elderly subgroups (aHR 0.69 [95% CI, 0.53–0.90]). Overall, there was greater reduction in the risk of primary outcome as more ABC criteria were fulfilled, both in the overall high-risk patients, as well as in the individual subgroups [Figure].
Conclusion
In a large, contemporary European AF cohort there was a significant proportion of high-risk patients. Among these, a low prevalence of integrated care, as assessed by adherence to ABC pathway, was found. Nonetheless, a clinical management adherent to the ABC pathway was associated with a significant reduction in the risk of adverse outcomes, the benefits of which were more significant with increasing number of ABC criteria adherent.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- W Y Ding
- University of Liverpool , Liverpool , United Kingdom
| | | | | | - M Vitolo
- University of Liverpool , Liverpool , United Kingdom
| | - A M Fawzy
- University of Liverpool , Liverpool , United Kingdom
| | - G Boriani
- Modena Polyclinic Modena University Hospital , Modena , Italy
| | - F Marin
- University of Murcia , Murcia , Spain
| | | | | | - L Fauchier
- University Hospital of Tours , Tours , France
| | - G Y H Lip
- University of Liverpool , Liverpool , United Kingdom
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2
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Boriani G, Vitolo M, Proietti M, Malavasi VL, Bonini N, Romiti GF, Imberti JF, Fauchier L, Nabauer M, Potpara TS, Dan GA, Kalarus Z, Maggioni AP, Lane DA, Lip GYH. Anaemia and adverse outcomes in European patients with atrial fibrillation: a report from the ESC-EHRA EORP atrial fibrillation general long-term registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Anaemia is an independent predictor of atrial fibrillation (AF) and a common comorbidity. Real world data on the impact of anaemia on clinical outcomes, and on the benefits and risks of oral anticoagulation (OAC) are limited.
Purpose
To investigate the association of different degrees of anaemia with adverse outcomes in a cohort of European patients with AF.
Methods
We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry with baseline hemoglobin (Hb) values. Patients were stratified according to World Health Organization (WHO) definition of anaemia: (i) No anaemia (Hb≥12.0g/dl for women and Hb≥13.0g/dl for men), Mild anaemia (Hb 11.0–11.9g/dl for women and Hb 11.0–12.9g/dl for men), and moderate-severe anaemia (Hb ≤10.9 g/dl for both sexes). Primary outcomes were all-cause death, major adverse cardiac events (MACE, as the composite of any thromboembolism (TE)/acute coronary syndrome/cardiovascular death) and major bleeding.
Results
From the original 11,096 AF patients enrolled in the Registry, 7767 (69.9%) were included in the present analysis (median age 70 years, interquartile range [IQR] 62–77, males 58.3%, CHA2DS2VASc score median 3 [2–4], HAS-BLED median 2 [1–2]). A total of 5973 (76.9%) patients did not have anaemia, 1156 (14.9%) had mild anaemia, and 638 (8.2%) had moderate/severe anaemia. Patients with anaemia were more likely to have more comorbidities, frailty, permanent AF and polypharmacy (≥5 drugs). Overall, 318 (18.4%) patients with anaemia and an indication for anticoagulation [i.e. CHA2DS2-VASc≥1 (males), or ≥2 (females)] did not receive any OAC. After a median (IQR) follow-up of 730 (692–749) days, all-cause death was 10.5% and there were 841 (11.6%) MACE and 186 (2.5%) major bleeds. Kaplan–Meier analysis showed a higher cumulative risk for patients with moderate-severe anaemia for all the outcomes considered (Figure) (Log Rank tests, all p<0.001). Adjusted Cox regression analyses revealed that patients with mild and moderate-severe anaemia had a higher risk for all-cause death (adjusted hazard ratio [aHR] 2.02, 95% confidence interval [CI] 1.71–2.40 and aHR 2.39, 95% CI 1.97–2.91, respectively), MACE (aHR 1.44, 95% CI 1.17–1.76 and aHR 1.64, 95% CI 1.30–2.07 respectively), and major bleeding (aHR 1.52, 05% CI 1.02–2.25 and aHR 3.73, 95% CI 2.59–5.37, respectively). Among patients with moderate-severe anaemia, use of OAC was associated with lower risk of all-cause mortality (HR 0.64, 95% CI 0.46–0.89) and MACE (HR 0.55, 95% CI 0.36–0.84), without a significant increased risk of major bleeding (HR 0.81, 95% CI 0.43–1.52).
Conclusions
In a large contemporary cohort of European AF patients, almost 25% have concomitant anaemia which is associated with an increased risk for all-cause mortality, MACE and major bleeding. Use of OAC was associated with a lower risk of all-cause mortality in patients with moderate-severe anaemia, without significant increased risk of major bleeding.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Since the start of EORP, the following companies have supported the programme: Abbott Vascular Int. (2011–2021), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2021), Bayer (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2016), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2011–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2017), Menarini Int. Op. (2009–2012), MSD-Merck & Co. (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), SERVIER (2010–2021), and Vifor (2019–2022)
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Affiliation(s)
- G Boriani
- Modena Polyclinic Modena University Hospital , Modena , Italy
| | - M Vitolo
- Modena Polyclinic Modena University Hospital , Modena , Italy
| | | | - V L Malavasi
- Modena Polyclinic Modena University Hospital , Modena , Italy
| | - N Bonini
- Modena Polyclinic Modena University Hospital , Modena , Italy
| | - G F Romiti
- Sapienza University of Rome , Rome , Italy
| | - J F Imberti
- Modena Polyclinic Modena University Hospital , Modena , Italy
| | - L Fauchier
- University Hospital of Tours , Tours , France
| | - M Nabauer
- Ludwig Maximilians University , Munich , Germany
| | | | - G A Dan
- University of Bucharest , Bucharest , Romania
| | - Z Kalarus
- Silesian Center for Heart Diseases (SCHD) , Zabrze , Poland
| | | | - D A Lane
- University of Liverpool , Liverpool , United Kingdom
| | - G Y H Lip
- University of Liverpool , Liverpool , United Kingdom
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3
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Proietti M, Romiti GF, Vitolo M, Bonini N, Fawzy AM, Ding WY, Fauchier L, Marin F, Nabauer M, Potpara TS, Dan GA, Boriani G, Lip GYH. Features of clinical complexity in european patients with atrial fibrillation: a report from the ESC-EHRA EORP atrial fibrillation general long-term registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
There is increasing concern regarding the burden of clinical complexity, beyond thromboembolic risk, in patients with atrial fibrillation (AF). Also, clinical complexity is heterogenous and entails differential impact on the patients' clinical course.
Purpose
To explore different complexity features in AF patients in determining differences in clinical management and outcomes.
Methods
We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Features of complexity were analysed in the context of the following high-risk groups: i) only CHA2DS2-VASc ≥2; ii) history of stroke/bleeding; iii) chronic kidney disease (creatinine clearance <60 mL/min, CKD); iv) frail (frailty index ≥0.25); v) ≥2 criteria. All these groups were compared to a low-risk group (CHA2DS2-VASc 0–1). We examined use of oral anticoagulant (OAC) and the risks of a composite outcome of all-cause death and major adverse cardiovascular events.
Results
A total of 10285 patients (mean [SD] age 68.8 [11.5] years, 4107 [39.9%] females) were included in the analysis. Of these, 3944 (38.3%) had only CHA2DS2-VASc ≥2; 412 (4.0%); history of stroke/bleeding; 1480 (14.4%) CKD; 1007 (9.8%) were frail; 1315 (12.8%) had ≥2 criteria; and 2127 (20.7%) were low-risk. After adjustment for age, sex, type of AF and EHRA score, compared to low-risk patients, all the other groups were associated with OAC prescription but with progressively lower odds ratio, while those ≥2 criteria which were least likely prescribed with OAC (Table 1).
After a mean (SD) 634.5 (223.0) days of follow-up, a total of 1432 events were recorded. After adjustment for confounders, Cox regression analysis found that all the complexity groups were associated with a higher risk of the composite outcome across the groups (Figure 1). In patients with available data about ABC (Atrial fibrillation Better Care) pathway adherence, the latter adherence was associated a significant incidence rate reduction (IRR) compared to non-ABC adherence in those with ≥2 criteria of clinical complexity (IRR 0.46, 95% CI 0.30–0.71), and in the CKD complexity group (IRR 0.57, 95% CI 0.41–0.81).
Conclusions
In a large contemporary cohort of European AF patients, features of clinical complexity affect differently prescriptions of OAC. All the subgroups of clinical complexity were associated with a higher risk of adverse outcomes, which were reduced by adherence to ABC pathway.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Since the start of EORP, the following companies have supported the programme: Abbott Vascular Int. (2011–2021), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2021), Bayer (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and PfizerAlliance (2011–2016), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2011–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2017), Menarini Int. Op. (2009–2012), MSD-Merck & Co. (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), SERVIER (2010–2021), and Vifor (2019–2022).
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Affiliation(s)
- M Proietti
- University of Milan, Department of Clinical Sciences and Community Health , Milan , Italy
| | - G F Romiti
- Sapienza University of Rome, Department of Translational and Precision Medicine , Rome , Italy
| | - M Vitolo
- University of Modena and Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences , Modena , Italy
| | - N Bonini
- University of Modena and Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences , Modena , Italy
| | - A M Fawzy
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences , Liverpool , United Kingdom
| | - W Y Ding
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences , Liverpool , United Kingdom
| | - L Fauchier
- University Hospital of Tours , Tours , France
| | - F Marin
- University of Murcia , Murcia , Spain
| | - M Nabauer
- Ludwig-Maximilians University , Munich , Germany
| | | | - G A Dan
- University of Medicine and Pharmacy Carol Davila , Bucharest , Romania
| | - G Boriani
- University of Modena and Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences , Modena , Italy
| | - G Y H Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences , Liverpool , United Kingdom
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4
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Romiti GF, Proietti M, Vitolo M, Bonini N, Fawzy AM, Ding WY, Fauchier L, Marin F, Nabauer M, Dan GA, Potpara T, Boriani G, Lip GYH. Impact of the atrial fibrillation better care pathway in clinically complex patients with atrial fibrillation: a report from the ESC-EHRA EORP-AF General Long-Term Registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The “Atrial fibrillation Better Care” (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We analyzed the impact of the ABC pathway in a contemporary cohort of clinically complex AF patients.
Methods
From the ESC-EHRA EORP-AF General Long-Term Registry, we analyzed clinically complex AF patients, defined as the presence of frailty (according to a 40-items Frailty Index), multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on the risk of all-cause death, major adverse cardiovascular events (MACEs) and the composite outcome of all-cause death and MACE was analyzed through Cox-regression analyses, and delay of event (DoE) analyses; number needed to treat (NNT) was also estimated at 1 year of follow-up.
Results
Among 9,966 AF patients, 8,289 (92.3%) were clinically complex. Risk of all outcomes was higher among clinically complex patient. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.71, 95% CI 0.57–0.89), major adverse cardiovascular events (MACEs, aHR: 0.68, 95% CI 0.53–0.87) and composite outcome (aHR: 0.69, 95% CI: 0.57–0.84). Using cluster analysis, we identified a high clinical complexity group of AF patients. Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.73, 95% CI 0.55–0.96) and composite outcome (aHR: 0.69, 95% CI 0.57–0.84) in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all-cause death (Figure 1), MACEs, and composite outcome in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the NNTs for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome.
Conclusions
An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes amongst clinically complex AF patients.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Since the start of EORP, several companies have supported the programme with unrestricted grants.
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Affiliation(s)
- G F Romiti
- University of Liverpool , Liverpool , United Kingdom
| | - M Proietti
- University of Milan, Department of Clinical Sciences and Community Health , Milan , Italy
| | - M Vitolo
- University of Modena and Reggio Emilia, Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences , Modena , Italy
| | - N Bonini
- University of Modena and Reggio Emilia, Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences , Modena , Italy
| | - A M Fawzy
- University of Liverpool , Liverpool , United Kingdom
| | - W Y Ding
- University of Liverpool , Liverpool , United Kingdom
| | - L Fauchier
- Centre Hospitalier Universitaire Trousseau, Service de Cardiologie , Tours , France
| | - F Marin
- Virgen de la Arrixaca University Clinical Hospital, Department of Cardiology , Murcia , Spain
| | - M Nabauer
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - G A Dan
- Colentina University Hospital, University of Medicine “Carol Davila” , Bucharest , Romania
| | - T Potpara
- School of Medicine, Belgrade University , Belgrade , Serbia
| | - G Boriani
- University of Modena and Reggio Emilia, Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences , Modena , Italy
| | - G Y H Lip
- University of Liverpool , Liverpool , United Kingdom
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5
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Vitolo M, Proietti M, Bonini N, Romiti GF, Fauchier L, Marin F, Nabauer M, Potpara TS, Dan GA, Kalarus Z, Tavazzi L, Maggioni AP, Lane DA, Lip GYH, Boriani G. Factors associated with progression of atrial fibrillation and impact on all-cause mortality: an ancillary analysis from the ESC-EHRA EURObservational Research Programme in Atrial Fibrillation General. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Paroxysmal atrial fibrillation (AF) often shows a natural progression towards more sustained forms of the arrhythmia. Real-world data on clinical factors associated to AF progression and its impact on long-term outcome are limited.
Purpose
To investigate the factors associated with progression of AF and its impact on all-cause mortality in a contemporary cohort of European AF patients
Methods
We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Patients with paroxysmal AF at baseline or first detected AF who underwent successful cardioversion were included. Patients with known rhythm status at 1-year were then stratified into two groups: (i) No AF progression and (ii) AF progression (as defined by transition to persistent or permanent AF). All-cause mortality at 2-year of follow-up was the primary outcome of the analysis.
Results
A total of 2688 patients were included (median age 67 years, interquartile range [IQR] 60–75, females 44.7%, CHA2DS2VASc score median 3 [1–4], HASBLED median 1 [1–2]). After 1-year of follow-up 2094 (77.9%) patients showed no AF progression while 594 (22.1%) developed AF progression. On multivariable logistic regression analysis, no physical activity (odds ratio [OR] 1.35, 95% confidence interval [CI] 1.02–1.78), valvular heart disease (OR 1.63, 95% CI 1.23–2.15), left atrium diameter (OR 1.03, 95% CI 1.01–1.05) and left ventricular ejection fraction (OR 0.98, 95% CI 0.97–1.00) were independently associated with AF progression at 1-year. At the end of 2-year of follow-up, death occurred in 80/2621 (3.1%) patients. Kaplan-Meier analysis showed a lower cumulative survival from all-cause mortality in patients with AF progression compared to non-progression AF patients (Log Rank p=0.01, Figure 1). On multivariable Cox regression analysis, adjusted for age, sex, heart failure, coronary artery disease, hypertensions, diabetes mellitus, previous thromboembolic events, peripheral artery disease, chronic kidney disease and use of oral anticoagulants, patients with AF progression had an independently higher risk for all-cause mortality (adjusted hazard ratio [aHR] 1.77, 95% CI 1.09–2.89).
Conclusions
In a contemporary cohort of European AF patients, a substantial number of patients progressed to sustained AF within 1 year. Clinical factors related to atrial structural remodeling were independently associated with arrhythmia progression. AF progression was associated with an increased risk of all-cause mortality.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Since the start of EORP, the following companies have supported the programme: Abbott Vascular Int. (2011–2021), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2021), Bayer (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2016), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2011–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2017), Menarini Int. Op. (2009–2012), MSD-Merck & Co. (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), SERVIER (2010–2021), and Vifor (2019–2022).
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Affiliation(s)
- M Vitolo
- Modena Polyclinic Modena University Hospital , Modena , Italy
| | - M Proietti
- University of Milan, Department of Clinical Sciences and Community Health , Milan , Italy
| | - N Bonini
- Modena Polyclinic Modena University Hospital , Modena , Italy
| | - G F Romiti
- Sapienza University of Rome , Rome , Italy
| | - L Fauchier
- University Hospital of Tours , Tours , France
| | - F Marin
- University of Murcia , Murcia , Spain
| | - M Nabauer
- Ludwig Maximilians University , Munich , Germany
| | - T S Potpara
- University Belgrade Medical School , Belgrade , Serbia
| | - G A Dan
- University of Bucharest , Bucharest , Romania
| | - Z Kalarus
- Silesian Center for Heart Diseases (SCHD) , Zabrze , Poland
| | - L Tavazzi
- Maria Cecilia Hospital , Cotignola , Italy
| | | | - D A Lane
- University of Liverpool, Liverpool Centre for Cardiovascular Science , Liverpool , United Kingdom
| | - G Y H Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Science , Liverpool , United Kingdom
| | - G Boriani
- Modena Polyclinic Modena University Hospital , Modena , Italy
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6
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Bonini N, Proietti M, Romiti GF, Vitolo M, Fawzy AM, Ding YD, Fauchier L, Marin F, Nabauer M, Potpara TS, Dan GA, Boriani G, Lip GYH. Heart failure and cardiovascular outcomes in european patients with atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Heart failure (HF) has an intimate bidirectional association with atrial fibrillation (AF). Few data are available about the impact of HF phenotypes (HF with preserved ejection fraction, HFpEF; HF with mildly reduced ejection fraction, HFmrEF; HF with reduced ejection fraction, HFrEF) as predictors for adverse outcomes in AF patients.
Purpose
To investigate the association of HFpEF, HFmrEF and HFrEF with adverse outcomes in a large contemporary cohort of European AF patients and evaluate the effect of EF throughout its entire spectrum.
Methods
We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. HF patients were categorized according the three phenotypes and compared to those without HF (“non HF”). Main outcome was a composite outcome of all-cause death and major adverse cardiac events (MACE).
Results
Among the original 11,096 AF patients enrolled, 9857 (88.8%) were included in this analysis (median age 71 years, interquartile range [IQR 63–77], 40.1% females) with median EF 55% [IQR 45–61%] and CHA2DS2-VASc 3 [2–4]). In this cohort, 5935 (60.2%) were non HF patients, and 3240 (32.9%) had HF patients (with HF status and EF values data available). Accordingly, 1662 (51.2%) were categorized as HFpEF; 523 (14.1%) were HFmrEF; and 1235 (35.1%) were HFrEF.
After a median follow-up of 731 days [IQR 690–748], the composite outcome was significantly higher throughout HF categories (HFpEF 19.0%, HFmrEF 21.8% and HFrEF 29.6%, compared to non HF 10.7%; p<0.001). In a fully adjusted multivariate Cox regression, HF phenotypes were associated with a progressively higher risk for the composite outcome (HFpEF HR 1.45 [95% CI, 1.23–1.70]; HFmrEF HR 1.82 [95% CI, 1.45–2.3]; HFrEF HR 2.51 [95% CI, 2.14–2.95], when compared to non HF patients). Considering EF in its continuous spectrum, an adjusted regression curve analysis found that progressively lower EF was associated with a progressively higher risk for the composite outcome, both in HF and overall AF patients (Figure 1, left and right panel, respectively).
Conclusions
Over a two-years follow-up, in a large contemporary cohort of European AF patients, HF phenotypes were associated with a progressively higher risk for adverse outcomes. Lower EF values increased the risk of adverse outcomes both in HF patients and overall AF patients, irrespective of HF phenotype status.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Since the start of EORP, the following companies have supported the programme: Abbott Vascular Int. (2011–2021), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2021), Bayer (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2016), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2011–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2017), Menarini Int. Op. (2009–2012), MSD-Merck & Co. (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), SERVIER (2010–2021), and Vifor (2019–2022).
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Affiliation(s)
- N Bonini
- University of Liverpool , Liverpool , United Kingdom
| | | | - G F Romiti
- Sapienza University of Rome , Rome , Italy
| | - M Vitolo
- University of Modena and Reggio Emilia , Modena , Italy
| | - A M Fawzy
- University of Liverpool , Liverpool , United Kingdom
| | - Y D Ding
- University of Liverpool , Liverpool , United Kingdom
| | - L Fauchier
- University Hospital of Tours , Tours , France
| | - F Marin
- Virgen de la Arrixaca University Clinical Hospital , Murcia , Spain
| | - M Nabauer
- Ludwig Maximilians University , Munich , Germany
| | | | - G A Dan
- University of Bucharest Carol Davila , Bucharest , Romania
| | - G Boriani
- University of Modena and Reggio Emilia , Modena , Italy
| | - G Y H Lip
- University of Liverpool , Liverpool , United Kingdom
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7
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Proietti M, Romiti GF, Vitolo M, Bonini N, Boriani G, Lip GYH. Thromboembolic risk dynamics, integrated care management and outcomes in patients with atrial fibrillation: a proof-of-concept analysis from the SPORTIF trials. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Few data exist on the impact of thromboembolic risk dynamics in determining a higher risk of adverse clinical outcomes in atrial fibrillation (AF) patients. Moreover, no evidence is available about the possible impact of integrated care, as defined by the `Atrial fibrillation Better Care' (ABC) pathway, in modulating the clinical outcomes associated with the dynamic changes in risk.
Purpose
To study thromboembolic risk dynamics and the relationship with integrated care, also in determining the risk of adverse outcomes in AF patients.
