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Boesgaard Graversen C, Brink Valentin J, Lytken Larsen M, Riahi S, Holmberg T, Paaske Johnsen S. Non-Persistence with Medication as a Mediator for the Social Inequality in Risk of Major Adverse Cardiovascular Events in Patients with Incident Acute Coronary Syndrome: A Nationwide Cohort Study. Clin Epidemiol 2021; 13:1071-1083. [PMID: 34803405 PMCID: PMC8597923 DOI: 10.2147/clep.s335133] [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] [Received: 08/19/2021] [Accepted: 10/19/2021] [Indexed: 11/29/2022] Open
Abstract
Aim Low socioeconomic status is associated with higher risk of major adverse cardiovascular events (MACE) among patients with incident acute coronary syndrome (ACS). We examined whether non-persistence with antiplatelet and statin therapy mediated the income- and educational-related inequality in risk of MACE. Methods Using national registers, all Danish patients diagnosed with incident ACS from 2010 to 2017 were identified. The primary outcome (MACE) comprised all-cause death, cardiac death and cardiac readmission. Risk of MACE was handled by discrete time analyses using inverse probability of treatment weights. The mediator variable comprised non-persistence to a combined 2-dimensional measure of statin and antiplatelet treatment. The mediation analysis was evaluated by population average effects. Results The study population was 45,874 patients, of whom 16,958 (37.0%) were non-persistent with medication and 16,365 (35.7%) suffered MACE during the median follow-up of 3.5 years. Compared to patients with low income, the adjusted hazard ratio of MACE was lowered by 33% (HR: 0.67, 95% CI: 0.61–0.72) in men and by 34% (HR: 0.66, 95% CI: 0.61–0.72) in women with high income, respectively. Similar results were observed according to level of education. A socioeconomic difference in risk of non-persistence was found in men but not women and only in relation to income. The lower risk of non-persistence observed in high-income men mediated the lower risk of MACE by 12.6% (95% CI: 11.1–14.1%) compared with low-income men. Conclusion Non-persistence with medication mediated some of the income-related inequality in risk of MACE in men, but not women, with incident ACS.
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Affiliation(s)
| | - Jan Brink Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Mogens Lytken Larsen
- Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Teresa Holmberg
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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52
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Kragholm KH, Lindgren FL, Zaremba T, Freeman P, Andersen NH, Riahi S, Pareek M, Køber L, Torp-Pedersen C, Søgaard P, Hagendorff A, Tayal B. Mortality and ventricular arrhythmia after acute myocarditis: a nationwide registry-based follow-up study. Open Heart 2021; 8:openhrt-2021-001806. [PMID: 34675133 PMCID: PMC8532546 DOI: 10.1136/openhrt-2021-001806] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/01/2021] [Indexed: 12/20/2022] Open
Abstract
Objective Incidence and severity of acute myocarditis vary significantly in previous reports and there is a lack of epidemiological studies on the short-term risks of mortality, heart failure and ventricular arrhythmias in patients with acute myocarditis. Therefore, study aims were to examine 90-day risks of mortality, heart failure (HF) and ventricular arrhythmias in patients with acute myocarditis in comparison to age-matched and sex-matched background population controls. Methods In this nationwide register-based follow-up study of patients hospitalised with myocarditis between 2002 and 2018 in Denmark, 90-day risks of all-cause mortality, HF, ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation (VF)), cardiac arrest and implantable cardioverter-defibrillator (ICD) implantation were compared with age-matched and sex-matched controls from the background population (1:5 matching). Absolute risks standardised to the age, sex and comorbidity distribution of the entire study population were derived from multivariable Cox regression. Results A total of 2523 patients hospitalised with myocarditis were included. Median age was 48 years (Q1–Q3: 30–69) and 67.7% were men. Comorbidity burden was more pronounced among patients with myocarditis relative to controls. Standardised 90-day all-cause mortality risk was 4.9% for patients with acute myocarditis versus 0.3% for controls (p<0.001). Ninety-day standardised risks for other endpoints were 7.5% versus 0.1% for HF, 1.9% versus <0.1% for VF/VF/arrest risk and 1.6% versus <0.1% for ICD implantation (all p<0.001). Conclusions In this large nationwide register-based follow-up study, patients hospitalised with myocarditis had significantly higher 90-day risks of all-cause mortality, HF, ventricular arrhythmias, cardiac arrest and ICD implantation compared with background population controls.