Methods
We analysed patients from the randomized controlled SPORTIF III and V trials. Thromboembolic risk was assessed according to CHA2DS2-VASc score. Integrated care was assessed according to ABC pathway adherence. The primary endpoint was the composite clinical outcome of all-cause death and major adverse cardiovascular events.
Results
A total of 3589 patients [mean (SD) age was 70.9 (8.8) years; 30.4% female; median [IQR] baseline CHA2DS2-VASc 3 [2–4]) were available for the analysis. Over a mean 573.8 (SD 129.5) days of follow-up, a total of 67 (1.9%) reported an increase in CHA2DS2-VASc score, with a mean (SD) delta of 0.0295 (0.2257). Among those with increasing CHA2DS2-VASc, 29 (43.3%) reported a 1-point increase, 37 (55.2%) reported a 2-point increase and only 1 (1.5%) reported a 3-point increase. A total of 948 (26.4%) patients were managed adherent to ABC pathway and overall, a median (IQR) of 2 [1–3] ABC criteria were fulfilled in the patients included. An adjusted linear regression analysis found that an increasing number of ABC pathway criteria fulfilled was inversely associated with increase in CHA2DS2-VASc score throughout follow-up (Beta −0.010, 95% CI −0.019 to −0.001), p=0.045), while considering the single ABC criteria, only the “C” criteria was inversely associated with an increase in CHA2DS2-VASc score (Beta −0.018, 95% CI −0.034 to −0.001, p=0.038). A total of 255 (7.1%) clinical events were recorded. An adjusted Cox regression analysis found that both increasing CHA2DS2-VASc score (HR 2.67, 95% CI 2.12–3.36, p<0.001) and increasing number of ABC pathway criteria fulfilled (HR 0.71, 95% CI 0.61–0.82) were independently associated with adverse outcomes. A regression line studying the interaction between increasing CHA2DS2-VASc, and ABC pathway adherence showed trends for improved risk reductions in clinical adverse outcomes when patients with increasing thromboembolic risk were managed according to integrated care [Figure 1].
Conclusions
Integrated care was associated with a lower progression in the thromboembolic risk of AF patients, particular through the optimal management of cardiovascular risk factors and comorbidities. Both increasing thromboembolic risk and increasing adherence to ABC pathway were independently associated, although inversely, with occurrence of adverse clinical outcomes.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Proietti
- University of Milan, Department of Clinical Sciences and Community Health , Milan , Italy
| | - G F Romiti
- Sapienza University of Rome, Department of Translational and Precision Medicine , Rome , Italy
| | - M Vitolo
- University of Modena and Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences , Modena , Italy
| | - N Bonini
- University of Modena and Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences , Modena , Italy
| | - G Boriani
- University of Modena and Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences , Modena , Italy
| | - G Y H Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences , Liverpool , United Kingdom
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8
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Boriani G, Diemberger I, Pisano' ECL, Pieragnoli P, Locatelli A, Capucci A, Talarico A, Zecchin M, Rapacciuolo A, Piacenti M, Indolfi C, Arias MA, Checchinato C, D'Onofrio A. Influence of obesity and overweight on the association between sleep-disordered breathing and atrial fibrillation: the DASAP-HF study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The association between sleep apnea (SA) and atrial fibrillation (AF) has been well described. However, it remains unclear whether the association is causative or primarily dependent on shared comorbidities such as obesity. The Respiratory Disturbance Index (RDI) computed by an implantable cardioverter defibrillator (ICD) algorithm accurately identifies severe SA, whether central or obstructive in origin.
Purpose
In the present analysis we studied in patients with heart failure the contribution of obesity in the relationship between SA, measured by RDI, and AF.
Methods
Patients with ejection fraction ≤35% implanted with an ICD endowed with an algorithm (ApneaScan) that calculates the RDI each night, were enrolled and followed-up for 24 months. The weekly mean RDI value was considered, as calculated during the entire follow-up period. The endpoint was daily AF burden of ≥6 hours.
Results
164 patients (age 67±10 years, 75% male, ejection fraction 29±5%) had usable RDI values during the entire follow-up period. Body mass index (BMI) was <25 kg/m2 in 62 patients (normal), 25.0–29.9 kg/m2 in 66 patients (overweight), ≥ 30 kg/m2 in 36 patients (obese). When compared with normal patients (31±11 episodes/h), the average RDI value calculated during the entire follow-up period did not differ in overweight patients (35±13 episodes/h, p=0.114), but was significantly higher in obese patients (39±12 episodes/h, p=0.002). During follow-up, AF burden ≥6 hours/day was documented in 48 (29%) patients (BMI ≥ versus <25 kg/m2; HR: 1.47, 95% CI: 0.83–2.60, p=0.197; BMI ≥ versus <30 kg/m2; HR: 0.98, 95% CI: 0.46–2.09, p=0.963). Based on the ROC curve analysis, average RDI ≥37 episodes/h maximized sensitivity and specificity for the prediction of AF (Area under the curve: 0.63, 95% CI: 0.55–0.70, p=0.011). Device-detected RDI ≥37 episodes/h was associated with the occurrence of AF on univariate analysis (HR: 3.88, 95% CI: 2.02–7.44, p<0.001), as well as after correction for either BMI ≥25 kg/m2 (HR: 3.76, 95% CI: 1.94–7.26, p<0.001), or BMI ≥30 kg/m2 (HR: 4.15, 95% CI: 2.15–8.04, p<0.001).
Conclusions
In heart failure patients, we confirmed the association between ICD-detected SA and AF, an association that persisted independent of patient body habitus.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The study is supported by a research grant from Boston Scientific
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Affiliation(s)
- G Boriani
- Modena Polyclinic Modena University Hospital , Modena , Italy
| | - I Diemberger
- Institute of Cardiology, Univ. of Bologna , Bologna , Italy
| | | | | | | | - A Capucci
- Marche Polytechnic University of Ancona , Ancona , Italy
| | | | - M Zecchin
- University of Trieste , Trieste , Italy
| | | | - M Piacenti
- Fondazione Toscana Gabriele Monasterio , Pisa , Italy
| | - C Indolfi
- Magna Graecia University of Catanzaro , Catanzaro , Italy
| | - M A Arias
- Hospital Virgen de la Salud , Toledo , Spain
| | - C Checchinato
- Santa Croce Hospital of Moncalieri , Moncalieri , Italy
| | - A D'Onofrio
- AO dei Colli - Monaldi Hospital , Naples , Italy
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9
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Proietti M, Romiti GF, Vitolo M, Harrison SL, Lane DA, Fauchier L, Marin F, Näbauer M, Potpara TS, Dan GA, Maggioni AP, Cesari M, Boriani G, Lip GYH, Ekmekçiu U, Paparisto V, Tase M, Gjergo H, Dragoti J, Goda A, Ciutea M, Ahadi N, el Husseini Z, Raepers M, Leroy J, Haushan P, Jourdan A, Lepiece C, Desteghe L, Vijgen J, Koopman P, Van Genechten G, Heidbuchel H, Boussy T, De Coninck M, Van Eeckhoutte H, Bouckaert N, Friart A, Boreux J, Arend C, Evrard P, Stefan L, Hoffer E, Herzet J, Massoz M, Celentano C, Sprynger M, Pierard L, Melon P, Van Hauwaert B, Kuppens C, Faes D, Van Lier D, Van Dorpe A, Gerardy A, Deceuninck O, Xhaet O, Dormal F, Ballant E, Blommaert D, Yakova D, Hristov M, Yncheva T, Stancheva N, Tisheva S, Tokmakova M, Nikolov F, Gencheva D, Shalganov T, Kunev B, Stoyanov M, Marchov D, Gelev V, Traykov V, Kisheva A, Tsvyatkov H, Shtereva R, Bakalska-Georgieva S, Slavcheva S, Yotov Y, Kubíčková M, Marni Joensen A, Gammelmark A, Hvilsted Rasmussen L, Dinesen P, Riahi S, Krogh Venø S, Sorensen B, Korsgaard A, Andersen K, Fragtrup Hellum C, Svenningsen A, Nyvad O, Wiggers P, May O, Aarup A, Graversen B, Jensen L, Andersen M, Svejgaard M, Vester S, Hansen S, Lynggaard V, Ciudad M, Vettus R, Muda P, Maestre A, Castaño S, Cheggour S, Poulard J, Mouquet V, Leparrée S, Bouet J, Taieb J, Doucy A, Duquenne H, Furber A, Dupuis J, Rautureau J, Font M, Damiano P, Lacrimini M, Abalea J, Boismal S, Menez T, Mansourati J, Range G, Gorka H, Laure C, Vassalière C, Elbaz N, Lellouche N, Djouadi K, Roubille F, Dietz D, Davy J, Granier M, Winum P, Leperchois-Jacquey C, Kassim H, Marijon E, Le Heuzey J, Fedida J, Maupain C, Himbert C, Gandjbakhch E, Hidden-Lucet F, Duthoit G, Badenco N, Chastre T, Waintraub X, Oudihat M, Lacoste J, Stephan C, Bader H, Delarche N, Giry L, Arnaud D, Lopez C, Boury F, Brunello I, Lefèvre M, Mingam R, Haissaguerre M, Le Bidan M, Pavin D, Le Moal V, Leclercq C, Piot O, Beitar T, Martel I, Schmid A, Sadki N, Romeyer-Bouchard C, Da Costa A, Arnault I, Boyer M, Piat C, Fauchier L, Lozance N, Nastevska S, Doneva A, Fortomaroska Milevska B, Sheshoski B, Petroska K, Taneska N, Bakrecheski N, Lazarovska K, Jovevska S, Ristovski V, Antovski A, Lazarova E, Kotlar I, Taleski J, Poposka L, Kedev S, Zlatanovik N, Jordanova S, Bajraktarova Proseva T, Doncovska S, Maisuradze D, Esakia A, Sagirashvili E, Lartsuliani K, Natelashvili N, Gumberidze N, Gvenetadze R, Etsadashvili K, Gotonelia N, Kuridze N, Papiashvili G, Menabde I, Glöggler S, Napp A, Lebherz C, Romero H, Schmitz K, Berger M, Zink M, Köster S, Sachse J, Vonderhagen E, Soiron G, Mischke K, Reith R, Schneider M, Rieker W, Boscher D, Taschareck A, Beer A, Oster D, Ritter O, Adamczewski J, Walter S, Frommhold A, Luckner E, Richter J, Schellner M, Landgraf S, Bartholome S, Naumann R, Schoeler J, Westermeier D, William F, Wilhelm K, Maerkl M, Oekinghaus R, Denart M, Kriete M, Tebbe U, Scheibner T, Gruber M, Gerlach A, Beckendorf C, Anneken L, Arnold M, Lengerer S, Bal Z, Uecker C, Förtsch H, Fechner S, Mages V, Martens E, Methe H, Schmidt T, Schaeffer B, Hoffmann B, Moser J, Heitmann K, Willems S, Willems S, Klaus C, Lange I, Durak M, Esen E, Mibach F, Mibach H, Utech A, Gabelmann M, Stumm R, Ländle V, Gartner C, Goerg C, Kaul N, Messer S, Burkhardt D, Sander C, Orthen R, Kaes S, Baumer A, Dodos F, Barth A, Schaeffer G, Gaertner J, Winkler J, Fahrig A, Aring J, Wenzel I, Steiner S, Kliesch A, Kratz E, Winter K, Schneider P, Haag A, Mutscher I, Bosch R, Taggeselle J, Meixner S, Schnabel A, Shamalla A, Hötz H, Korinth A, Rheinert C, Mehltretter G, Schön B, Schön N, Starflinger A, Englmann E, Baytok G, Laschinger T, Ritscher G, Gerth A, Dechering D, Eckardt L, Kuhlmann M, Proskynitopoulos N, Brunn J, Foth K, Axthelm C, Hohensee H, Eberhard K, Turbanisch S, Hassler N, Koestler A, Stenzel G, Kschiwan D, Schwefer M, Neiner S, Hettwer S, Haeussler-Schuchardt M, Degenhardt R, Sennhenn S, Steiner S, Brendel M, Stoehr A, Widjaja W, Loehndorf S, Logemann A, Hoskamp J, Grundt J, Block M, Ulrych R, Reithmeier A, Panagopoulos V, Martignani C, Bernucci D, Fantecchi E, Diemberger I, Ziacchi M, Biffi M, Cimaglia P, Frisoni J, Boriani G, Giannini I, Boni S, Fumagalli S, Pupo S, Di Chiara A, Mirone P, Fantecchi E, Boriani G, Pesce F, Zoccali C, Malavasi VL, Mussagaliyeva A, Ahyt B, Salihova Z, Koshum-Bayeva K, Kerimkulova A, Bairamukova A, Mirrakhimov E, Lurina B, Zuzans R, Jegere S, Mintale I, Kupics K, Jubele K, Erglis A, Kalejs O, Vanhear K, Burg M, Cachia M, Abela E, Warwicker S, Tabone T, Xuereb R, Asanovic D, Drakalovic D, Vukmirovic M, Pavlovic N, Music L, Bulatovic N, Boskovic A, Uiterwaal H, Bijsterveld N, De Groot J, Neefs J, van den Berg N, Piersma F, Wilde A, Hagens V, Van Es J, Van Opstal J, Van Rennes B, Verheij H, Breukers W, Tjeerdsma G, Nijmeijer R, Wegink D, Binnema R, Said S, Erküner Ö, Philippens S, van Doorn W, Crijns H, Szili-Torok T, Bhagwandien R, Janse P, Muskens A, van Eck M, Gevers R, van der Ven N, Duygun A, Rahel B, Meeder J, Vold A, Holst Hansen C, Engset I, Atar D, Dyduch-Fejklowicz B, Koba E, Cichocka M, Sokal A, Kubicius A, Pruchniewicz E, Kowalik-Sztylc A, Czapla W, Mróz I, Kozlowski M, Pawlowski T, Tendera M, Winiarska-Filipek A, Fidyk A, Slowikowski A, Haberka M, Lachor-Broda M, Biedron M, Gasior Z, Kołodziej M, Janion M, Gorczyca-Michta I, Wozakowska-Kaplon B, Stasiak M, Jakubowski P, Ciurus T, Drozdz J, Simiera M, Zajac P, Wcislo T, Zycinski P, Kasprzak J, Olejnik A, Harc-Dyl E, Miarka J, Pasieka M, Ziemińska-Łuć M, Bujak W, Śliwiński A, Grech A, Morka J, Petrykowska K, Prasał M, Hordyński G, Feusette P, Lipski P, Wester A, Streb W, Romanek J, Woźniak P, Chlebuś M, Szafarz P, Stanik W, Zakrzewski M, Kaźmierczak J, Przybylska A, Skorek E, Błaszczyk H, Stępień M, Szabowski S, Krysiak W, Szymańska M, Karasiński J, Blicharz J, Skura M, Hałas K, Michalczyk L, Orski Z, Krzyżanowski K, Skrobowski A, Zieliński L, Tomaszewska-Kiecana M, Dłużniewski M, Kiliszek M, Peller M, Budnik M, Balsam P, Opolski G, Tymińska A, Ozierański K, Wancerz A, Borowiec A, Majos E, Dabrowski R, Szwed H, Musialik-Lydka A, Leopold-Jadczyk A, Jedrzejczyk-Patej E, Koziel M, Lenarczyk R, Mazurek M, Kalarus Z, Krzemien-Wolska K, Starosta P, Nowalany-Kozielska E, Orzechowska A, Szpot M, Staszel M, Almeida S, Pereira H, Brandão Alves L, Miranda R, Ribeiro L, Costa F, Morgado F, Carmo P, Galvao Santos P, Bernardo R, Adragão P, Ferreira da Silva G, Peres M, Alves M, Leal M, Cordeiro A, Magalhães P, Fontes P, Leão S, Delgado A, Costa A, Marmelo B, Rodrigues B, Moreira D, Santos J, Santos L, Terchet A, Darabantiu D, Mercea S, Turcin Halka V, Pop Moldovan A, Gabor A, Doka B, Catanescu G, Rus H, Oboroceanu L, Bobescu E, Popescu R, Dan A, Buzea A, Daha I, Dan G, Neuhoff I, Baluta M, Ploesteanu R, Dumitrache N, Vintila M, Daraban A, Japie C, Badila E, Tewelde H, Hostiuc M, Frunza S, Tintea E, Bartos D, Ciobanu A, Popescu I, Toma N, Gherghinescu C, Cretu D, Patrascu N, Stoicescu C, Udroiu C, Bicescu G, Vintila V, Vinereanu D, Cinteza M, Rimbas R, Grecu M, Cozma A, Boros F, Ille M, Tica O, Tor R, Corina A, Jeewooth A, Maria B, Georgiana C, Natalia C, Alin D, Dinu-Andrei D, Livia M, Daniela R, Larisa R, Umaar S, Tamara T, Ioachim Popescu M, Nistor D, Sus I, Coborosanu O, Alina-Ramona N, Dan R, Petrescu L, Ionescu G, Popescu I, Vacarescu C, Goanta E, Mangea M, Ionac A, Mornos C, Cozma D, Pescariu S, Solodovnicova E, Soldatova I, Shutova J, Tjuleneva L, Zubova T, Uskov V, Obukhov D, Rusanova G, Soldatova I, Isakova N, Odinsova S, Arhipova T, Kazakevich E, Serdechnaya E, Zavyalova O, Novikova T, Riabaia I, Zhigalov S, Drozdova E, Luchkina I, Monogarova Y, Hegya D, Rodionova L, Rodionova L, Nevzorova V, Soldatova I, Lusanova O, Arandjelovic A, Toncev D, Milanov M, Sekularac N, Zdravkovic M, Hinic S, Dimkovic S, Acimovic T, Saric J, Polovina M, Potpara T, Vujisic-Tesic B, Nedeljkovic M, Zlatar M, Asanin M, Vasic V, Popovic Z, Djikic D, Sipic M, Peric V, Dejanovic B, Milosevic N, Stevanovic A, Andric A, Pencic B, Pavlovic-Kleut M, Celic V, Pavlovic M, Petrovic M, Vuleta M, Petrovic N, Simovic S, Savovic Z, Milanov S, Davidovic G, Iric-Cupic V, Simonovic D, Stojanovic M, Stojanovic S, Mitic V, Ilic V, Petrovic D, Deljanin Ilic M, Ilic S, Stoickov V, Markovic S, Kovacevic S, García Fernandez A, Perez Cabeza A, Anguita M, Tercedor Sanchez L, Mau E, Loayssa J, Ayarra M, Carpintero M, Roldán Rabadan I, Leal M, Gil Ortega M, Tello Montoliu A, Orenes Piñero E, Manzano Fernández S, Marín F, Romero Aniorte A, Veliz Martínez A, Quintana Giner M, Ballesteros G, Palacio M, Alcalde O, García-Bolao I, Bertomeu Gonzalez V, Otero-Raviña F, García Seara J, Gonzalez Juanatey J, Dayal N, Maziarski P, Gentil-Baron P, Shah D, Koç M, Onrat E, Dural IE, Yilmaz K, Özin B, Tan Kurklu S, Atmaca Y, Canpolat U, Tokgozoglu L, Dolu AK, Demirtas B, Sahin D, Ozcan Celebi O, Diker E, Gagirci G, Turk UO, Ari H, Polat N, Toprak N, Sucu M, Akin Serdar O, Taha Alper A, Kepez A, Yuksel Y, Uzunselvi A, Yuksel S, Sahin M, Kayapinar O, Ozcan T, Kaya H, Yilmaz MB, Kutlu M, Demir M, Gibbs C, Kaminskiene S, Bryce M, Skinner A, Belcher G, Hunt J, Stancombe L, Holbrook B, Peters C, Tettersell S, Shantsila A, Lane D, Senoo K, Proietti M, Russell K, Domingos P, Hussain S, Partridge J, Haynes R, Bahadur S, Brown R, McMahon S, Y H Lip G, McDonald J, Balachandran K, Singh R, Garg S, Desai H, Davies K, Goddard W, Galasko G, Rahman I, Chua Y, Payne O, Preston S, Brennan O, Pedley L, Whiteside C, Dickinson C, Brown J, Jones K, Benham L, Brady R, Buchanan L, Ashton A, Crowther H, Fairlamb H, Thornthwaite S, Relph C, McSkeane A, Poultney U, Kelsall N, Rice P, Wilson T, Wrigley M, Kaba R, Patel T, Young E, Law J, Runnett C, Thomas H, McKie H, Fuller J, Pick S, Sharp A, Hunt A, Thorpe K, Hardman C, Cusack E, Adams L, Hough M, Keenan S, Bowring A, Watts J, Zaman J, Goffin K, Nutt H, Beerachee Y, Featherstone J, Mills C, Pearson J, Stephenson L, Grant S, Wilson A, Hawksworth C, Alam I, Robinson M, Ryan S, Egdell R, Gibson E, Holland M, Leonard D, Mishra B, Ahmad S, Randall H, Hill J, Reid L, George M, McKinley S, Brockway L, Milligan W, Sobolewska J, Muir J, Tuckis L, Winstanley L, Jacob P, Kaye S, Morby L, Jan A, Sewell T, Boos C, Wadams B, Cope C, Jefferey P, Andrews N, Getty A, Suttling A, Turner C, Hudson K, Austin R, Howe S, Iqbal R, Gandhi N, Brophy K, Mirza P, Willard E, Collins S, Ndlovu N, Subkovas E, Karthikeyan V, Waggett L, Wood A, Bolger A, Stockport J, Evans L, Harman E, Starling J, Williams L, Saul V, Sinha M, Bell L, Tudgay S, Kemp S, Brown J, Frost L, Ingram T, Loughlin A, Adams C, Adams M, Hurford F, Owen C, Miller C, Donaldson D, Tivenan H, Button H, Nasser A, Jhagra O, Stidolph B, Brown C, Livingstone C, Duffy M, Madgwick P, Roberts P, Greenwood E, Fletcher L, Beveridge M, Earles S, McKenzie D, Beacock D, Dayer M, Seddon M, Greenwell D, Luxton F, Venn F, Mills H, Rewbury J, James K, Roberts K, Tonks L, Felmeden D, Taggu W, Summerhayes A, Hughes D, Sutton J, Felmeden L, Khan M, Walker E, Norris L, O’Donohoe L, Mozid A, Dymond H, Lloyd-Jones H, Saunders G, Simmons D, Coles D, Cotterill D, Beech S, Kidd S, Wrigley B, Petkar S, Smallwood A, Jones R, Radford E, Milgate S, Metherell S, Cottam V, Buckley C, Broadley A, Wood D, Allison J, Rennie K, Balian L, Howard L, Pippard L, Board S, Pitt-Kerby T. Epidemiology and impact of frailty in patients with atrial fibrillation in Europe. Age Ageing 2022; 51:6670566. [PMID: 35997262 DOI: 10.1093/ageing/afac192] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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: 03/17/2022] [Revised: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. OBJECTIVES We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients. METHODS A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. RESULTS Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. CONCLUSIONS In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.
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Affiliation(s)
- Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Translational and Precision Medicine, Sapienza - University of Rome, Italy
| | - Marco Vitolo
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Francisco Marin
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBER-CV, Murcia, Spain
| | - Michael Näbauer
- Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Center of Serbia, Belgrade, Serbia
| | - Gheorghe-Andrei Dan
- University of Medicine, 'Carol Davila', Colentina University Hospital, Bucharest, Romania
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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10
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Mazza A, Bendini M, Bianchi V, Esposito C, Calo’ L, Andreoli C, Santobuono V, Dello Russo A, Chianese R, La Greca C, Santoro A, Giubilato G, Strisciuglio T, Valsecchi S, Boriani G. Device-detected sleep-disordered breathing predicts implantable defibrillator therapy in patients with heart failure. Europace 2022. [DOI: 10.1093/europace/euac053.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Sleep-disordered breathing is highly prevalent in heart failure (HF) and it has been suggested as a risk factor for malignant ventricular arrhythmias. The Respiratory Disturbance Index (RDI) algorithm computed by select implantable cardioverter defibrillators (ICDs) can identify severe sleep apnea (SA).
Purpose
In the present analysis we evaluated the association between ICD-detected SA and the incidence of appropriate ICD therapy in patients with HF.
Methods
We enrolled 411 HF patients (age 69±10years, 77% male, ejection fraction 32±8%), implanted with an ICD endowed with an algorithm (ApneaScan, Boston Scientific) that calculates the RDI each night. In this analysis the weekly mean RDI value was considered. The endpoint was the first appropriate ICD shock. The median follow-up was 26 months [25th–75th percentile: 16-35].
Results
During follow-up, one or more ICD shocks were documented in 58 (14%) patients.
Patients with shocks were younger (66±13years versus 70±10years, p=0.038), and more frequently implanted for secondary prevention (21% versus 10%, p=0.026). The maximum RDI value calculated during the entire follow-up period did not differ between patients with and without shocks (55±15episodes/h versus 54±14episodes/h, p=0.539). However, the ICD-detected RDI showed a considerable variability during follow-up. The overall median of the weekly RDI was 33episodes/h [25th–75th percentile: 24-45]. Using a time-dependent Cox regression model, the continuously measured weekly mean RDI≥45episodes/h was independently associated with shock occurrence (HR:4.63, 95%CI:2.54-8.43, p<0.001), after correction for baseline confounders (age, secondary prevention).
Conclusions
In HF patients, patients were more likely to receive appropriate ICD shocks during periods of time when they exhibited more sleep-disordered breathing.
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Affiliation(s)
- A Mazza
- Hospital Santa Maria della Stella, Orvieto, Italy
| | - M Bendini
- Hospital Santa Maria della Stella, Orvieto, Italy
| | - V Bianchi
- AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
| | - C Esposito
- San Giovanni di Dio and Ruggi d’Aragona University Hospital, Salerno, Italy
| | - L Calo’
- Polyclinic Casilino, Rome, Italy
| | - C Andreoli
- San Giovanni Battista Hospital, Foligno, Italy
| | | | | | - R Chianese
- Hospital Sant’anna E San Sebastiano, Caserta, Italy
| | - C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | - A Santoro
- Senese University Hospital, Siena, Italy
| | - G Giubilato
- Presidio Ospedaliero di Frosinone, Frosinone, Italy
| | | | | | - G Boriani
- University-Hospital Polyclinic of Modena, Modena, Italy
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11
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Boriani G, Maisano A, Bonini N, Albini A, Imberti JF, Venturelli A, Camaioni G, Passiatore M, De Mitri G, Nanni G, Girolami D, Siena V, Sgreccia D, Valenti AC, Vitolo M. Implementation of cardiology tele-visits after COVID-19 pandemic: the INFO-COVID survey. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3109] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
During the COVID-19 pandemic, implementation of telemedicine has represented a new potential option for outpatient care.
Purpose
The aim of our study was to evaluate digital literacy among cardiology outpatients.
Methods
From March to June 2020 a survey on telehealth among cardiology outpatients was performed. Digital literacy was investigated through six main domains: age; sex; educational level; Internet access; availability of Internet sources; knowledge and use of teleconference software programs.
Results
The study included 1067 patients, median age 79 years, 41.3% females. The majority of the patients (58.0%) had a secondary school degree, but among patients aged ≥75 years old the most represented educational level was primary school or none. Overall, for Internet access, there was a splitting between “never” (42.1%) and “every day” (41.0%), while only 2.7% answered “at least 1/month” and 14.2% “at least 1/week”. In the total population, the most used devices for Internet access were smartphones (59.0%), and WhatsApp represented the most used app (57.3%). Internet users were younger compared to non-Internet users (63 versus 78 years old, respectively) and with a higher educational level. Age and educational level were associated with non-use of Internet (age-per 10-year increase odds ratio [OR] 3.07, 95% confidence interval [CI] 2.54–3.71, secondary school OR 0.18, 95% CI 0.12–0.26, university OR 0.05, 95% CI 0.02–0.10) (Figure 1).
Conclusions
Telemedicine represents an appealing option to implement medical practice, and for its development it is important to address the gaps in patients' digital skills, with age and educational level being key factors in this setting.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Factors associated with Internet non-use
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Affiliation(s)
- G Boriani
- University of Modena & Reggio Emilia, Modena, Italy
| | - A Maisano
- University of Modena & Reggio Emilia, Modena, Italy
| | - N Bonini
- University of Modena & Reggio Emilia, Modena, Italy
| | - A Albini
- University of Modena & Reggio Emilia, Modena, Italy
| | - J F Imberti
- University of Modena & Reggio Emilia, Modena, Italy
| | - A Venturelli
- University of Modena & Reggio Emilia, Modena, Italy
| | - G Camaioni
- University of Modena & Reggio Emilia, Modena, Italy
| | - M Passiatore
- University of Modena & Reggio Emilia, Modena, Italy
| | - G De Mitri
- University of Modena & Reggio Emilia, Modena, Italy
| | - G Nanni
- University of Modena & Reggio Emilia, Modena, Italy
| | - D Girolami
- University of Modena & Reggio Emilia, Modena, Italy
| | - V Siena
- University of Modena & Reggio Emilia, Modena, Italy
| | - D Sgreccia
- University of Modena & Reggio Emilia, Modena, Italy
| | - A C Valenti
- University of Modena & Reggio Emilia, Modena, Italy
| | - M Vitolo
- University of Modena & Reggio Emilia, Modena, Italy
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12
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Blomstrom-Lundqvist C, Camm A, Goette A, Kowey P, Merino J, Piccini J, Reiffel J, Saksena S, Boriani G. Antiarrhythmic medication for atrial fibrillation (AIM-AF) study: a physician survey of antiarrhythmic drug (AAD) treatment practices and guideline adherence in Europe. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The 2020 European Society of Cardiology (ESC) guidelines provide detailed recommendations for the management of patients with atrial fibrillation (AF). In symptomatic patients, AADs are advised for rhythm control.
Purpose
This study was designed to investigate AAD treatment practices and adherence to guidelines in four European countries.
Methods
An online survey (n=321) of cardiologists or cardiac electrophysiologists (CDs) and interventional electrophysiologists (EPs) was conducted in Germany (DE; n=83), Italy (IT; n=95), Sweden (SE; n=60) and the UK (n=83). Respondents were actively treating ≥10 patients with AF.
Results
(1) The majority of physicians considered guidelines to be the most important non-patient factor influencing their AF management practices (pooled: 65%; range: 55–72%), with 96%
(range: 89–100%) following ESC guidelines. Although amiodarone use was most frequent in heart failure with reduced left ventricular (LV) ejection fraction (pooled: 91%; range: 88–93%) where it is a recommended first-line option, non-adherent AAD selection was common. Amiodarone was frequently selected as a typical treatment choice for minimal/no structural heart disease (SHD) where it is not recommended for initial therapy; this was particularly common in the UK versus SE (Figure 1). Other deviations included use of class 1C drugs in those with coronary artery disease (CAD) (with the exception of SE; Figure 1) and other SHD, as well as use of sotalol in LV hypertrophy (pooled: 30%) and renal impairment (Figure 1). Furthermore, absence of inpatient initiation of sotalol was generally high, with the exception of SE (Figure 1).
(2) Sotalol and dronedarone use in CAD varied between country (pooled: 28% [range: 16–41%] and pooled: 19% [range: 10–54%], respectively).
(3) CDs and EPs used rhythm control as initial therapy in most patients with paroxysmal AF (PAF); however, other than SE, this was not the case for persistent AF (Figure 2).
(4) AADs were preferred over ablation as initial therapy for individuals with infrequent, mildly symptomatic PAF (pooled: 61%), with the exception of SE (48%). Ablation was favoured for most patients with frequent, symptomatic PAF; however, in SE, AADs were preferred for infrequent, highly symptomatic PAF (53%) and frequent, symptomatic PAF (53%).
(5) Rhythm control therapies were selected for asymptomatic or subclinical AF; AADs were used more often (average: 41% [range: 22–60%]; ablation was used less frequently (average: 11% [range: 2–18%]).
Conclusion
Despite assertion that guidelines are the primary determinant for rhythm control treatment decisions, non-adherence was notable in European practice. While deviation may be reasonable in select individual patients, in general, non-adherence could compromise patient safety. As such, establishing the drivers of non-adherent practices is key, and education directed at clinicians to improve optimal and safe use of AADs is warranted in Europe.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Sanofi
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Affiliation(s)
| | - A.J Camm
- St George's University, London, United Kingdom
| | - A Goette
- Saint Vincenz Hospital Paderborn, Paderborn, Germany
| | - P.R Kowey
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, United States of America
| | - J.L Merino
- La Paz University Hospital, Madrid, Spain
| | - J.P Piccini
- Duke Clinical Research Institute, Durham, United States of America
| | - J.A Reiffel
- Columbia University, New York, United States of America
| | - S Saksena
- Rutgers Robert Wood Johnson Medical School, Piscataway, United States of America
| | - G Boriani
- University of Modena & Reggio Emilia, Modena, Italy
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13
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Ding W, Proietti M, Boriani G, Marin F, Blomstrom-Lundqvist C, Fauchier L, Potpara T, Lip G. Digoxin vs. beta-blocker therapy in atrial fibrillation: analysis from the ESC-EHRA EORP Atrial Fibrillation General Long-Term (AFGen LT) Registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There is a long-standing and unresolved controversy over the effects of digoxin on mortality. Furthermore, there is scarce evidence comparing the use of digoxin to beta-blocker in the general population with atrial fibrillation (AF). In this study, we aimed to evaluate the effects of digoxin over beta-blocker therapy among patients with AF.
Methods
Patients from the EORP-AF General Long-Term Registry with AF who were treated with either digoxin or beta-blocker were included. All patients were over 18 years old and had documented evidence of AF within 12 months prior to enrolment. The outcomes of interest were all-cause mortality, cardiovascular (CV) mortality, non-CV mortality and number of patients with unplanned hospitalisation (total and AF-related). These were recorded until the last known follow-up available.
Results
Of 6377 patients, 549 (8.6%) and 5828 (91.4%) were treated with digoxin and beta-blockers, respectively. Patients in the digoxin group were older (73 vs. 71 years, p<0.001) with reduced renal function (eGFR 65.4 vs. 68.7 mL/min/1.73m2, p=0.002), and had (in general) greater burden of comorbidities in terms of chronic kidney disease, chronic obstructive pulmonary disease, heart failure, hypertension and peripheral artery disease. Nonetheless, the use of anticoagulation therapy was comparable between both groups (p=0.112).
Over 24 months follow-up, there were 550 (8.6%) all-cause mortality and 1304 (23.6%) patients with unplanned emergency hospitalisation. Digoxin use was associated with increased all-cause mortality (hazard ratio [HR] 1.90 [95% CI, 1.48–2.44]), both from CV and non-CV causes (CV: HR 2.21 [95% CI, 1.49–3.26]); non-CV: HR 1.70 [95% CI, 1.04–2.79]). There was no statistical difference in terms of unplanned emergency hospitalisation (HR 0.99 [95% CI, 0.80–1.21]) and AF-related hospitalisation (HR 0.78 [95% CI, 0.58–1.06]) between both groups.
Using multivariable cox regression analysis, digoxin compared to beta-blocker therapy was independently linked to increased all-cause mortality (HR 1.52 [95% CI, 1.11–2.09]) and CV mortality (HR 1.82 [95% CI, 1.11–2.97]), but was not related to non-CV mortality (HR 1.31 [95% CI, 0.71–2.41]), emergency hospitalisation (HR 0.91 [95% CI, 0.71–1.16]) or AF-related hospitalisation (HR 0.88 [95% CI, 0.62–1.24]), after adjustment for known risk factors.
Conclusion
We demonstrated that the use of digoxin was independently associated with excess all-cause mortality, driven by CV death, but was non-inferior to beta-blocker in terms of preventing unplanned emergency or AF-related hospitalisation, after accounting for important risk factors.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- W.Y Ding
- University of Liverpool, Liverpool, United Kingdom
| | | | - G Boriani
- University of Modena & Reggio Emilia, Modena, Italy
| | - F Marin
- University of Murcia, Murcia, Spain
| | | | - L Fauchier
- University Hospital of Tours, Tours, France
| | | | - G.Y.H Lip
- University of Liverpool, Liverpool, United Kingdom
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14
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Malavasi VL, Vitolo M, Proietti M, Fauchier L, Marin F, Nabauer M, Potpara TS, Dan GA, Kalarus Z, Lane DA, Lip GYH, Boriani G. Impact of malignancy on outcomes in European patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in Atrial Fibrillation General Long-Term Registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Management of patients with atrial fibrillation (AF) and malignancy is a clinical challenge given the paucity of evidence supporting the appropriate clinical management.
Purpose
To evaluate the outcomes of patients with active or prior malignancy in a large contemporary cohort of European AF patients.
Methods
We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. We stratified the population into three categories (i) No Malignancy (NoM) (ii) Prior Malignancy (PriorM) and (iii) Active Malignancy (ActM). The primary outcome for this analysis was all-cause death among the three groups. The association between anticoagulant treatment, all-cause death and haemorrhagic events was also evaluated.
Results
Among the original 11 096 AF patients enrolled, 10 383 were included in this analysis (median age 71 years (interquartile range [IQR] 63–77, males 59.7%). Of these, 9 597 (92.4%) were NoM patients, 577 (5.6%) PriorM and 209 (2%) ActM. Patients with malignancy (prior or active) had a higher median age, median CHA2DS2-VASc and HAS-BLED scores, compared to patients without malignancy (p<0.001). Lack of anticoagulation (AC) prescription occurred more commonly in ActM (21.5%) as compared with the other groups (PriorM 10.1% vs NoM 12.8%, p<0.001). In case of AC treatment, patients with ActM were treated more frequently with heparins (ActM 8.1% vs PriorM 2.4% vs NoM 2%, p<0.001).
After a median follow-up of 730 days [IQR 692–749], 982 (9.5%) patients died. Among all deaths, the proportion of cardiovascular death was different according to the three groups (40.0% in NoM, 26.0% in PrioM and 22.2% in ActM, p=0.002). For all cause-death, Kaplan-Meier analysis showed a progressively higher cumulative risk in the PriorM and ActM groups compared to NoM patients (Figure 1).
On multivariable Cox regression analysis, adjusted for CHA2DS2-VASc score, use of AC, type of AF and chronic kidney disease, ActM group was independently associated with a higher risk for all cause death (hazard ratio [HR] 2.90, 95% confidence interval [CI] 2.23–3.76) while PriorM group was not.
Among PriorM and NoM patients, multivariable adjusted Cox regression analysis found that the use of any AC was independently associated with a lower risk for all-cause death (HR 0.36, 95% CI 0.19–0.66; HR 0.66, 95% CI 0.54–0.81). No significant association between AC and all-cause death was found for ActM patients.
Conclusions
In a large contemporary cohort of European AF patients, active malignancy was found to be independently associated with all-cause death. Use of any AC was associated with a lower risk for all-cause death in patients with no malignancies and with prior malignancies, but with no significant association amongst patients with active malignancies.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Since the start of EORP, the following companies have supported the programme: Abbott Vascular Int. (2011–2021), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2021), Bayer (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2016), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2011–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2017), Menarini Int. Op. (2009–2012), MSD-Merck & Co. (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), SERVIER (2010–2021), and Vifor (2019–2022). Figure 1. Kaplan-Meier for all-cause death
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Affiliation(s)
- V L Malavasi
- University of Modena & Reggio Emilia, Modena, Italy
| | - M Vitolo
- University of Modena & Reggio Emilia, Modena, Italy
| | - M Proietti
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - L Fauchier
- University Hospital of Tours, Tours, France
| | - F Marin
- Hospital Universitario Virgen Arrixaca, Murcia, Spain
| | - M Nabauer
- Ludwig Maximilians University Hospital, Munich, Germany
| | - T S Potpara
- University Belgrade Medical School, Belgrade, Serbia
| | - G A Dan
- Colentina University Hospital, Bucharest, Romania
| | - Z Kalarus
- Silesian Center for Heart Diseases (SCHD), Zabrze, Poland
| | - D A Lane
- University of Liverpool, Liverpool, United Kingdom
| | - G Y H Lip
- University of Liverpool, Liverpool, United Kingdom
| | - G Boriani
- University of Modena & Reggio Emilia, Modena, Italy
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15
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Romiti GF, Corica B, Borgi M, Vitolo M, Miyazawa K, Healey JS, Lane DA, Boriani G, Basili S, Lip GYH, Proietti M. Epidemiology of subclinical atrial fibrillation in patients with cardiac implantable electronic devices: a systematic review and meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Sub-clinical atrial fibrillation (SCAF) and atrial high-rate episodes (AHREs), seen as high-frequency atrial tachyarrhythmias in patients with cardiac implantable electronic devices (CIEDs), have gained prominence as determinants of clinical atrial fibrillation (AF) and increased stroke risk. As a result, several studies investigating their role in predicting the onset of AF and AHRE-related outcomes have been conducted but uncertainty exists on the epidemiology of AHRE.
Purpose
To estimate the incidence of SCAF, according to presence of AHREs in patients with CIEDs, through a systematic review and meta-analysis of the available literature.
Methods
PubMed and EMBASE were searched from inception to 27th January 2021 for all studies documenting the incidence of AHREs in patients with CIEDs. We included all studies with ≥100 patients reporting data on AHREs incidence. Pooled prevalence and incidence rates were computed; we also performed meta-regressions for pooled incidence rates, according to relevant study-level characteristics. This study was registered in PROSPERO: CRD42019106994.
Results
Among the 2,515 results retrieved, we included 51 studies in the systematic review and meta-analysis, with a total of 68,414 patients. Meta-analysis of included studies showed a pooled prevalence of 28.2% (95% CI: 24.3–32.5%, I2=99%), with a pooled incidence rate (IR) of 15 new AHRE cases per 100 patient-years (95% CI: 12–19, I2=100%). Given the large heterogeneity showed in the pooled estimates we performed additional analyses. Regarding pooled prevalence, we performed several subgroup analyses, according to various studies baseline characteristics, which did not show any significant difference in any of the subgroups examined. Regarding IR, a multivariable meta-regression analysis showed that decreasing follow-up time and increasing age were the only factors significantly associated with AHRE incidence, explaining a large proportion of heterogeneity (R2=68%, p<0.001; Figure 1, Panel A and B respectively). Accordingly, the AHRE IR was highest at 1 year follow-up and in the oldest subjects. Presence of SCAF was significantly associated with older age, higher CHA2DS2-VASc score, and higher prevalence of hypertension, heart failure and history of cerebrovascular disease.
Conclusions
This systematic review and meta-regression demonstrated that SCAF is very common in patients with CIEDs, with an overall IR for AHREs of up to 15 per 100 patient-years; increasing with age and decreasing with longer follow-up time. Presence of SCAF was associated with an overall higher clinical risk profile compared to those subjects without SCAF.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Meta-regression for AHRE Incidence
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Affiliation(s)
| | - B Corica
- Sapienza University of Rome, Rome, Italy
| | - M Borgi
- University of Messina, Messina, Italy
| | - M Vitolo
- University of Modena & Reggio Emilia, Modena, Italy
| | - K Miyazawa
- Chiba University Graduate School of Medicine, Chiba, Japan
| | | | - D A Lane
- University of Liverpool, Liverpool, United Kingdom
| | - G Boriani
- University of Modena & Reggio Emilia, Modena, Italy
| | - S Basili
- Sapienza University of Rome, Rome, Italy
| | - G Y H Lip
- University of Liverpool, Liverpool, United Kingdom
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16
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Boriani G, Pisano' E, Pieragnoli P, Locatelli A, Capucci A, Talarico A, Zecchin M, Rapacciuolo A, Piacenti M, Indolfi C, Arias M, Diemberger I, Checchinato C, D'Onofrio A. Implantable defibrillator-computed respiratory disturbance index predicts new-onset atrial fibrillation: the DASAP-HF study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Sleep apnea (SA), as measured by polysomnography, is a risk factor for atrial fibrillation (AF). The DASAP-HF study previously demonstrated that the Respiratory Disturbance Index (RDI) computed by an implantable cardioverter defibrillator (ICD) algorithm accurately identifies severe SA, is associated with cardiovascular events, and independently predicts death.
Purpose
In the present analysis we tested the hypothesis that device-detected RDI could also predict AF burden.
Methods
Patients with left ventricular ejection fraction ≤35% implanted with an ICD were enrolled and followed-up for 24 months. One month after implantation, patients underwent a polysomnographic study. The weekly average RDI value was considered, as calculated by the algorithm during the entire follow-up period and over a 1 week period preceding the sleep study, and patients were stratified according to an RDI value ≥ or <30 episodes/hour. The endpoints were: daily AF burden of ≥5 minutes, ≥6 hours, ≥23 hours.
Results
164 enrolled patients had usable RDI values during the entire follow-up period. Severe SA (RDI≥30 episodes/h) was diagnosed in 92 (56%) patients at the time of the polysomnographic study. During a median follow-up of 25 months, AF burden ≥5 minutes/day was documented in 70 (43%), ≥6 hours/day in 48 (29%), and ≥23 hours/day in 33 (20%) patients. Device-detected RDI≥30 episodes/h at the time of the polysomnographic study, as well as the polysomnography-measured apnea hypopnea index ≥30 episodes/h, were not associated with the occurrence of the endpoints, using a Cox regression model. However, using time-dependent Cox model continuously measured weekly average RDI≥30episodes/h was independently associated with AF burden ≥5 minutes/day (HR: 2.13, 95% CI: 1.24–3.65, p=0.006), ≥6 hours/day (HR: 2.75, 95% CI: 1.37–5.49, p=0.004), and ≥23 hours/day (HR: 2.26, 95% CI: 1.05–4.86, p=0.037), after correction for history of AF, left atrial diameter, and gender.
Conclusions
In heart failure patients implanted with an ICD, device-diagnosed severe SA is associated with a higher risk of AF. In particular, severe SA on follow-up data review identifies patients who are from two- to three-fold more likely to experience an AF episode, according to various thresholds of daily AF burden.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Promoted by the Italian Heart Rhythm Society (AIAC).Supported by a research grant from Boston Scientific.
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Affiliation(s)
- G Boriani
- University of Modena & Reggio Emilia, Modena, Italy
| | | | | | | | - A Capucci
- Marche Polytechnic University of Ancona, Ancona, Italy
| | | | - M Zecchin
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | | | - M Piacenti
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - C Indolfi
- Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - M.A Arias
- Hospital Virgen de la Salud, Toledo, Spain
| | - I Diemberger
- Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh, Bologna, Italy
| | - C Checchinato
- Santa Croce Hospital of Moncalieri, Moncalieri, Italy
| | - A D'Onofrio
- AO dei Colli-Monaldi Hospital, Naples, Italy
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17
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Ding W, Proietti M, Boriani G, Marin F, Blomstrom-Lundqvist C, Fauchier L, Potpara T, Lip G. Clinical application of the novel 4S-AF scheme for the characterisation of patients with atrial fibrillation: a report from the ESC-EHRA EORP Atrial Fibrillation General Long-Term (AFGen LT) registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Current classification systems recommended by major international guidelines are based on a single domain of atrial fibrillation (AF): temporal pattern, symptom severity or underlying comorbidity. Lack of integration between these various elements limits our approach to patients with AF and acts as a barrier against the delivery of better holistic care. The 4S-AF classification scheme was recently introduced as a means for the characterisation of patients with AF. It comprises of 4 domains: stroke risk (St), symptoms (Sy), severity of AF burden (Sb) and substrate (Su). We sought to examine the implementation of the 4S-AF scheme in the EORP-AF General Long-Term Registry and effects of individual domains on outcomes in AF.
Methods
Patients with AF from 250 centres across 27 participating European countries were included. All patients were over 18 years old and had electrocardiographic confirmation of AF within 12 months prior to enrolment. Data on demographics and comorbidities were collected at baseline. Individual domains of the 4S-AF scheme were assessed using the CHA2DS2-VASc score (St), European Heart Rhythm Association classification (Sy), temporal classification of AF (Sb), and cardiovascular risk factors and the degree of left atrial enlargement (Su). Each of these domains were used during multivariable cox regression analysis.
Results
A total of 6321 patients were included in the present analysis, corresponding to 57.0% of the original cohort of 11096 patients. The median age of patients was 70 (interquartile range [IQR] 62–77) years with 2615 (41.4%) females. Among these patients, 528 (8.4%) had low stroke risk (St=0), 3002 (47.5%) no or mild symptoms (Sy=0), 2558 (40.5%) newly diagnosed or paroxysmal AF (Sb=0), and 322 (5.1%) no cardiovascular risk factors or left atrial enlargement (Su=0).
Median follow-up was 24 months. Using multivariable cox regression analysis, independent predictors of all-cause mortality were (St) (adjusted hazard ratio [aHR] 8.21 [95% CI, 2.60–25.9]), (Sb) (aHR 1.21 [95% CI, 1.08–1.35]) and (Su) (aHR 1.27 [95% CI, 1.14–1.41]). For cardiovascular mortality and any thromboembolic event, only (Su) (aHR 1.73 [95% CI, 1.45–2.06]) and (Sy) (aHR 1.29 [95% CI, 1.00–1.66]) were statistically important, respectively. None of the domains were independently linked to ischaemic stroke or major bleeding.
Conclusion
Overall, we demonstrated that the 4S-AF scheme may be used to provide clinical characterisation of patients with AF using routinely collected data, and each of the domains within the 4S-AF scheme were independently associated with adverse long-term outcomes of all-cause mortality, cardiovascular mortality and/or any thromboembolic event.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- W.Y Ding
- University of Liverpool, Liverpool, United Kingdom
| | | | - G Boriani
- University of Modena & Reggio Emilia, Modena, Italy
| | - F Marin
- University of Murcia, Murcia, Spain
| | | | - L Fauchier
- University Hospital of Tours, Tours, France
| | | | - G.Y.H Lip
- University of Liverpool, Liverpool, United Kingdom
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18
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Engler D, Hanson C, Desteghe L, Boriani G, Diederichsen SZ, Freedman B, Pala E, Potpara T, Witt H, Heidbuchel H, Neubeck L, Schnabel RB. Atrial fibrillation screening: feasible approaches and implementation challenges across Europe. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) screening has the potential to increase early detection and possibly reduce complications of AF. Guidelines recommend screening, but the most appropriate approaches are unknown.
Purpose
We aimed to explore the views of stakeholders across Europe about the opportunities and challenges of implementing four different AF screening scenarios.
Method
This qualitative study included 21 semi-structured interviews with healthcare professionals and regulators potentially involved in AF screening implementation in nine European countries. Data were analysed using thematic analysis.
Results
Three themes evolved. 1) Current approaches to screening: there are no national AF screening programmes, with most AF detected in symptomatic patients. Patient-led screening exists via personal devices, creating screening inequity by the reach of screening programmes being limited to those who access healthcare services. 2) Feasibility of screening approaches: single time point opportunistic screening in primary care using single lead ECG devices was considered the most feasible approach and AF screening may be possible in previously unexplored settings such as dentists and podiatrists. Software algorithms may aid identification of patients suitable for screening and telehealth services have the potential to support diagnosis. However, there is a need for advocacy to encourage the use of telehealth to aid AF diagnosis, and training for screening familiarisation and troubleshooting.
3) Implementation requirements: sufficient evidence of benefit is required. National rather than pan-European screening processes must be developed due to different payment mechanisms and health service regulations.
There is concern that the rapid spread of wearable devices for heart rate monitoring may increase workload due to false positives in low risk populations for AF. Data security and inclusivity for those without access to primary care or personal devices must be addressed.
Conclusions
There is an overall awareness of AF screening. Opportunistic screening appears to be most feasible across Europe. Challenges that need to be addressed concern health inequalities, identification of best target groups for screening, streamlined processes, the need for evidence of benefit, and a tailored approach adapted to national realities.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): H2020 Screening ScenariosGraphical abstract
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Affiliation(s)
- D Engler
- University Heart Center Hamburg, Hamburg, Germany
| | - C Hanson
- Edinburgh Napier University, School of Health and Social Care, Edinburgh, United Kingdom, Edinburgh, United Kingdom
| | - L Desteghe
- Jessa Hospital Hasselt and Antwerp University Hospital, Faculty of Medicine and Life Sciences, Hasselt and Antwerp, Belgium
| | - G Boriani
- University of Modena & Reggio Emilia, Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy
| | - S Z Diederichsen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - B Freedman
- Heart Research Institute, Heart Rhythm and Stroke Group, Sydney, Australia
| | - E Pala
- University Hospital Vall d'Hebron, Neurovascular Research Laboratory, Barcelona, Spain
| | - T Potpara
- University of Belgrade, Deptartment for Intensive Arrhythmia Care, Belgrade, Serbia
| | - H Witt
- Pfizer Pharma GmbH, Berlin, Germany
| | - H Heidbuchel
- University Hospital Antwerp, Department of Cardiology, Antwerp, Belgium
| | - L Neubeck
- Edinburgh Napier University, School of Health and Social Care, Edinburgh, United Kingdom, Edinburgh, United Kingdom
| | - R B Schnabel
- University Heart Center Hamburg, Hamburg, Germany
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19
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Proietti M, Romiti G, Raparelli V, Diemberger I, Boriani G, Marzetti E, Lip G, Cesari M. Prevalence and impact of frailty in patients with atrial fibrillation: a systematic review and meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Frailty is a clinical syndrome characterized by a reduced physiologic function, increased vulnerability to stressors, and an increased risk of adverse outcomes. Patients with Atrial Fibrillation (AF) are often burdened with a high number of comorbidities and prone to frailty. The prevalence of frailty, its management and association with major outcomes in patients with AF are still unclear.
Purpose
To estimate the pooled prevalence of frailty in patients with AF, as well as its association with AF-related risk factors and comorbidities, oral anticoagulants (OAC) prescription, and major outcomes.
Methods
We systematically searched PubMed and EMBASE, from inception to 31st January 2021, for studies reporting the prevalence of frailty (irrespective of the tool used for assessment). Pooled prevalence, odds ratio (OR), and 95% Confidence Intervals (CI) were computed using random-effect models; heterogeneity was assessed through the inconsistency index (I2). This study was registered in PROSPERO: CRD42021235854.
Results
A total of 1,116 studies were retrieved from the literature search, and 31 were finally included in the systematic review (n=842,521 patients). The frailty pooled prevalence was 39.6% (95% CI=29.2%-51.0%, I2=100%; Figure 1). Significant subgroup differences were observed according to geographical location (higher prevalence found in European-based cohorts; p=0.003) and type of tool used for the assessment (higher prevalence in studies using the Clinical Frailty Scale and Tilburg Frailty Index tools; p<0.001). Meta-regressions showed that study-level mean age and prevalence of hypertension, diabetes, and history of stroke were directly associated with frailty prevalence. Frailty was significantly associated with a 29% reduced probability of OAC prescription in observational studies (OR=0.71, 95% CI=0.62–0.81). Frail patients with AF were at higher risk of all-cause death (OR=4.12, 95% CI=3.15–5.41), ischemic stroke (OR=1.55, 95% CI=1.01–2.38), and bleeding (OR=1.55, 95% CI=1.12–2.14), compared to non-frail patients with AF.
Conclusions
In this systematic review and meta-analysis analysis, the prevalence of frailty was high in patients with AF, and associated with study-level mean age and prevalence of several stroke risk factors. Frailty may influence the management of patients, and worsening the prognosis for all major AF-related outcomes.
Funding Acknowledgement
Type of funding sources: None. Prevalence of Frailty among AF patients
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Affiliation(s)
| | - G.F Romiti
- Sapienza University of Rome, Rome, Italy
| | | | | | - G Boriani
- University of Modena & Reggio Emilia, Modena, Italy
| | - E Marzetti
- Catholic University of the Sacred Heart, Rome, Italy
| | - G.Y.H Lip
- University of Liverpool, Liverpool, United Kingdom
| | - M Cesari
- University of Milan, Milan, Italy
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20
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Erküner Ö, van Eck M, Xhaet O, Verheij H, Neefs J, Duygun A, Nijmeijer R, Saïd SAM, Uiterwaal H, Hagens V, Bhagwandien R, Szili-Torok T, Bijsterveld N, Tjeerdsma G, Vijgen J, Friart A, Hoffer E, Evrard P, Srynger M, Meeder J, de Groot JR, van Opstal J, Gevers R, Lip GYH, Boriani G, Crijns HJGM, Luermans JGLM, Mairesse GH. Contemporary management of patients with atrial fibrillation in the Netherlands and Belgium: a report from the EORP-AF long-term general registry. Neth Heart J 2021; 29:584-594. [PMID: 34524620 PMCID: PMC8556427 DOI: 10.1007/s12471-021-01634-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Contemporary data regarding the characteristics, treatment and outcomes of patients with atrial fibrillation (AF) are needed. We aimed to assess these data and guideline adherence in the EURObservational Research Programme on Atrial Fibrillation (EORP-AF) long-term general registry. METHODS We analysed 967 patients from the EORP-AF long-term general registry included in the Netherlands and Belgium from 2013 to 2016. Baseline and 1‑year follow-up data were gathered. RESULTS At baseline, 887 patients (92%) received anticoagulant treatment. In 88 (10%) of these patients, no indication for chronic anticoagulant treatment was present. A rhythm intervention was performed or planned in 52 of these patients, meaning that the remaining 36 (41%) were anticoagulated without indication. Forty patients were not anticoagulated, even though they had an indication for chronic anticoagulation. Additionally, 63 of the 371 patients (17%) treated with a non-vitamin K antagonist oral anticoagulant (NOAC) were incorrectly dosed. In total, 50 patients (5%) were overtreated and 89 patients (9%) were undertreated. However, the occurrence of major adverse cardiac and cerebrovascular events (MACCE) was still low with 4.2% (37 patients). CONCLUSIONS Overtreatment and undertreatment with anticoagulants are still observable in 14% of this contemporary, West-European AF population. Still, MACCE occurred in only 4% of the patients after 1 year of follow-up.
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Affiliation(s)
- Ö Erküner
- Department of Cardiology, Maastricht University Medical Center + (MUMC+), Maastricht, The Netherlands. .,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
| | - M van Eck
- Department of Cardiology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - O Xhaet
- Department of Cardiology, CHU Namur, Yvoir, Belgium
| | - H Verheij
- Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - J Neefs
- Department of Cardiology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - A Duygun
- Department of Cardiology, VieCuri Medical Center, Venlo, The Netherlands
| | - R Nijmeijer
- Department of Cardiology, Tjongerschans Hospital Heerenveen, Heerenveen, The Netherlands
| | - S A M Saïd
- Department of Cardiology, Ziekenhuis Groep Twente, Hengelo, The Netherlands
| | - H Uiterwaal
- Department of Cardiology, Flevo Hospital, Almere, The Netherlands
| | - V Hagens
- Department of Cardiology, Ommelander Hospital Group, Delfzijl, The Netherlands
| | - R Bhagwandien
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - T Szili-Torok
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - N Bijsterveld
- Department of Cardiology, Flevo Hospital, Almere, The Netherlands
| | - G Tjeerdsma
- Department of Cardiology, Tjongerschans Hospital Heerenveen, Heerenveen, The Netherlands
| | - J Vijgen
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - A Friart
- Department of Cardiology, CHU Tivoli, La Louvière, Belgium
| | - E Hoffer
- Department of Cardiology, CHR Citadelle, Liège, Belgium
| | - P Evrard
- Department of Cardiology, CHC St Joseph, Liège, Belgium
| | - M Srynger
- Department of Cardiology, CHU Liège, Liège, Belgium
| | - J Meeder
- Department of Cardiology, VieCuri Medical Center, Venlo, The Netherlands
| | - J R de Groot
- Department of Cardiology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - J van Opstal
- Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - R Gevers
- Department of Cardiology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - G Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - G Boriani
- Modena University Hospital, Department of Cardiology, University of Modena and Reggio Emilia, Modena, Italy
| | - H J G M Crijns
- Department of Cardiology, Maastricht University Medical Center + (MUMC+), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - J G L M Luermans
- Department of Cardiology, Maastricht University Medical Center + (MUMC+), Maastricht, The Netherlands
| | - G H Mairesse
- Arlon and Clinique Ste Thérèse, Department of Cardiology, Cliniques du Sud-Luxembourg, Bastogne, Belgium
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21
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Proietti M, Vitolo M, Harrison S, Lane DA, Fauchier L, Marin F, Nabauer M, Potpara TS, Dan GA, Boriani G, Lip GYH. Impact on outcomes in Europe: a cluster analysis from the ESC-EHRA EORP AF general long-term registry. Europace 2021. [DOI: 10.1093/europace/euab116.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
ESC-EHRA EORP AF General Long-Term Registry Investigators
Introduction
Data derived from recent observational studies in atrial fibrillation (AF) show how the complexity of the clinical phenotype, beyond baseline thromboembolic risk, can increase risk of major adverse outcomes. Importantly, risk factors tend to occur in clusters, rather than occur individually in isolation.
Aims
To describe AF patients’ clinical phenotypes among a large contemporary European AF cohort and to analyse the differential impact of these clinical phenotypes on the occurrence of major adverse outcomes.
Methods
We performed a hierarchical cluster analysis based on Ward’s Method and using Squared Euclidean Distance using 22 clinical covariates. All variables were considered as binary. Examining the distances between cluster coefficients and by visual inspection of the dendrogram produced we identified the optimal number of clusters. Patients with data available for all 22 variables were included. We considered occurrence of cardiovascular events and all-cause death.
Results
Among the original 11096 patients included, 9363 (84.4%) were available for this analysis. The cluster analysis identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients with prevalent noncardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients mainly admitted for first detected and paroxysmal AF with low prevalence of concomitant conditions; Cluster 3 (n = 2955; 31.6%) included patients with high prevalence of permanent AF, cardiac risk factors and comorbidities. Thromboembolic and bleeding risks were higher in Cluster 3 and progressively lower in Cluster 1 and Cluster 2 (both p < 0.001). Use of oral anticoagulant was significantly lower for Cluster 2 (83.2% vs. 86.5% and 86.7% in Cluster 1 and Cluster 3, respectively; p < 0.001). Over a mean follow-up of 22.5 (SD5.5) months, Cluster 3 had the highest rate of both cardiovascular events (10.0%) and all-cause death (13.2%), compared with Cluster 1 (6.6% and 9.4%, respectively) and Cluster 2 (3.7% and 3.8%, respectively) (both p < 0.001). Kaplan-Meier curves (Figure) show that Cluster 2 (green line) had the lowest cumulative risk of outcomes; risk was progressively higher in Cluster 1 (orange line) and Cluster 3 (yellow line). A Cox multivariable regression analysis, adjusted for type of AF, symptomatic status, CHA2DS2-VASc score and use of oral anticoagulants, showed that both Cluster 3 and Cluster 1 were associated with a significantly increased risk of cardiovascular events (HR: 1.80, 95%CI: 1.39-2.33 and HR: 1.40, 95%CI: 1.09-1.80, respectively) and all-cause death (HR: 1.80, 95%CI: 1.40-2.30 and HR: 1.66, 95%CI: 1.30-2.11) compared to Cluster 2.
Conclusions
In European AF patients, three main clinical clusters were identified, those with non-cardiac comorbidities, low risk and cardiac comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of cardiovascular events and all-cause death. Abstract Figure. Kaplan-Meier Curves for Outcomes
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Affiliation(s)
| | - M Vitolo
- University of Modena & Reggio Emilia, Modena, Italy
| | - S Harrison
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - DA Lane
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - L Fauchier
- University Hospital of Tours, Tours, France
| | - F Marin
- Hospital Universitario Virgen Arrixaca, Murcia, Spain
| | - M Nabauer
- Ludwig Maximilians University Hospital, Munich, Germany
| | - TS Potpara
- University of Belgrade, Belgrade, Serbia
| | - GA Dan
- Colentina University Hospital, Bucharest, Romania
| | - G Boriani
- University of Modena & Reggio Emilia, Modena, Italy
| | - GYH Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom of Great Britain & Northern Ireland
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22
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Boriani G, Proietti M, Laroche C, Fauchier L, Marin F, Nabauer M, Potpara T, Dan GA, Kalarus Z, Tavazzi L, Maggioni AP, Lip GYH. Association between thromboembolic and bleeding risk with adverse outcomes in contemporary European atrial fibrillation patients: final analysis from the ESC-EHRA EORP AF general long-term registry. Europace 2021. [DOI: 10.1093/europace/euab116.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
The ESC-EHRA EORP AF General Long-Term Registry provides a contemporary snapshot of European atrial fibrillation (AF) patients’ characteristics and management. Aims: We present data about the final 2-years follow-up observation of AF patients enrolled in the ESC-EHRA EORP AF General Long-Term Registry.
Methods
A contemporary evaluation of residual risk of adverse outcomes in a cohort of largely anticoagulated AF patients according to the baseline thromboembolic and bleeding risk, defined according to CHA2DS2-VASc and HAS-BLED scores. We determined cardiovascular (CV) events, CV death and all-cause death as outcomes.
Results
Among the original 11069 patients enrolled, 8409 (76.0%) patients had available follow-up status at the end of the 2-years follow-up. Patients age, female sex and most comorbidities were progressively more prevalent across the spectrum of thromboembolic and bleeding risk. Data on adverse outcomes were available for 10087 (91.1%), over the 2-year observation period. Outcome rates were progressively higher across CHA2DS2-VASc and HAS-BLED scores (all p < 0.0001). A fully adjusted Cox multivariable regression analysis, adjusted for clinical covariates selected by a univariate procedure and not included in the scores, showed that increasing baseline CHA2DS2-VASc score was associated with an higher risk for CV events (hazard ratio [HR]: 1.25, 95% confidence interval [CI]: 1.21-1.30), CV death (HR: 1.31, 95%CI: 1.25-1.38) and all-cause death (HR: 1.30, 95%CI: 1.25-1.36). Similarly, increasing baseline HAS-BLED score was associated with an increased risk for all 3 outcomes (HR: 1.21, 95%CI: 1.13-1.28; HR: 1.24, 95%CI: 1.14-1.34; HR: 1.22, 95%CI: 1.14-1.31, respectively). An association with a progressively higher risk was found for all outcomes across the spectrum of thromboembolic and bleeding risk [Figure]. Both CHA2DS2-VASc and HAS-BLED scores showed a modest to good predictive ability for cardiovascular (CV) events, CV death and all-cause death, in terms of c-index and 95% CI[0.66 (0.64-0.68) and 0.62 (0.61-0.64), 0.70 (0.68-0.72) and 0.65 (0.63-0.67), 0.69 (0.68-0.71) and 0.64 (0.63-0.66) for CHA2DS2-VASc and HAS-BLED for each outcome respectively.
Conclusions
In this large contemporary European-wide cohort of AF patients, both baseline thromboembolic and bleeding risks were associated to an increased risk of major clinical outcomes. Both scores are reflective of high risk clinical states, and are predictive of major adverse outcomes even in a large cohort of largely anticoagulated patients with a lower residual risk of adverse outcomes. Abstract Figure.
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Affiliation(s)
- G Boriani
- University of Modena & Reggio Emilia, Modena, Italy
| | | | - C Laroche
- European Society of Cardiology, Sophia-Antipolis, France
| | - L Fauchier
- University Hospital of Tours, Tours, France
| | - F Marin
- Hospital Universitario Virgen Arrixaca, Murcia, Spain
| | - M Nabauer
- University Hospital of Munich, Munich, Germany
| | - T Potpara
- Clinical center of Serbia, Belgrade, Serbia
| | - GA Dan
- Carol Davila Emergency Clinical Military Hospital, Bucharest, Romania
| | - Z Kalarus
- Silesian Center for Heart Diseases (SCHD), Zabrze, Poland
| | - L Tavazzi
- Maria Cecilia Hospital, Cotignola, Italy
| | - AP Maggioni
- European Society of Cardiology, Sophia-Antipolis, France
| | - GYH Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom of Great Britain & Northern Ireland
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23
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Romiti GF, Corica B, Pipitone E, Vitolo M, Raparelli V, Basili S, Boriani G, Harari S, Lip GYH, Proietti M. Prevalence, management and impact of chronic obstructive pulmonary disease in atrial fibrillation: a systematic review and meta-analysis of 4,200,000 patients. Europace 2021. [DOI: 10.1093/europace/euab116.143] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
AF-COMET Collaborative Group
Background
Multimorbidity is a major concern in patients with atrial fibrillation (AF). Among other diseases, the prevalence of chronic obstructive pulmonary disease (COPD) in these patients is unclear, and its association with adverse outcomes is often overlooked. Moreover, uncertainties on the treatment of patients with both AF and COPD still exist, and may lead to undertreatment.
Purpose
The aim of this study is to estimate the prevalence of COPD, and its impact on management and outcomes in patients with AF.
Methods
A systematic review and meta-analysis was conducted according to PRISMA guidelines. All studies reporting the prevalence of COPD in AF patients were included and pooled. Data on comorbidities, beta-blockers (BBs) and oral anticoagulant (OAC) prescription, and outcomes (all-cause death, cardiovascular death, ischemic stroke, major bleeding) were pooled and compared according to COPD status; the impact of BBs on outcomes in patients with COPD was also investigated. All analyses were performed using random-effect models; subgroup analysis and meta-regressions were also performed to account for heterogeneity.
Results
Among 46 studies, the pooled prevalence of COPD was 13% (95% Confidence Intervals (CI): 10-16%), with high heterogeneity between studies; significant differences were found according to geographical locations and definition of COPD. A multivariable meta-regression model which included age, female sex, history of hypertension, diabetes and chronic heart failure (CHF) was able to explain a significant proportion of the heterogeneity (R2 = 69.8%). COPD was associated with a higher prevalence of diabetes, coronary artery disease, CHF and stroke (Fig. 1, panel A), as well as higher CHA2DS2-VASc scores and age (Fig. 1, panel B), and lower probability of BB prescription (Odds Ratio (OR): 0.77, 95%CI: 0.61-0.98). Patients with COPD showed higher risk of all-cause death (OR: 2.22, 95%CI: 1.93-2.55), cardiovascular death (OR: 1.84, 95%CI: 1.39-2.43) and major bleeding (OR: 1.45, 95%CI: 1.17-1.80) (Fig.1, Panel C); no significant differences in outcomes were observed according to BBs use in AF patients with COPD (Fig. 1, panel D).
Conclusion
COPD is common in AF, being found in 1 every 8 patients, and is associated with an increased burden of comorbidities, differential management and worse outcomes, with more than two-fold higher risk of all-cause death and increased risk of CV death and major bleeding. Therapy with BBs does not increase the risk of adverse outcomes in these patients. Abstract Figure.
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Affiliation(s)
- GF Romiti
- Sapienza University of Rome, Department of Translational and Precision Medicine, Rome, Italy
| | - B Corica
- Sapienza University of Rome, Department of Translational and Precision Medicine, Rome, Italy
| | - E Pipitone
- Ospedale Regionale “Beata Vergine”, Mendrisio, Switzerland
| | - M Vitolo
- University of Modena & Reggio Emilia, Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy
| | - V Raparelli
- University of Ferrara, Department of Translational Medicine, Ferrara, Italy
| | - S Basili
- Sapienza University of Rome, Department of Translational and Precision Medicine, Rome, Italy
| | - G Boriani
- University of Modena & Reggio Emilia, Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy
| | - S Harari
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - GYH Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - M Proietti
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
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24
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Camm AJ, Blomstrom-Lundqvist C, Boriani G, Goette A, Kowey PR, Merino JL, Piccini JP, Saksena S, Reiffel JA. Antiarrhythmic Medication for Atrial Fibrillation (AIM-AF) study: A physician survey of antiarrhythmic drug (AAD) treatment practices and guideline adherence in the EU and USA. Europace 2021. [DOI: 10.1093/europace/euab116.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Sanofi
Introduction
The 2020 European Society of Cardiology and the 2019 USA (AHA/ACC/HRS) guidelines recommend the use of AADs for rhythm control in patients with symptomatic AF. This study sought to understand AAD treatment practices and adherence to guidelines across the EU and the USA.
Method
An online physician survey of cardiologists, cardiac electrophysiologists and interventional electrophysiologists (N = 569) was conducted in the USA, Germany, Italy and the UK. All respondents were actively treating ≥10 AF patients who received drug therapy and/or who had received or were referred for ablation. This extensively detailed survey explored questions on physician demographics, AF types, and drug treatment and ablation practices.
Results: Of the responses obtained
(1) Amiodarone was used frequently across co-morbidity categories (highest use in those with heart failure with reduced left ventricular ejection fraction [LVEF] [80%]), including in those in which it is not indicated for initial therapy (minimal or no structural heart disease: 26%). Other deviations from guideline recommendations, include: class 1C drugs were used with structural heart disease, including coronary artery disease (CAD) (average class 1C use in CAD-related comorbidities: 6%); sotalol was used with renal dysfunction (22%); and drugs such as sotalol and dofetilide were initiated out of hospital (56% and 17% of respondents, respectively). (2) Nonetheless, a majority of respondents (53%) considered guidelines as the most important non-patient factor in influencing their choice of AF management. (3) Rhythm control was selected more frequently as primary therapy for paroxysmal AF (PAF) (59% of patients) while rate control was used more often for persistent AF (53%). (4) For PAF, AADs were preferred as 1st line more often than ablation, especially if PAF was infrequent and mildly symptomatic (59% of respondents) while ablation was preferred more if frequent symptomatic PAF and for recurrent persistent AF. (5) Rhythm control (AAD or ablation) was chosen in notable numbers for asymptomatic AF and subclinical AF (AADs: 36% and 37%, respectively; ablation: 9% and 14%, respectively). (6) AAD use for those with a first or recurrent episodes of symptomatic AF was 60% or 47%, respectively. (7) Efficacy and safety were chosen as the most important considerations for choice of specific rhythm control therapy (49% and 33%, respectively), and reduction of mortality and cardiovascular hospitalisation (23%) were as important as maintaining sinus rhythm (26%) for rhythm therapy goals.
Conclusions
Although surveyed clinicians consider guidelines important, deviations in patient types and treatments chosen that compromise safety or were not indicated were common. Findings suggest a lack of understanding of the pharmacology and safe use of AADs, highlighting an important need for further education. Abstract Figure.
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Affiliation(s)
- AJ Camm
- St George’s University, London, United Kingdom of Great Britain & Northern Ireland
| | | | - G Boriani
- University of Modena & Reggio Emilia, Modena, Italy
| | - A Goette
- Saint Vincenz Hospital Paderborn, Paderborn, Germany
| | - PR Kowey
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, United States of America
| | - JL Merino
- La Paz University Hospital, Madrid, Spain
| | - JP Piccini
- Duke Clinical Research Institute, Durham, United States of America
| | - S Saksena
- Rutgers Robert Wood Johnson Medical School, Piscataway, United States of America
| | - JA Reiffel
- Columbia University, New York, United States of America
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25
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Malavasi V, Fantecchi E, Tordoni V, Melara L, Barbieri A, Valenti A, Menozzi M, Sgreccia D, Talarico M, Imberti J, Vitolo M, Boriani G. Factors affecting progression to permanent atrial fibrillation in an unselected population of patients with non-permanent form of atrial fibrillation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Natural history of atrial fibrillation (AF) shows a progression of arrhythmia from non-permanent to permanent AF. Permanent AF was found associated with a worse prognosis than non-permanent one.
Aim
To assess the factors associated with progression to permanent AF in an unselected population of AF patients with non-permanent AF.
Methods
In this prospective study we enrolled in- as well as out-patients with non-permanent AF and age ≥18 years, with at least one episode of ECG-documented AF within 1 year. The patients were followed-up at 1 month and every 6 months thereafter.
Results
Out of 523 patients, 314 (60%) were in non-permanent AF (80 [25.5%] paroxysmal AF, 165 [52.5%] persistent AF, 69 [2%] first diagnosed AF), mostly male (188, 59.9%), median age 71 years (IQ range 62–77), median CHA2DS2VASc 3 (1–4), median HATCH score 1 (1–2). After a median follow-up of 701 (IQ range 437–902) days, 66 patients (21%) showed permanent AF.
CHA2DS2VASc and HATCH scores were incrementally associated to progression to permanent AF (CHA2DS2VASc χ2 p=0.001; HATCH χ2 p=0.017; p for trend CHA2DS2VASc <0.001, HATCH p=0.001).
At multivariable Cox proportional hazard regression the following variables were significantly associated with AF progression: age (hazard ratio [HR] 1.041; 95% CI: 1.004–1.079; p=0.028), at least moderate left atrial (LA) enlargement (>42 ml/m2) (HR 2.092; 95% CI: 1.132–3.866; p=0.018), antiarrhythmics drugs after the enrollment (HR 0.087; 95% CI: 0.011–0.662; p=0.018), EHRA score >2 (HR 0.351; 95% CI: 0.158–0.779; p=0.010) and Valvular HD (HR 2.161; 95% CI: 1.057–4.420; p=0.035). Adding LA dilation to HATCH score (HATCH-LA) and assigning 2 points based on multivariable Cox regression, HATCH-LA was statistically better in ROC curves in prediction of AF progression vs HATCH score (area under the curve 0.695 vs 0.636; DeLong p=0.0225). Survival-free curves on freedom from permanent AF using as discriminator HATCH-LA score ≤2 vs >2 led to a statistically significant difference (χ2=16.080 p<0.001), but the same was not found for HATCH score (χ2 =3.099; p=0.078).
Conclusions
In patients without permanent AF, progression of AF was independentely related to age, LA dilation, AF symptoms severity, antiarrhythmic drugs and Valvular HD. HATCH score predicted AF progression and adding to it LA dilation (at least moderate) improved patients stratification for the risk of evolution to permanent AF.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- V.L Malavasi
- University of Modena & Reggio Emilia, Div. Cardiology, Modena, Italy
| | - E Fantecchi
- University of Modena & Reggio Emilia, Div. Cardiology, Modena, Italy
| | - V Tordoni
- University of Modena & Reggio Emilia, Div. Cardiology, Modena, Italy
| | - L Melara
- University of Modena & Reggio Emilia, Div. Cardiology, Modena, Italy
| | - A Barbieri
- University of Modena & Reggio Emilia, Div. Cardiology, Modena, Italy
| | - A.C Valenti
- University of Modena & Reggio Emilia, Div. Cardiology, Modena, Italy
| | - M Menozzi
- University of Modena & Reggio Emilia, Div. Cardiology, Modena, Italy
| | - D Sgreccia
- University of Modena & Reggio Emilia, Div. Cardiology, Modena, Italy
| | - M Talarico
- University of Modena & Reggio Emilia, Div. Cardiology, Modena, Italy
| | - J Imberti
- University of Modena & Reggio Emilia, Div. Cardiology, Modena, Italy
| | - M Vitolo
- University of Modena & Reggio Emilia, Div. Cardiology, Modena, Italy
| | - G Boriani
- University of Modena & Reggio Emilia, Div. Cardiology, Modena, Italy
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26
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Boriani G, Sakamoto Y, Iacopino S, Komura S, Pieragnoli P, Minamiguchi H, Infusino T, Noma T, De Rosa F, Takahashi Y, Biffi M. Prevention of long-lasting atrial fibrillation through antitachycardia pacing in 584 dual-chamber pacemaker patients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is a frequent arrhythmia in pacemaker patients and is associated with poor quality of life and increased risks of heart failure, dementia, stroke, and death. The MINERVA trial has shown that the combination of 3 pacing algorithms – 1) atrial antitachycardia pacing (aATP), 2) atrial preventive pacing and 3) managed ventricular pacing (MVP) - delays progression to persistent and permanent AF, compared with standard DDDR pacing mode and with MVP mode, in pacemaker patients with AF history.
Purpose
We performed a comparative non randomized evaluation to confirm the hypothesis that aATP is the main driver of persistent/permanent AF reduction independently on the effect of preventive atrial pacing.
Methods
Thirty-one Italian and Japanese Cardiology centers included consecutive dual-chamber pacemaker patients with AF history. aATP was programmed in all patients while preventive atrial pacing was not enabled. Comparison was made with all the 3 groups in MINERVA randomized trial. The main endpoint was incidence of AF longer than 7 consecutive days, as detected by device diagnostics.
Results
A total of 146 patients (73 years old, 54% male) were included and followed for a median observation period of 31 months. The 2-year incidence of AF>7 days was 12% in the aATP group, very similar to that found in the arm of the MINERVA trial with aATP enabled (13.8%, p=0.732) and significantly lower than AF incidence found in the MINERVA Control DDDR arm (25.8%, p=0.012) and in the MINERVA MVP arm (25.9%, p=0.025).
Conclusions
In a real-world population of dual-chamber pacemaker patients with AF history, use of aATP was associated with low incidence of persistent AF during follow up, highlighting that the positive results of the MINERVA trial are related to the effectiveness of aATP rather than to the effects of preventive atrial pacing.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- G Boriani
- University of Modena & Reggio Emilia, Div. Cardiology, Modena, Italy
| | - Y Sakamoto
- Toyohashi Heart Center, Toyohashi, Japan
| | - S Iacopino
- Maria Cecilia Hospital, Cotignola, Italy
| | - S Komura
- Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | | | | | | | - T Noma
- Kagawa University Hospital, Kagawa, Japan
| | - F De Rosa
- Ospedale SS Annunziata, Cosenza, Italy
| | - Y Takahashi
- Tokyo Medical and Dental University, Tokyo, Japan
| | - M Biffi
- Universitary Hospital Sant'orsola Malpighi, Bologna, Italy
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27
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Vitolo M, Proietti M, Harrison S, Kalarus Z, Tavazzi L, Potpara T, Lane D, Boriani G, Lip G. Impact of physical activity on all-cause mortality in European patients with atrial fibrillation: a report from the ESC-EHRA EORP AF General Long-Term Registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Physical activity (PA) may have a beneficial contribution for outcomes in patients with atrial fibrillation (AF).
Purpose
We aimed to evaluate the impact of self-reported PA in a large contemporary cohort of European AF patients on the risk of all-cause mortality.
Methods
We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Self-reported PA was categorized, on the basis of reported time spent exercising, as follows: i) No PA; ii) Occasional PA; iii) Regular PA; iv) Intense PA. The primary outcome was all-cause death.
Results
Over 11096, a total of 8699 (78.4%) patients (mean age (SD) 69.1 (11.5); 40.7% female) had available data about PA and follow-up observation and were included in the analysis. Of these, 3703 (42.6%) reported no PA, 2829 (32.5%) occasional PA, 1824 (21.0%) regular PA, with only 343 (3.9%) reporting intense PA. With the 4 increasing PA categories, mean age, proportion of female patients, CHA2DS2-VASc and HAS-BLED scores were progressively lower (all p<0.001). Use of vitamin K antagonist (VKA) declined across the classes of PA (53.1% vs. 52.2% vs. 44.5% vs. 33.9%, p<0.001), while use of non-VKA OACs (NOACs) conversely increased. During a mean (SD) 680.6 (171.5) days of follow-up, there were a total of 848 (9.7%) all-cause death events. Based on Kaplan-Meier analysis, there was a progressively lower cumulative risk for all-cause death according to PA categories [Figure]. A multivariable Cox regression analysis, adjusting for CHA2DS2-VASc score, use of OAC at baseline and type of AF, found a lower risk of all-cause death associated with increasing levels of PA (Hazard ratio [HR]: 0.69, 95% confidence interval [CI]: 0.59–0.81 for occasional PA, HR: 0.45, 95% CI: 0.35–0.58 for regular PA, HR: 0.41, 95% CI: 0.23–0.76 for intense PA, when compared to no PA). In a sensitivity analysis, a regular-intense PA was inversely associated with occurrence of cardiovascular (CV) death, after multivariable adjustments for comorbidities (HR: 0.54, 95% CI: 0.37–0.77).
Conclusions
In a large contemporary cohort of European AF patients, self-reported PA was found to be inversely associated with all-cause death and CV death.
Kaplan-Meier Curves
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Since the start of EORP, several companies have supported the programme with unrestricted grants
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Affiliation(s)
- M Vitolo
- University of Modena & Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy
| | - M Proietti
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - S Harrison
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - Z Kalarus
- Silesian Center for Heart Diseases (SCHD), Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Zabrze, Poland
| | - L Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - T Potpara
- University Belgrade Medical School, Belgrade, Serbia
| | - D.A Lane
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - G Boriani
- University of Modena & Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy
| | - G.Y.H Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
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28
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Valzania C, Bonfiglioli R, Fallani F, Frisoni J, Biffi M, Boriani G, Galie' N. Long-term follow-up of cardiac resynchronization therapy patients with non-ischemic dilated cardiomyopathy assessed by radionuclide angiography. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
While the beneficial effects of cardiac resynchronization therapy (CRT) have been widely investigated soon after CRT implantation, relatively few data are available on long-term clinical outcomes of CRT recipients.
Aim
To investigate long-term outcomes of CRT patients with non-ischemic dilated cardiomyopathy stratified as responders and non-responders according to radionuclide angiography.
Methods
Consecutive heart failure patients with non-ischemic dilated cardiomyopathy undergoing CRT implantation at our University Hospital between 2007 and 2013 were enrolled. All patients were assessed with equilibrium Tc99 radionuclide angiography at baseline and after 3 months of CRT. Left ventricular (LV) ejection fraction was computed on the basis of relative end-diastolic and end-systolic counts, and intraventricular dyssynchrony was derived by Fourier phase analysis. Response to CRT was defined by an absolute increase in LV ejection fraction (LVEF) ≥5% at 3-month follow-up. Clinical outcome was assessed after 10 years through hospital records review.
Results
Forty-seven patients (83% men, 63±11 years) were included in the study. At 3 months, 25 (53%) patients were identified as CRT responders according to LVEF increase (from 26±8 to 38±12%, p<0.001). In these patients, LV dyssynchrony decreased from 59±30° to 29±18° (p<0.001). Twenty-two (47%) patients were defined as non-responders. No significant changes in LVEF and LV dyssynchrony (50±30° vs. 38±19°, p=0.07) were observed in non-responders. At long-term follow-up (11±2 years), all-cause and cardiac mortality rates were 24% and 12% in responders vs. 32% and 27% in non-responders, respectively (p=ns). Heart transplantation was performed in 3 patients. One (4%) patient among CRT responders compared with 6 (27%) patients among non-responders died of worsening heart failure (p=0.03).
Conclusions
Although late overall mortality of non-ischemic CRT recipients was not significantly different between mid-term responders and non-responders, CRT responders were at lower risk of worsening heart failure death.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Valzania
- University Hospital Polyclinic San Orsola-Malpighi, Department of Cardiology, Bologna, Italy
| | - R Bonfiglioli
- Universitary Hospital Sant'orsola Malpighi, Nuclear Medicine, Bologna, Italy
| | - F Fallani
- University Hospital Polyclinic San Orsola-Malpighi, Department of Cardiology, Bologna, Italy
| | - J Frisoni
- University Hospital Polyclinic San Orsola-Malpighi, Department of Cardiology, Bologna, Italy
| | - M Biffi
- University Hospital Polyclinic San Orsola-Malpighi, Department of Cardiology, Bologna, Italy
| | - G Boriani
- University of Modena and Reggio Emilia, Modena Polyclinic, Department of Cardiology, Modena, Italy
| | - N Galie'
- University Hospital Polyclinic San Orsola-Malpighi, Department of Cardiology, Bologna, Italy
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29
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Boriani G, Proietti M, Laroche C, Fauchier L, Marin F, Nabauer M, Potpara T, Dan G, Kalarus Z, Tavazzi L, Maggioni A, Lip G. Impact of body mass index on outcomes in European patients with atrial fibrillation: the ESC EHRA EORP Atrial Fibrillation General Long-Term registry (AFGen LT). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The impact of body mass index (BMI) on outcomes in patients with atrial fibrillation (AF) has been largely debated.
Aims
To describe the relationship between BMI categories and clinical outcomes in a large cohort of European AF patients.
Methods
We included all AF patients with available baseline BMI and creatinine clearance and 1-year follow-up data enrolled in the EORP-AF General Long-Term Registry. Outcomes considered were: i) a composite of any thromboembolic event (TE)/acute coronary syndrome (ACS)/cardiovascular (CV) death; ii) CV death; iii) all-cause death.
Results
A total of 7,759 patients were included in this analysis. Of these, 55 (0.7%) were underweight, 2,074 (26.7%) were normal weight, 3,170 (40.9%) were overweight, 1,703 (21.9%) were obese and 757 (9.8%) were severe obese. Mean age was progressively lower across the categories (p<0.0001), with proportion of patients aged≥75 years also progressively lower (52.7% in underweight to 19.4% in severe obese patients; p<0.001). Both underweight (41.8%) and severe obese (25.0%) patients were more likely symptomatic (p<0.001). Mean CHA2DS2-VASc score was higher in underweight patients (p=0.0325). Use of any oral anticoagulant therapy was progressively higher across the BMI categories (p<0.001). At 1-year follow-up the rate of all outcomes considered were highest for underweight patients and lowest in severe obese [Figure 1]. On univariate Cox regression analysis, being underweight was consistently associated to a higher risk for all outcomes, while increasing of weight categories was associated with progressively lower risk for adverse outcomes. After full adjustment with clinical and pharmacological characteristics, no effect of higher BMI classes was found for any outcome, but an independent association with an increased risk of CV death and all-cause death was seen for underweight patients (Table 1).
Conclusions
In a large cohort of European AF patients a progressively lower rate of outcomes was found across increasing BMI classes. After full adjustments, no significant association was found between the higher BMI classes and outcomes. Underweight was associated with an increased risk for CV death and all-cause death.
Figure 1. Outcomes at 1-year Follow-up
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Since the start of EORP programme, several companies have supported it with unrestricted grants
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Affiliation(s)
- G Boriani
- University of Modena & Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy
| | | | - C Laroche
- European Society of Cardiology, EURObservational Research Programme Department, Sophia-Antipolis, France
| | - L Fauchier
- University Hospital of Tours, Cardiology Department, Tours, France
| | - F Marin
- University of Murcia, Cardiology Department, Murcia, Spain
| | - M Nabauer
- Ludwig-Maximilians University, Cardiology Department, Munich, Germany
| | - T Potpara
- Clinical center of Serbia, Cardiology Department, Belgrade, Serbia
| | - G.A Dan
- Colentina University Hospital, Bucharest, Romania
| | - Z Kalarus
- Silesian Center for Heart Diseases (SCHD), Zabrze, Poland
| | - L Tavazzi
- Maria Cecilia Hospital, Cotignola, Italy
| | | | - G.Y.H Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
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Boriani G, D'Onofrio A, Pisano E, Pieragnoli P, Locatelli A, Capucci A, Talarico A, Sinagra G, Rapacciuolo A, Piacenti M, Indolfi C, Checchinato C, Ricci R. ICD-detected respiratory disturbance index: accuracy for sleep apnea detection and prognostic value. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose
In patients affected by heart failure an association exists between sleep apnea (SA) measured by polysomnography and adverse outcome. Impedance-based implantable cardioverter defibrillator (ICD) algorithms have been designed to compute the Respiratory Disturbance Index (RDI) to identify severe SA. The purpose of the DASAP-HF study was to evaluate the accuracy of RDI for the prediction of severe SA, and investigate the prognostic value of device-detected RDI values.
Methods
Patients with left ventricular ejection fraction ≤35% implanted with an ICD were enrolled and followed for 24 months. One month after implantation, patients underwent a polysomnographic study (PS) for assessing the apnea-hypopnea index (AHI). The average RDI value was calculated over a 1-week period preceding the sleep study and compared with the assessment of severe SA at PS (AHI ≥30 episodes/h). The endpoint was all-cause death after 24 months.
Results
224 out of 265 enrolled patients had usable RDI values. Patients characteristics: 79% male, 67±10 years, BMI 27±7kg/m2, ejection fraction 29±5%, 54% ischemic cardiomyopathy, 50% CRT-D. The mean AHI value at PS was 21±15 episodes/h. The mean RDI value recorded during the week preceding PS was 30±16 episodes/h. RDI values accurately identified severe SA diagnosed at PS (AUC 0.77; 95% CI 0.70–0.83; P=0.001). Based on the ROC curve analysis, RDI ≥29 episodes/h and AHI ≥17 episodes/h maximized sensitivity and specificity for the prediction of death. Both indexes were independently associated with all-cause death but, after correction for the other independent significant prognostic variables, RDI≥29episodes/h yielded stronger prediction (HR: 12.22, 95% CI:1.64–91.37, p=0.015) as compared to AHI ≥17episodes/h (HR: 4.14, 95% CI:1.17–14.66, p=0.028). Moreover, severe SA diagnosed at PS (AHI ≥30episodes/h) was not associated with death (HR: 1.20, 95% CI:0.3817–3.8266, p=0.761).
Conclusions
In heart failure patients indicated to ICD, severe SA was confirmed to be associated with survival. The ICD-measured RDI accurately identified severe SA detected at PS, and was associated with the risk of death at long-term.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Boston Scientific
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Affiliation(s)
- G Boriani
- University of Modena & Reggio Emilia, Div. Cardiology, Modena, Italy
| | - A D'Onofrio
- AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
| | - E Pisano
- Vito Fazzi Hospital, Lecce, Italy
| | | | | | - A Capucci
- Marche Polytechnic University of Ancona, Ancona, Italy
| | | | - G Sinagra
- University of Trieste, Trieste, Italy
| | | | - M Piacenti
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - C Indolfi
- Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - C Checchinato
- Santa Croce Hospital of Moncalieri, Moncalieri, Italy
| | - R.P Ricci
- Italian Heart Rhythm Society (AIAC), Rome, Italy
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Vitolo M, Proietti M, Harrison S, Fauchier L, Marin F, Potpara T, Lane D, Boriani G, Lip G. Temporal changes in quality of life amongst European atrial fibrillation patients: relationship to all-cause mortality. A report from the ESC-EHRA EORP-AF General Long-Term Registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) significantly impacts on patients' quality of life (QoL). An impaired QoL has been associated with worse outcomes even in AF patients, but contemporary data in a large-scale pan-European population are limited.
Purpose
We aimed to assess temporal changes in AF patients' QoL across 2 years follow-up observation, and the relationship of QoL changes with all-cause death.
Methods
We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. The EQ-5D-5L questionnaire was used to assess QoL. A Health Utility Score (HUS), indicating the overall health state (1 equals perfect health), was derived. Differences throughout the follow-up (Baseline, 1-Y FU, 2-Y FU) observation were assessed. The study outcome was all-cause mortality.
Results
Out of a total of 11906 patients, 8097 (73.0%) were available for this analysis. Mean (SD) age was 69.1 (11.5) years; 60.8% males; median CHA2DS2-VASc and HASBLED scores were 3 (IQR 2–4) and 1 (1–2), respectively. The mean (SD) HUS at baseline was 0.815 (0.200) and 0.834 (0.196), 0.829 (0.195) at 1-year follow-up and 2-year follow-up, respectively (p<0.0001 for changes over time). Patients with a higher CHA2DS2-VASc score (CHA2DS2-VASc 6–9) reported a significant reduction in the quality of life, compared to the other CHA2DS2-VASc strata, with a mean (SD) HUS decreasing from 0.754 (0.214) at baseline to 0.727 (0.238) at 2-year follow-up (F=6.538, p<0.0001) (Figure). Multivariate analysis demonstrated that age [−0.001 (95% CI [−0.002, −0.121]) and coronary artery disease (CAD) [−0.016 (95% CI [−0.029, −0.004] were independently inversely associated with increasing QoL. Positive changes in HUS over time were inversely associated with an increase in the risk of all-cause death, even after adjusting for chronic kidney disease, liver disease, chronic obstructive pulmonary disease, oral anticoagulants and type of AF (OR:0.24, 95% CI: 0.13–0.45 for increasing HUS difference, as a continuous variable).
Conclusions
In a contemporary European-wide cohort of AF patients, significant temporal changes in QoL were found. Patients at higher stroke risk according to CHA2DS2-VASc score showed a significant reduction in the QoL. Age and CAD were independently associated with changes in QoL. A greater reduction in HUS (i.e. worsening QoL) over time was associated with a higher risk of all-cause death.
Temporal changes in HUS
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Since the start of EORP, several companies have supported the programme with unrestricted grants
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Affiliation(s)
- M Vitolo
- University of Modena & Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy
| | - M Proietti
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - S Harrison
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - L Fauchier
- University Hospital of Tours, Service de Cardiologie, Tours, France
| | - F Marin
- Hospital Universitario Virgen Arrixaca, Department of Cardiology, Univeristy of Murcia, Murcia, Spain
| | - T Potpara
- University Belgrade Medical School, Belgrade, Serbia
| | - D.A Lane
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - G Boriani
- University of Modena & Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy
| | - G.Y.H Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
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Proietti M, Vitolo M, Harrison S, Dan G, Maggioni A, Potpara T, Lane D, Boriani G, Lip G. Relationship between frailty and all-cause mortality in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational research programme AF general long-term registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Frailty is a major health determinant for cardiovascular disease. Thus far, data on frailty in patients with atrial fibrillation (AF) are limited.
Aims
To evaluate frailty in a large contemporary cohort of European AF patients, the relationship with oral anticoagulant (OAC) prescription and with risk of all-cause death.
Methods
We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. A 38-items frailty index (FI) was derived from baseline characteristics according to the accumulation of deficits model proposed by Rockwood and Mitnitsky. All-cause mortality was the primary study outcome.
Results
Out of the 11096 AF enrolled patients, data for evaluating frailty were available for 6557 (59.1%) patients who have been included in this analysis (mean [SD] age 68.9 [11.5], 37.7% females). Baseline median [IQR] CHA2DS2-VASc and HAS-BLED were 3 [2–4] and 1 [1–2], respectively. At baseline, median [IQR] FI was 0.16 (0.12–0.23), with 1276 (19.5%) patients considered “not-frail” (FI<0.10), 4033 (61.5%) considered “pre-frail” (FI 0.10–0.25) and 1248 (19.0%) considered “frail” (FI≥0.25). Age, female prevalence, CHA2DS2-VASc and HAS-BLED progressively increased across the FI classes (all p<0.001). Use of OAC progressively increased among FI classes; after adjustments FI was not associated with OAC prescription (odds ratio [OR]: 1.09, 95% confidence interval [CI]: 0.98–1.19 for each 0.10 FI increase). Conversely, FI was directly associated with vitamin K antagonist (VKA) use (OR: 1.26, 95% CI: 1.18–1.34 for each 0.10 FI increase) and inversely associated with non-VKA OACs (NOACs) use (OR: 0.82, 95% CI: 0.77–0.88). FI was significantly correlated with CHA2DS2-VASc (Rho= 0.516, p<0.001). Over a median [IQR] follow-up of 731 [704–749] days, there were 569 (8.7%) all-cause death events. Kaplan-Meier curves [Figure] showed an increasing cumulative risk for all-cause death according to FI categories. A Cox multivariable analysis, adjusted for age, sex, type of AF and use of OAC, found that increasing FI as a continuous variable was associated with an increased risk of all-cause death (hazard ratio [HR]: 1.56, 95% CI: 1.40–1.73 for each 0.10 FI increase). An association with all-cause death risk was found across the FI categories (HR: 1.71, 95% CI: 1.23–2.38 and HR: 2.88, 95% CI: 2.02–4.12, respectively for pre-frail and frail patients compared to non-frail ones). FI was also predictive of all-cause death (c-index: 0.660, 95% CI: 0.637–0.682; p<0.001).
Conclusions
In a European contemporary cohort of AF patients the burden of frailty is significant, with almost 1 out of 5 patients found to be “frail”. Frailty influenced significantly the choice of OAC therapy and was associated with (and predictive of) all-cause death at follow-up.
Kaplan-Meier Curves
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Since the start of EORP programme, several companies have supported it with unrestricted grants.
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Affiliation(s)
| | - M Vitolo
- University of Modena & Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy
| | - S Harrison
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - G.A Dan
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - A.P Maggioni
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - T Potpara
- Clinical center of Serbia, Intensive Arrhythmia Care, Cardiology Clinic, Belgrade, Serbia
| | - D.A Lane
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - G Boriani
- University of Modena & Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy
| | - G.Y.H Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
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Spinella A, Macripo’ P, Cocchiara E, Galli E, Lumetti F, Magnani L, Coppi F, Mattioli AV, Rossi R, Boriani G, Salvarani C, Giuggioli D. AB0611 STRAIN ANALYSIS OF THE RIGHT VENTRICLE USING 2D-SPECKLE TRACKING ECHOCARDIOGRAPHY IN A COHORT OF PATIENTS WITH SYSTEMIC SCLEROSIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Systemic Sclerosis (SSc) is a rare and life-threatening connective tissue disease with multiple organ impairment. Cardio-pulmonary involvement is common: pulmonary fibrosis, pulmonary hypertension (PH), and electrical disorders are the most serious complications and causes of increased mortality.Objectives:We evaluated features related with the onset and development of PH in a cohort of SSc patients. We further studied ecocardiographic abnormalities, by means of 2D-speckle tracking echocardiography (STE) with specific reference to the right ventricular strain measure (RV-strain).Methods:We analyzed data from 50 SSc patients (pts) referred to our University-based Rheumatology Centre and SSc Unit from January 2007 to June 2019 (F/M 45/5; lc/dcSSc 45/5; mean age 59.20±14.357 years; mean disease duration 12.08±8.75 years). All pts underwent general and cardio-pulmonary assessment in our Cardio-Rheumatology Clinic. The following parameters were considered: blood exams, in particular inflammation indexes, uric acid test and serum autoantibodies; pulmonary function tests; high resolution scan of the lungs (HRCT); standard electrocardiogram (ECG) and RV-strain measured by 2D-STE. These examinations were performed according to clinical picture and current methodologies. We compared SSc subjects with (10/50) and without (40/50) PH diagnosis during follow-up regardless of treatments.Results:SSc pts with PH didn’t show significant alterations concerning RV-strain if compared with pts without PH (p=0.707). Nevertheless, RV-strain value was modified in relation to TAPSE alterations in all pts but this data correlated with right ventricular dilatation only in PH subjects. Furthermore, interesting significant values about dilatation of right and left atria (p=0.007, p=0.048), dilatation of inferior vena cava (p=0.037) and right ventricle (p=0.023) were observed. Left ventricular hypertrophy (p=0.012) as well as valvular insufficiencies (mitral and aortic) were more frequent in PH group too (p=0.016). These pts showed higher incidence of skin ulcers (p=0.0001), higher values of blood pressure (p=0.004), elevated uric acid levels (p=0,027) and anti-centromere antibodies positivity (p=0.0001).Conclusion:Our research provides further evidence of the prognostic value of echocardiographic findings in SSc subjects, with focus on PH. Population enlargement is ongoing in order to identify more accurate results about RV-strain, considering the efficacy of PH treatments on cardiac contractility. Speckle tracking echocardiography proves to be a sensitive, low-cost, non-invasive and reliable tool to detect early cardiac impairment in Ssc, full of potential future prospects.Disclosure of Interests:None declared
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Boriani G, Ruff CT, Kuder JF, Shi M, Lanz H, Antman EM, Braunwald E, Giugliano RP. 460Edoxaban versus warfarin in atrial fibrillation patients with low, mid and high body weight: analysis of outcomes in the engage AF TIMI 48 trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The impact on outcomes of oral anticoagulants in pts at extremes of body weight have not been well-characterized.
Aim
To analyse the outcomes of pts with atrial fibrillation (AF) enrolled in ENGAGE AF-TMI 48 randomized to warfarin (W) targeting INR 2.0–3.0, higher (HDE) or lower dose regimens of edoxaban (LDE), focusing on subgroups of patients at the extremes of weight.
Methods and results
Among 21105 pts enrolled in the trial we identified 3 subgroups: 1082 with low body weight (LBW) (<5th percentile, <55kg), 2153 with mid body weight (MBW) (45–55th percentile, 80–84 kg), and 1093 patients with high body weight (HBE) (>95th percentile, >120 kg). Baseline characteristics differed markedly (LWB pts were older and more likely Asian, women, with prior TIA/stroke, renal dysfunction) resulting in a trend towards higher rates of stroke/systemic embolism (SSE: 6.5% vs 4.7% in MBW vs 1.6% in HBW) and major bleeding (MB: 9.3% vs 7.7% in MBW vs 6.5% in HBW) in the warfarin arm. The risks of SSE (Pint = 0.52) were similar between W and HDE regardless of body weight, while the relative reduction in MB was greatest in LBW patients (HR reduction45%, 23%, 1% across weight groups; Pint = 0.35) (Figure). Net clinical outcomes (SEE/major bleeding/death) tended to be most favourable for LBW pts (HR 0.67 [0.50–0.90]; Pint 0.084) (Figure).
Main outcomes during follow up
Conclusions
In ENGAGE AF-TIMI 48 the profile of AF pts with LBW markedly differed suggesting a more fragile clinical status. Use of dose-adjusted edoxaban, as compared to W, was associated with similar efficacy regardless of weight, while bleeding and net outcomes were most favourable in LBW pts.
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Affiliation(s)
- G Boriani
- University of Modena & Reggio Emilia, Modena, Italy
| | - C T Ruff
- Brigham and Womens Hospital, TIMI Study Group, Boston, United States of America
| | - J F Kuder
- Brigham and Womens Hospital, TIMI Study Group, Boston, United States of America
| | - M Shi
- Daiichi Sankyo, Inc., Basking Ridge, NJ, United States of America
| | - H Lanz
- Daiichi Sankyo Europe GmbH, Munich, Germany
| | - E M Antman
- Brigham and Womens Hospital, TIMI Study Group, Boston, United States of America
| | - E Braunwald
- Brigham and Womens Hospital, TIMI Study Group, Boston, United States of America
| | - R P Giugliano
- Brigham and Womens Hospital, TIMI Study Group, Boston, United States of America
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Proietti M, Laroche C, Tello-Montoliu A, Lenarczyk R, Dan GA, Maggioni AP, Lip GYH, Boriani G. P5656Heart failure clinical phenotypes and outcomes in patients with atrial fibrillation: an analysis from the eurobservational research programme in atrial fibrillation long-term general registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Heart failure (HF) is a well-known risk factor for atrial fibrillation (AF). Moreover, HF is associated with worse clinical outcomes in patients with known AF. Recently, phenotypes of HF have been redefined according to the level of ejection fraction (EF). New data are needed to understand if a differential risk for outcomes exists according to the new phenotypes' definitions.
Purpose
To evaluate the risk of major adverse outcomes in patients with AF and HF according to HF clinical phenotypes.
Methods
We performed a subgroup analysis of AF patients enrolled in the EORP-AF Long-Term General Registry with a history of HF at baseline, available EF and follow-up data. Patients were categorized as follows: i) EF<40%, i.e. HF reduced EF [HFrEF]; ii) EF 40–49%, i.e. HF mid-range EF [HFmrEF]; iii) EF ≥50%, i.e. HF preserved EF [HFpEF]. Any thromboembolic event (TE)/acute coronary syndrome (ACS)/cardiovascular (CV) death, CV death and all-cause death were recorded.
Results
A total of 3409 patients were included in this analysis: of these, 907 (26.6%) had HFrEF, 779 (22.9%) had HFmrEF and 1723 (50.5%) had HFpEF. An increasing proportion with CHA2DS2-VASc ≥2 was found across the three groups: 90.4% in HFrEF, 94.6% in HFmrEF and 97.3% in HFpEF (p<0.001), while lower proportions of HAS-BLED ≥3 were seen (28.0% in HFrEF, 26.3% in HFmrEF and 23.6% in HFpEF, p=0.035). At discharge patients with HFpEF were less likely treated with antiplatelet drugs (22.0%) compared to other classes and were less prescribed with vitamin K antagonists (VKA) (57.0%) and with any oral anticoagulant (OAC) (85.7%). No differences were found in terms of non-vitamin K antagonist oral anticoagulant use. At 1-year follow-up, a progressively lower rate for all study outcomes (all p<0.001), with an increasing cumulative survival, was found across the three groups, with patients with HFpEF having better survival (all p<0.0001 for Kaplan-Meier curves). After full adjustment, Cox regression analysis showed that compared to HFrEF, HFmrEF and HFpEF were associated with risk of all study outcomes (Table).
Cox Regression Analysis HR (95% CI) Any TE/ACS/CV Death CV Death All-Cause Death HFmrEF 0.65 (0.49–0.86) 0.53 (0.38–0.74) 0.55 (0.41–0.74) HFpEF 0.50 (0.39–0.64) 0.42 (0.31–0.56) 0.45 (0.35–0.59) ACS = Acute Coronary Syndrome; CI = Confidence Interval; CV = Cardiovascular; EF = Ejection Fraction; HF = Heart Failure; HR = Hazard Ratio.
Conclusions
In this cohort of AF patients with HF, HFpEF was the most common phenotype, being associated with a profile related to an increased thromboembolic risk. Compared to HFrEF, both HFmrEF and HFpEF were associated with a lower risk of all major adverse outcomes in AF patients.
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Affiliation(s)
- M Proietti
- The Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - C Laroche
- European Society of Cardiology, EURObservational Research Programme Department, Sophia-Antipolis, France
| | - A Tello-Montoliu
- Hospital Clínico Univeristario Virgen de la Arrixaca, Department of Cardiology, Murcia, Spain
| | - R Lenarczyk
- Silesian Center for Heart Diseases (SCHD), Zabrze, Poland
| | - G A Dan
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - A P Maggioni
- ANMCO Foundation For Your Heart, Florence, Italy
| | - G Y H Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - G Boriani
- University of Modena & Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy
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Ditaranto R, Rapezzi C, Boriani G, Pasquale F, Graziosi M, Vitale G, Berardini A, Lanati G, Corsini A, Caponetti G, Lattanzi G, Potena L, Ziacchi M, Leone O, Biagini E. P6455Differences in cardiac phenotype and natural history of laminopathies with and without neuromuscular presentation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aim
To look for differences in cardiac phenotype and natural history of patients affected by laminopathy, according to the presence or less of neuromuscular involvement at clinical presentation.
Methods
We prospectively analyzed 47 consecutive pts with a genetic diagnosis of laminopathy followed at a single centre between 1994 and 2017. Additionally, reports of clinical and instrumental evaluations before referral at our centre were retrospectively evaluated.
Results
Neuromuscular presentation, mainly as Emery-Dreifuss muscular dystrophy (EDMD), was present in 21 (46%) cases (14 LMNA and 7 EMD gene mutations). These pts had symptoms earlier (9 vs 39 years, p<0.001) in life compared to pts without neuromuscular onset (26 LMNA gene mutations), and clinical manifestations anticipated the first evidence of cardiac disease by a mean time of 15±8 years (maximum time gap of 38 years). Despite a similar prevalence of atrial fibrillation/flutter (AF) (71% vs 65%, p=0.758) and atrio-ventricular blocks (48% vs 65%, p=0.250), pts with neuromuscular onset experienced AF and pace-maker implantation at a significantly younger age (27 vs 41 yrs, p=0.015 and 23 vs 44 yrs, p=0.027 respectively). Differently a higher prevalence of sinus node dysfunction (33% vs 4%; p=0.015) and atrial paralysis (14% vs 4%; p=0.311) was reported in pts with neuromuscular onset. Prevalence of cardiomyopathy (CMP) (73% vs 33%, p=0.008) and sustained ventricular tachyarrhythmias were higher among pts with cardiac onset (23% vs 4%, p=0.111) whereas the prevalence of heart transplantations and median age of recipients were similar in the two groups (24% vs 20%, p=1.000 and 46 vs 43, p=0.592 years respectively). All pts with neuromuscular onset who received a diagnosis of CMP had a previous history of rhythm disturbance except 2 cases, where a concomitant diagnosis of the 2 disorders was formulated. On the contrary a strict temporal progression from rhythm disturbances to CMP (or viceversa) was not appreciable in the other group: AF and AVBs could precede the diagnosis of CMP be diagnosed at the same time or later.
Conclusions
In pts affected by laminopathy neuromuscular involvement, when present, was most often the first clinical manifestation and preceded cardiological involvement, with a long time frame in some cases. Except for sinus node dysfunction, much more frequent in patients with EDMD, a similar prevalence of rhythm disturbances was reported, although pts with neuromuscular clinical onset were younger at diagnosis of AF and at PM implantation. Pts without neuromuscular presentation had a higher prevalence of CMP and ventricular arrhythmias, albeit a similar rate of heart transplantation. In pts with neuromuscular onset, cardiac involvement was characterized by a stepwise progression from rhythm disturbances to CMP, where a strict temporal progression from rhythm disturbances to CMP was not observed in the group of pts without neuromuscular clinical onset.
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Affiliation(s)
- R Ditaranto
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - C Rapezzi
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - G Boriani
- University of Modena & Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - F Pasquale
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - M Graziosi
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - G Vitale
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - A Berardini
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - G Lanati
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - A Corsini
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - G Caponetti
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - G Lattanzi
- University of Bologna, Italian National Research Council
- CNR • Institute of Molecular Genetics IGM Bologna, Bologna, Italy
| | - L Potena
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - M Ziacchi
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - O Leone
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - E Biagini
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
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Boriani G, Proietti M, Laroche C, Diemberger I, Kalarus Z, Potpara T, Fauchier L, Crijns HJGM, Maggioni A, Lip GYH. P3784Impact of progressively impaired renal function on major adverse outcomes in European patients with atrial fibrillation: a report from the ESC EORP-AF long-term general registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Renal function is an important predictor of major adverse outcomes in the general population. In the setting of atrial fibrillation (AF), renal dysfunction may act both as a risk factor and a proxy of vascular risk factors and comorbidities.
Methods
We analyzed the association of renal function, as estimated glomerular filtration rate (eGFR) using the CKD-EPI formula, with 1-year outcomes in a “real-world” cohort of European AF patients from the EORP-AF Long-Term General Registry.
Results
7725 were available for this analysis. Of these, 1294 (16.7%) had normal renal function (≥90 mL/min/1.73 m2), 3848 (49.8%) mildly reduced renal function (60–89 mL/min/1.73 m2), 2311 (29.9%) moderately reduced renal function (30–59 mL/min/1.73 m2) and 272 (3.5%) severely reduced renal function (<30 mL/min/1.73 m2). CHA2DS2-VASc and HAS-BLED scores values increased across eGFR strata (p<0.0001). Among patients qualifying for oral anticoagulant (OAC) therapy, those with severely impaired renal function were less often prescribed with any OAC (79.8%, p<0.0001), more likely with vitamin K antagonist (62.9%) than non-vitamin K antagonist oral anticoagulants (16.9%) (p<0.0001). At 1-year follow-up the rates of any thromboembolic event (TE)/acute coronary syndrome (ACS)/cardiovascular (CV) death progressively increased with worsening renal function, up to 20.7% in patients with severe dysfunction (p<0.0001). Rates of CV death and all-cause death were higher in severe renal dysfunction (16.9% and 21.3%; p<0.0001). Cox regression analysis (adjusted for known predictors) showed that eGFR <30 mL/min/1.73 m2, compared to normal renal function was associated with an increased risk of all the adverse outcomes (Table). eGFR decrease by 10 mL/min/1.73 m2 was associated with increased risks (Table).
Any TE/ACS/CV Death CV Death All-Cause Death mL/min/1.73 m2 HR (95% CI) HR (95% CI) HR (95% CI) eGFR ≥90 (ref.) – – – eGFR 60–89 0.99 (0.67–1.46) 0.81 (0.44–1.51) 0.74 (0.47–1.19) eGFR 30–50 1.12 (0.74–1.69) 1.00 (0.53–1.89) 0.95 (0.59–1.54) eGFR <30 2.47 (1.52–3.99) 2.73 (1.36–5.49) 2.16 (1.25–3.72) eGFR (by 10 mL/min/1.73 m2 decrease) 1.11 (1.05–1.17) 1.18 (1.10–1.27) 1.11 (1.03–1.18) ACS = Acute coronary syndrome; CI = Confidence interval; CV = Cardiovascular; eGFR = estimated Glomerular Filtration Rate; HR = Hazard ratio; TE = Thromboembolic event.
Conclusions
In AF patients, impaired renal function at baseline is associated with a progressive increase in the risk of major adverse outcomes during follow up. Severe renal dysfunction is an independent predictor of all the adverse outcomes.
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Affiliation(s)
- G Boriani
- University of Modena & Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy
| | - M Proietti
- The Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - C Laroche
- European Society of Cardiology, EURObservational Research Programme Department, Sophia-Antipolis, France
| | - I Diemberger
- University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
| | - Z Kalarus
- Silesian Center for Heart Diseases (SCHD), Zabrze, Poland
| | - T Potpara
- University of Belgrade, School of Medicine, Belgrade, Serbia
| | - L Fauchier
- University F. Rabelais of Tours, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Tours, France
| | - H J G M Crijns
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - A Maggioni
- ANMCO Foundation For Your Heart, Florence, Italy
| | - G Y H Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
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Boriani G, Proietti M, Laroche C, Fantecchi E, Popescu M, Marin F, Maggioni AP, Lip GYH. P3759Comparison of equations for renal function assessment and major adverse outcomes in atrial fibrillation: an analysis from the EORP-AF long-term general registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Several equations exist to estimate creatinine clearance according to serum creatinine values and baseline characteristics. The CKD-EPI equation is usually recommended in general population, while the Cockroft-Gault (CG) equation has been used in atrial fibrillation (AF) clinical trials.
Purpose
To perform a comparison between 6 different equations for evaluation of renal function in AF patients.
Methods
We calculated CKD-EPI, CG, body surface area adjusted CG (CG BSA), MDRD, BIS1 and FAS equations in AF patients enrolled in the EORP-AF Long-Term General Registry. Outcomes at 1-year follow-up were considered.
Results
Renal equations were calculated in 7725 patients. According to CKD-EPI mean (SD) creatinine clearance was 69.14 (21.06) mL/min/1.73 m2. Taking CKD-EPI as reference, the MDRD equation showed the highest agreement (weighted kappa [95% CI]: 0.843 [0.833–0.852]), while CK showed the lowest agreement (weighted kappa [95% CI]: 0.593 [0.580–0.606]. The remaining equations showed moderate agreement. Cox regression analysis showed that all equations were inversely associated with all major adverse outcomes [Figure]. The CKD-EPI equation showed modest predictive ability for the three outcomes (c-statistics: any TE/ACS/CV Death: 0.63379; CV Death: 0.68512; All-Cause Death: 0.67183), with all other equations reporting higher c-statistics (delta-c statistic ranging from +0.01497 for FAS equation for any TE/ACS/CV Death to +0.04547 for CG BSA for all-cause death) for all outcomes (all p<0.0001, for any equation for any outcome). Compared to CKD-EPI, all the other equations showed an improvement in prediction of outcomes, according to IDI and NRI, with the exception of FAS equation for any TE/ACS/CV Death. CG BSA equation showed the greatest improvement in prediction of outcomes compared to CKD-EPI (relative IDI: 21.9% for any TE/ACS/CV Death, 28.8% for CV Death, 34.4% for All-Cause Death).
Cox Regression Analysis
Conclusions
Compared to CKD-EPI equation, all the other equations for creatine clearance has stronger associations with adverse outcomes, with the CG BSA reporting the higher yield for all the outcomes considered.
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Affiliation(s)
- G Boriani
- University of Modena & Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy
| | - M Proietti
- The Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - C Laroche
- European Society of Cardiology, EURObservational Research Programme Department, Sophia-Antipolis, France
| | - E Fantecchi
- University of Modena & Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy
| | - M Popescu
- University of Medicine and Pharmacy of Craiova, Center of Clinical and Experimental Medicine, Craiova, Romania
| | - F Marin
- Hospital Clínico Univeristario Virgen de la Arrixaca, Department of Cardiology, Murcia, Spain
| | - A P Maggioni
- ANMCO Foundation For Your Heart, Florence, Italy
| | - G Y H Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
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Imberti JF, Placentino F, Malavasi VL, Demarco G, Lohr F, Boriani G. P682Radiotherapy-induced malfunction in cancer patients with cardiac implantable electronic devices. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The number of patients with cardiac implantable electronic devices (CIED) requiring a radiation therapy (RT) for cancer treatment is increasing over time. Nevertheless, the rate and predictors of CIED malfunctions are still controversial.
Purpose
The aim of our study is to estimate the prevalence and possible predictors of RT-related CIED malfunctions and to describe malfunction characteristics.
Methods
We retrospectively reviewed medical records of all pacemaker (PM)/implantable cardioverter defibrillator (ICD) patients who underwent RT at our centre between January 2004 and July 2018. We included data from the CIED interrogation performed before the RT course to the first interrogation after the end of the RT course. As a safety measure, during RT a magnet was applied to every ICD and, in all PM-dependent patients, the device was temporarily reprogrammed in V00. Device relocation from the RT field was performed in 2/150 (1.3%) RT courses.
Results
One hundred twenty-seven patients were included, who underwent 150 separate RT courses. Eighty one percent of patients had a PM, while 19% had an ICD. Of note 17.4% of patients were PM-dependent. Neutron producing RT was used in 37/139 (26.6%) patients, whereas marginal neutron producing and non-neutron producing RT was used in 9/139 (6.4%) and 93/139 (67%) patients respectively. The cumulative dose (Dmax) delivered to the CIED exceeded 5Gy only in 2/132 (1.5%) cases. Three device-related malfunctions were found (2%). None of them were life-threatening or lead to a clinical event. All dysfunctions were resolved by reprogramming the device and did not require CIED substitution or leads extraction. Details of dysfunctions included: 1) a partial reset of an ICD, leading to self-reprogramming in safety mode, 2) full reset of a PM, which required the re-initialisation of the device and 3) programming change of the magnetic PM frequency to 30bpm (instead of 90 bpm). In all cases the Dmax delivered to the CIED was <1Gy. A neutron producing RT was used in the first two cases, whereas a non-neutron producing RT was used in the last case.
Conclusions
In accordance with the current literature, our results show that RT in patients with CIED is substantially safe. Malfunctions are uncommon and do not result in clinical events, but can develop even if the Dmax delivered to the CIED is <1 Gy. Device interrogation on a regular basis is advisable to promptly recognise CIED malfunctions.
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Affiliation(s)
- J F Imberti
- Azienda Ospedaliero Universitaria, Cardiology, Modena, Italy
| | - F Placentino
- Azienda Ospedaliero Universitaria, Cardiology, Modena, Italy
| | - V L Malavasi
- Azienda Ospedaliero Universitaria, Cardiology, Modena, Italy
| | - G Demarco
- Azienda Ospedaliero Universitaria, Radiotherapy, Modena, Italy
| | - F Lohr
- Azienda Ospedaliero Universitaria, Radiotherapy, Modena, Italy
| | - G Boriani
- Azienda Ospedaliero Universitaria, Cardiology, Modena, Italy
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Boriani G, Pieragnoli P, Botto GL, Gulizia M, Landolina M, Ricci R, Proclemer A, Ziacchi M, Zanotto G, Ricciardi G, Facchin D, Comisso J, Grammatico A, Biffi M. P6556Prevention of long-lasting atrial fibrillation through device therapy in dual-chamber pacemakers: analysis on 1384 patients of the role of Reactive ATP and atrial preventive pacing. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is the most prevalent heart rhythm disorder in clinical practice and it is associated with poor quality of life and increased risks of heart failure, dementia, stroke, and death. Moreover AF management is a huge cost for healthcare systems. AF is irregular, typically originates from the pulmonary veins, and as such, requires cardioversion to terminate persistent episodes. AF is not susceptible to pace-termination, however, the MINERVA trial has shown that AF may transform in slower organized rhythms such as atrial flutter or atrial tachycardia, which can often be terminated by atrial anticahycardia pacing (ATP); in particular by Reactive ATP, a specific ATP feature which can be re-armed when atrial arrhythmias get slower or more regular. The MINERVA trial showed that the combination of ATP, preventive atrial pacing algorithms and minimal ventricular pacing (MVP) was associated with lower progression to persistent and permanent AF, compared with standard DDD pacing mode and to MVP mode, in pacemaker patients with clinical history of AF.
Purpose
We aimed to confirm MINERVA trial results in real-world clinical practice and to evaluate whether AF prevention was associated with preventive atrial pacing or solely with ATP. Indeed in our project atrial preventive pacing algorithms were not enabled and the pacing mode (DDD or MVP) was chosen according to patients' AV conduction characteristics.
Methods
Consecutive dual-chamber pacemaker patients with sinus node disease and device detected AT/AF were prospectively followed by 30 Italian cardiologic centers in an observational research. Clinical and device data were collected and reviewed by expert cardiologists to assess AT/AF occurrence through in clinic visit and/or remote transmissions of device data.
Results
A total of 239 patients (73 years old, 56% male) wearing a dual-chamber pacemaker with Reactive ATP were included in the project, followed for a median observation period of 13 months and compared with 1145 patients included in the MINERVA trial followed for a median observation period of 34 months and programmed with DDD pacing mode (383 patients), MVP (389 patients) and MVP+Reactive ATP+preventive algorithms (373 patients). As shown in the following figure incidence of 7 consecutive days of AF in the patients treated by DDD/MVP+Reactive ATP in real-world clinical practice was very similar to that found in the MINERVA trial arm programmed with MVP+Reactive ATP+preventive algorithms.
Incidence of AF longer than 7 days
Conclusions
Our analysis performed in a population of sinus node disease patients with dual-chamber pacemakers confirmed MINERVA trial results in terms of prevention of long-lasting AF episodes. In particular these results confirm the benefit associated with the use of Reactive ATP, rather than preventive atrial pacing algorithms.
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Affiliation(s)
- G Boriani
- University of Modena & Reggio Emilia, Modena, Italy
| | - P Pieragnoli
- Careggi University Hospital (AOUC), Florence, Italy
| | - G L Botto
- Rho Hospital, Cardiology Department, Rho, Italy
| | | | | | - R Ricci
- San Filippo Neri Hospital, Rome, Italy
| | - A Proclemer
- University Hospital Santa Maria della Misericordia, Udine, Italy
| | - M Ziacchi
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - G Zanotto
- Civil Hospital of Legnano, Legnago, Italy
| | - G Ricciardi
- Careggi University Hospital (AOUC), Florence, Italy
| | - D Facchin
- University Hospital Santa Maria della Misericordia, Udine, Italy
| | - J Comisso
- Medtronic Italia SpA, Clinical Department, Milano, Italy
| | - A Grammatico
- Medtronic Core Clinical Solutions, Study & Scientific Solutions, Rome, Italy
| | - M Biffi
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
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Boriani G, Botto GL, Pieragnoli P, Ricci RP, Biffi M, Marini M, Sagone A, Avella A, Pignalberi C, Ziacchi M, Ricciardi G, Tartaglione E, Grammatico A, Gasparini M. P3746Temporal patterns of premature atrial contractions predict atrial fibrillation occurrence in bradycardia patients continuously monitored through pacemaker diagnostics. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The frequency of premature atrial complexes (PACs) has been indirectly related with atrial fibrillation (AF) occurrence and adverse outcomes.
Objective
To evaluate whether temporal patterns of PACs are directly associated with AF onset in pacemaker patients with continuous monitoring of the atrial rhythm.
Methods
Overall, 193 pacemaker patients (49% female, 72±9 years old), enrolled in a national registry, were analyzed. Frequency of daily PACs was measured in a 14-day initial observation period, during which patients were in sinus rhythm. In the following period, temporal occurrence and frequency of daily PACs and eventual onset of AF were derived by pacemaker diagnostics.
Results
In the run-in period, median PACs frequency was 614 PACs/day (interquartile range=70–3056). Subsequently, in a median follow-up of 6 months, AF occurred in 109 patients, in particular in 37/96 (38.5%) patients with a PAC rate<614 PACs/day and in 72/97 (74.2%) patients with PAC rate≥614 PACs/day (p<0.001). In patients with AF occurrence, the number of daily PACs, normalized by dividing for the average of PACs in 10 preceding days, progressively increased in the 5–6 days preceding AF (Figure). Cox Model predictive analysis showed that the risk of AF was significantly higher in patients with a relative increase of the daily PACs higher than 30% compared with PACs average number in 10 preceding days (hazard ratio (95% confidence interval) = 3.67 (2.40–5.59), p<0.001).
PACs changes daily trend before AF
Conclusion
PACs frequency increases in the 5–6 days preceding AF onset. A relative increase of the daily PACs is significantly associated with the risk of AF occurrence.
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Affiliation(s)
- G Boriani
- University of Modena & Reggio Emilia, Modena, Italy
| | - G L Botto
- Cardiology Dept. Rho Hospital, Rho (MIlan), Italy
| | - P Pieragnoli
- Careggi University Hospital (AOUC), Florence, Italy
| | - R P Ricci
- San Filippo Neri Hospital, Cardiology Dept., Rome, Italy
| | - M Biffi
- Bologna University Hospital, Cardiology Dept., Bologna, Italy
| | - M Marini
- Santa Chiara Hospital in Trento, Cardiology Dept., Trento, Italy
| | - A Sagone
- IRCCS Multimedica of Milan, Cardiology Dept., Milan, Italy
| | - A Avella
- San Camillo Forlanini Hospital, Cardiology Dept., Rome, Italy
| | - C Pignalberi
- San Filippo Neri Hospital, Cardiology Dept., Rome, Italy
| | - M Ziacchi
- Bologna University Hospital, Cardiology Dept., Bologna, Italy
| | - G Ricciardi
- Careggi University Hospital (AOUC), Florence, Italy
| | | | | | - M Gasparini
- Istituto Clinico Humanitas, Cardiology Dept., Milan, Italy
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Zecchin M, Torre M, Ortis B, Proclemer A, Carrani E, Sampaolo L, Ricci RP, Boriani G. P287015 year trend in ICD utilization according to the Italian national administrative database: an analysis of age groups. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
To achieve a complete coverage of all Implantable Cardioverter Defibrillator (ICD) performed in Italy between 2001 and 2015, data from the National Hospital Discharge Database (SDO: “Scheda di Dimissione Ospedaliera”) were analyzed. Frequencies and implant rate of ICD and Cardiac Resynchronization Therapy/Defibrillator (CRTD) according to the Italian population were computed. Data were analyzed for the following age classes: <50, 50–80, >80.
Results
Total number of ICD increased from 3141 in 2001 (implant rate 54/million inhabitants) to 23.540 in 2015 (387/million). From 2009 to 2015 CRT-D increased from 2916 in 2009 (49/million) to 8245 in 2015 (136/million), while the proportion of CRT/total ICD from 17% to 35%.
Mean age (from 67±12 in 2001 to 68±12 in 2015) and the proportion of males (from 80% to 79%) remained unchanged.
Ischemic heart disease was the most frequent diagnosis (55.6% in 2001, 45.4% in 2015).
ICD for secondary prevention have been reducing from 55.6% to 13.6% (ventricular tachycardia, VT) and from 18.1% to 5.9% (ventricular fibrillation, VF). The proportion of patients with heart failure (from 23.9% to 47.9%), hypertension (from 11.2% to 16.2%), diabetes mellitus (6.5% to 11.6%) and renal insufficiency (from 4.4% to 8%) increased.
The proportion of CRT/ICD remained constant (except for the 2009, where a possible underdiagnosis is very likely), between 43% and 39%.
In patients <50 years old the number of ICD increased from 367 (10/million) in 2001 to 1829 (52/million) in 2015; the most frequent diagnosis was idiopathic cardiomyopathy (30%), while ischemic heart disease was present in 20%. An increase of the proportion of patients with the diagnosis of heart failure (from 13.8% to 33.6%), hypertension (from 4.3% to 8.5%), diabetes mellitus (1.5% to 3.9%) and renal insufficiency (from 1.3% to 2.2%) was observed.
In patients >80 years old the number of ICD increased from 195 (82/million) in 2001 to 3902 (981/million) in 2015; ischemic heart disease was the most frequent diagnosis (53.8% in 2001, 43.5% in 2015). ICD for secondary prevention reduced from 50.3% to 14,8% (VT) and from 16.4% to 4.1% (VF), with an increase of the proportion of patients with heart failure (from 22.6% to 46.3%), hypertension (from 11.8% to 17.1%), diabetes mellitus (5.6% to 9.9%) and renal insufficiency (from 7.2% to 12.1%).
Conclusions
There was a steady increase of ICD and CRTD implantation during the last fifteen years, especially in those >80 years; the proportion of patients treated for secondary prevention dramatically reduced since early 2000; an increase of co-morbidities was observed.
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Affiliation(s)
| | - M Torre
- Superior Institute of Health, Rome, Italy
| | - B Ortis
- University Hospital, Trieste, Italy
| | - A Proclemer
- University Hospital Santa Maria della Misericordia, Udine, Italy
| | - E Carrani
- Superior Institute of Health, Rome, Italy
| | - L Sampaolo
- Superior Institute of Health, Rome, Italy
| | - R P Ricci
- San Filippo Neri Hospital, Rome, Italy
| | - G Boriani
- University of Modena & Reggio Emilia, Modena, Italy
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Sgura FA, Arrotti S, Magnavacchi P, Tondi S, Gabbieri D, Vitolo M, Pennacchioni A, Autieri A, Boriani G. P1517Risk of acute kidney injury in transcatheter aortic valve implantation procedures and impact on 30-day outcome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Transcatheter aortic valve implantation (TAVI) is a safe and effective procedure for patients with symptomatic aortic stenosis who do not qualify for surgery. Nevertheless, post-procedure acute kidney injury (AKI) is a frequent complication and it is associated with worse outcomes.
Aim
To assess the impact of acute kidney injury (AKI) occurring immediately after the TAVI procedure on patients' outcome.
Methods
We conducted a multicenter retrospective study on patients treated with TAVI from 2010 to 2018. The assigned treatment, the selection of the device (self-expandable/balloon-expandable valve) and the type of approach used were determined by each individual Center on the basis of the patient's characteristics and the choice of the operator. All patients had an intermediate or high Society of Thoracic Surgeons (STS) score. Basal creatinine and glomerular filtrate (using the body mass index, sex and age) were evaluated for each patient. According to the KDIGO criteria, AKI is defined as an increase in serum creatinine (SCr) ≥0,3mg/dl within 48 hours or an increase in SCr ≥1.5 times baseline or urine volume <0,5ml/kg/h for 6 hours. The incidence of post procedural AKI and its correlation with the short-term mortality and outcomes was evaluated as primary end point (stroke/TIA/RIND, cardiac tamponade, bleeding, vascular complications, cardiocirculatory arrest with subsequent ROSC, definitive pacemaker implantation, postoperative atrial fibrillation, left bundle branch block de novo).Postoperative outcomes were defined according to the updated Valve Academic Research Consortium 2 definitions
Results
A total of 371 pts were analysed. Mean age was 82.3±5.9 and the majority of the pts had an STS score>10 (97.6%). Incidence of Acute kidney Injury (AKI) stage 3 post TAVI, according to VARC-2 criteria, was 16,2%. In patient with AKI, the hospitalization time was longer 18,7±6,1 days vs 8,4±6,1 days without AKI (p<0,01). Patients with AKI had an increased risk of in hospital mortality (OR 50,0; 95% CI 5,2–390,16; p<0,01) and 30 day mortality (OR: 5,88; 95% CI 2,08–16,60; p<0,01). Acute Kidney Injury instead was more common in patients treated with transapical access (OD 3,9-CI 95% 2,16–7,07; p<0,01) or with PAD (OR 1,87 - CI 95% 1,03–3,41; p=0,03)
AKI and short term mortality
Conclusion
Acute kidney injury is a frequent complication after TAVI. AKI seems to be the strongest predictor for 30 day mortality and increases the hospitalization time. AKI was more common in patients treated with a transapical approach or if they presented a PAD. In contrast, pre-procedural chronic kidney disease did not seem to correlate directly with an increased risk of AKI.
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Affiliation(s)
- F A Sgura
- University of Modena & Reggio Emilia, Modena, Italy
| | - S Arrotti
- University of Modena & Reggio Emilia, Modena, Italy
| | - P Magnavacchi
- Nuovo Ospedale S. Agostino-Estense, Cardiology Division, Modena, Italy
| | - S Tondi
- Nuovo Ospedale S. Agostino-Estense, Cardiology Division, Modena, Italy
| | - D Gabbieri
- Hesperia Hospital, Department of Cardiology-Cardiothoracic Surgery, Modena, Italy
| | - M Vitolo
- University of Modena & Reggio Emilia, Modena, Italy
| | | | - A Autieri
- University of Modena & Reggio Emilia, Modena, Italy
| | - G Boriani
- University of Modena & Reggio Emilia, Modena, Italy
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Grigioni F, Benfari G, Vanoverschelde JL, Tribouilloy C, Avierinos JF, Bursi F, Suri RM, Guerra F, Pasquet A, Rusinaru D, Marcelli E, Théron A, Barbieri A, Michelena H, Lazam S, Szymanski C, Nkomo VT, Capucci A, Thapa P, Enriquez-Sarano M, Suri R, Clavel M, Maalouf J, Michelena H, Nkomo VT, Enriquez-Sarano M, Tribouilloy C, Trojette F, Szymanski C, Rusinaru D, Touati G, Remadi J, Guerra F, Capucci A, Grigioni F, Russo A, Biagini E, Pasquale F, Ferlito M, Rapezzi C, Savini C, Marinelli G, Pacini D, Gargiulo G, Di Bartolomeo R, Boulif J, de Meester C, El Khoury G, Gerber B, Lazam S, Pasquet A, Noirhomme P, Vancraeynest D, Vanoverschelde JL, Avierinos J, Collard F, Théron A, Habib G, Barbieri A, Bursi F, Mantovani F, Lugli R, Modena M, Boriani G, Bacchi-Reggiani L. Long-Term Implications of Atrial Fibrillation in Patients With Degenerative Mitral Regurgitation. J Am Coll Cardiol 2019; 73:264-274. [DOI: 10.1016/j.jacc.2018.10.067] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 10/11/2018] [Accepted: 10/16/2018] [Indexed: 11/15/2022]
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Ziacchi M, Diemberger I, Corzani A, Martignani C, Mazzotti A, Massaro G, Valzania C, Rapezzi C, Boriani G, Biffi M. Cardiac resynchronization therapy: a comparison among left ventricular bipolar, quadripolar and active fixation leads. Sci Rep 2018; 8:13262. [PMID: 30185834 PMCID: PMC6125407 DOI: 10.1038/s41598-018-31692-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/08/2018] [Indexed: 11/09/2022] Open
Abstract
We evaluated the performance of 3 different left ventricular leads (LV) for resynchronization therapy: bipolar (BL), quadripolar (QL) and active fixation leads (AFL). We enrolled 290 consecutive CRTD candidates implanted with BL (n = 136) or QL (n = 97) or AFL (n = 57). Over a minimum 10 months follow-up, we assessed: (a) composite technical endpoint (TE) (phrenic nerve stimulation at 8 V@0.4 ms, safety margin between myocardial and phrenic threshold <2V, LV dislodgement and failure to achieve the target pacing site), (b) composite clinical endpoint (CE) (death, hospitalization for heart failure, heart transplantation, lead extraction for infection), (c) reverse remodeling (RR) (reduction of end systolic volume >15%). Baseline characteristics of the 3 groups were similar. At follow-up the incidence of TE was 36.3%, 14.3% and 19.9% in BL, AFL and QL, respectively (p < 0.01). Moreover, the incidence of RR was 56%, 64% and 68% in BL, AFL and QL respectively (p = 0.02). There were no significant differences in CE (p = 0.380). On a multivariable analysis, "non-BL leads" was the single predictor of an improved clinical outcome. QL and AFL are superior to conventional BL by enhancing pacing of the target site: AFL through prevention of lead dislodgement while QL through improved management of phrenic nerve stimulation.
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Affiliation(s)
- M Ziacchi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.
| | - I Diemberger
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - A Corzani
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - C Martignani
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - A Mazzotti
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - G Massaro
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - C Valzania
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - C Rapezzi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - G Boriani
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
- Cardiology Division. Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - M Biffi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
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Boriani G, Rovaris G, Ziacchi M, Mezzetti M, Biffi M, Lunati M, Pangallo A, Tomasi C, Zanotto G, Perrone C, Capucci A. P1285Detection of new onset of atrial fibrillation in patients wearing a single chamber defibrillator: insights from a multicentric experience. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G Boriani
- University of Modena and Reggio Emilia, Policlinico di Modena, Cardiology Division, Modena, Italy
| | | | - M Ziacchi
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - M Mezzetti
- S. M. della Misericordia Hospital, Urbino, Italy
| | - M Biffi
- Institute of Cardiology, Univ. of Bologna, Bologna, Italy
| | - M Lunati
- Niguarda Ca' Granda Hospital, Milan, Italy
| | - A Pangallo
- Bianchi Melacrino Morelli Hospital (BMM), Reggio Calabria, Italy
| | - C Tomasi
- Santa Maria delle Croci Hospital, Ravenna, Italy
| | | | - C Perrone
- U.L.S.S. 5 Ovest Vicentino, Arzignano (Vicenza), Italy
| | - A Capucci
- University Hospital Riuniti of Ancona, Ancona, Italy
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Boriani G, Proietti M, Laroche C, Diemberger I, Rheinert C, Serdechnaya EV, Diker E, Maggioni AP, Lip GYH. P3475Relationship between age and use of oral anticoagulant drugs in european atrial fibrillation patients: the EORP-AF general long-term registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G Boriani
- University of Modena & Reggio Emilia, Cardiology Department, Modena, Italy
| | - M Proietti
- University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom
| | - C Laroche
- European Society of Cardiology, EURObservational Research Programme Department, Sophia-Antipolis, France
| | - I Diemberger
- University Hospital Policlinic S. Orsola-Malpighi, Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
| | - C Rheinert
- Schwemlinger Gemeinschaftspraxis, Merzig/Saar, Germany
| | - E V Serdechnaya
- Northern State Medical University, Arkhangelsk, Russian Federation
| | - E Diker
- Medicana Hospital, Department of Cardiology, Ankara, Turkey
| | - A P Maggioni
- ANMCO Foundation For Your Heart, Florence, Italy
| | - G Y H Lip
- University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom
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Guerra F, Palmisano P, Dell'era G, Ammendola E, Ziacchi M, Laffi M, Angeletti A, Torriglia A, Accogli M, Occhetta E, Nigro G, Biffi M, Gaggioli G, Capucci A, Boriani G. P3883Overall and cardiovascular-related mortality after complications of cardiac implantable electronic devices: preliminary results from the IMPACT registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Guerra
- Marche Polytechnic University of Ancona, Cardiology and Arrhythmology Clinic, “Ospedali Riuniti” University Hospital, Ancona, Italy
| | - P Palmisano
- Cardinale G. Panico Hospital, Tricase, Italy
| | - G Dell'era
- Hospital Maggiore Della Carita, Novara, Italy
| | | | - M Ziacchi
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - M Laffi
- ASL3 Genovese Villa Scassi Hospital, Genoa, Italy
| | - A Angeletti
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - A Torriglia
- ASL3 Genovese Villa Scassi Hospital, Genoa, Italy
| | - M Accogli
- Cardinale G. Panico Hospital, Tricase, Italy
| | - E Occhetta
- Hospital Maggiore Della Carita, Novara, Italy
| | - G Nigro
- Second University of Naples, Naples, Italy
| | - M Biffi
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - G Gaggioli
- ASL3 Genovese Villa Scassi Hospital, Genoa, Italy
| | - A Capucci
- Marche Polytechnic University of Ancona, Cardiology and Arrhythmology Clinic, “Ospedali Riuniti” University Hospital, Ancona, Italy
| | - G Boriani
- University of Modena & Reggio Emilia, Modena, Italy
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Guerra F, Palmisano P, Dell'era G, Ammendola E, Ziacchi M, Laffi M, De Masi De Luca G, Troiano F, Accogli M, Occhetta E, Nigro G, Biffi M, Gaggioli G, Capucci A, Boriani G. 3293Healthcare resources utilization due to complications of cardiac implantable electronic devices: preliminary results from the IMPACT registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Guerra
- Marche Polytechnic University of Ancona, Cardiology and Arrhythmology Clinic, “Ospedali Riuniti” University Hospital, Ancona, Italy
| | - P Palmisano
- Cardinale G. Panico Hospital, Tricase, Italy
| | - G Dell'era
- Hospital Maggiore Della Carita, Novara, Italy
| | | | - M Ziacchi
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - M Laffi
- ASL3 Genovese Villa Scassi Hospital, Genoa, Italy
| | | | - F Troiano
- Marche Polytechnic University of Ancona, Cardiology and Arrhythmology Clinic, “Ospedali Riuniti” University Hospital, Ancona, Italy
| | - M Accogli
- Cardinale G. Panico Hospital, Tricase, Italy
| | - E Occhetta
- Hospital Maggiore Della Carita, Novara, Italy
| | - G Nigro
- Second University of Naples, Naples, Italy
| | - M Biffi
- University Hospital Policlinic S. Orsola-Malpighi, Bologna, Italy
| | - G Gaggioli
- ASL3 Genovese Villa Scassi Hospital, Genoa, Italy
| | - A Capucci
- Marche Polytechnic University of Ancona, Cardiology and Arrhythmology Clinic, “Ospedali Riuniti” University Hospital, Ancona, Italy
| | - G Boriani
- University of Modena & Reggio Emilia, Modena, Italy
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Malavasi VL, Fantecchi E, Gianolio L, Pesce F, Longo G, Cascinu S, Boriani G. P3500Atrial fibrillation in active malignancy: prescription of anticoagulants and impact on all-cause mortality. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- V L Malavasi
- Azienda Ospedaliero Universitaria, Cardiology, Modena, Italy
| | - E Fantecchi
- Azienda Ospedaliero Universitaria, Cardiology, Modena, Italy
| | - L Gianolio
- Azienda Ospedaliero Universitaria, Cardiology, Modena, Italy
| | - F Pesce
- Azienda Ospedaliero Universitaria, Cardiology, Modena, Italy
| | - G Longo
- University of Modena & Reggio Emilia, Oncology, Modena, Italy
| | - S Cascinu
- University of Modena & Reggio Emilia, Oncology, Modena, Italy
| | - G Boriani
- Azienda Ospedaliero Universitaria, Cardiology, Modena, Italy
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