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Affiliation(s)
- Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark .,Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Tomas Zaremba
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Phillip Freeman
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Manan Pareek
- Department of Cardiology, Nordsjællands Hospital, Hillerod, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Bhupendar Tayal
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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53
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Pedersen SS, Nielsen JC, Wehberg S, Jørgensen OD, Riahi S, Haarbo J, Philbert BT, Larsen ML, Johansen JB. New onset anxiety and depression in patients with an implantable cardioverter defibrillator during 24 months of follow-up (data from the national DEFIB-WOMEN study). Gen Hosp Psychiatry 2021; 72:59-65. [PMID: 34303115 DOI: 10.1016/j.genhosppsych.2021.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To examine the cumulative incidence of and covariates' association with new onset anxiety and depression in implantable cardioverter defibrillator (ICD) patients during 24 months of follow-up in patients without depression and anxiety at implant. METHODS Patients (n = 1040; 155 (14.9%) women; mean age: 64.2 ± 10.6) with a first-time ICD enrolled in the national, multi-center prospective observational DEFIB-WOMEN study comprised the study cohort. We obtained information on demographic and clinical data from the Danish Pacemaker and ICD Register. RESULTS During 24 months of follow-up, 138 (14.5%) patients developed new onset anxiety and 109 (11.3%) new onset depression. Age ≥ 60 [HR:0.60;95%CI:0.40-0.90] and an anxiety score between 3 and 4 [HR:2.85; 95%CI:1.71-4.75] and 5-7 [HR:5.97; 95%CI:3.77-9.45] on the Hospital Anxiety and Depression Scale (HADS) were associated with different hazards of new onset anxiety during follow-up. Age ≥ 60 [HR:0.62;95%CI:0.42-0.93] and a HADS depression score between 3 and 4 [HR:2.99;95%CI:1.80-4.95] and 5-7 [HR:6.45; 95%CI:4.12-10.10] were associated with different hazards of new onset depression. CONCLUSION During 24 months of follow-up, respectively 14.5% and 11.3% of patients developed new onset anxiety and depression, suggesting that screening patients at several timepoints, and in particular those with even minimally elevated HADS scores at baseline, may be warranted to identify patients at risk for poor health outcomes.
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Affiliation(s)
- Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark.
| | | | - Sonja Wehberg
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Ole Dan Jørgensen
- Department of Thoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jens Haarbo
- Department of Cardiology, Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Berit T Philbert
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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54
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Sidhu BS, Sieniewicz B, Gould J, Elliott MK, Mehta VS, Betts TR, James S, Turley AJ, Butter C, Seifert M, Boersma LVA, Riahi S, Neuzil P, Biffi M, Diemberger I, Vergara P, Arnold M, Keane DT, Defaye P, Deharo JC, Chow A, Schilling R, Behar JM, Leclercq C, Auricchio A, Niederer SA, Rinaldi CA. Leadless left ventricular endocardial pacing for CRT upgrades in previously failed and high-risk patients in comparison with coronary sinus CRT upgrades. Europace 2021; 23:1577-1585. [PMID: 34322707 PMCID: PMC8502498 DOI: 10.1093/europace/euab156] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Cardiac resynchronization therapy (CRT) upgrades may be less likely to improve following intervention. Leadless left ventricular (LV) endocardial pacing has been used for patients with previously failed CRT or high-risk upgrades. We compared procedural and long-term outcomes in patients undergoing coronary sinus (CS) CRT upgrades with high-risk and previously failed CRT upgrades undergoing LV endocardial upgrades. METHOD AND RESULTS Prospective consecutive CS upgrades between 2015 and 2019 were compared with those undergoing WiSE-CRT implantation. Cardiac resynchronization therapy response at 6 months was defined as improvement in clinical composite score (CCS) and a reduction in LV end-systolic volume (LVESV) ≥15%. A total of 225 patients were analysed; 121 CS and 104 endocardial upgrades. Patients receiving WiSE-CRT tended to have more comorbidities and were more likely to have previous cardiac surgery (30.9% vs. 16.5%; P = 0.012), hypertension (59.2% vs. 34.7%; P < 0.001), chronic obstructive airways disease (19.4% vs. 9.9%; P = 0.046), and chronic kidney disease (46.4% vs. 21.5%; P < 0.01) but similar LV ejection fraction (30.0 ± 8.3% vs. 29.5 ± 8.6%; P = 0.678). WiSE-CRT upgrades were successful in 97.1% with procedure-related mortality in 1.9%. Coronary sinus upgrades were successful in 97.5% of cases with a 2.5% rate of CS dissection and 5.6% lead malfunction/displacement. At 6 months, 91 WiSE-CRT upgrades and 107 CS upgrades had similar improvements in CCS (76.3% vs. 68.5%; P = 0.210) and reduction in LVESV ≥15% (54.2% vs. 56.3%; P = 0.835). CONCLUSION Despite prior failed upgrades and high-risk patients with more comorbidities, WiSE-CRT upgrades had high rates of procedural success and similar improvements in CCS and LV remodelling with CS upgrades.
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Affiliation(s)
- Baldeep Singh Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK.,Cardiology department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Benjamin Sieniewicz
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK.,Cardiology department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK.,Cardiology department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK.,Cardiology department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vishal S Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK.,Cardiology department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Timothy R Betts
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Simon James
- The James Cook Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Andrew J Turley
- The James Cook Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Christian Butter
- Immanuel Heart Center Bernau & Brandenburg Medical School Theodor Fontane, Germany
| | - Martin Seifert
- Immanuel Heart Center Bernau & Brandenburg Medical School Theodor Fontane, Germany
| | - Lucas V A Boersma
- St. Antonius Ziekenhuis, Nieuwegein, Utrecht, Netherlands/AUMC, Amsterdam, Netherlands
| | - Sam Riahi
- Aalborg University Hospital, Aalborg, Denmark
| | | | - Mauro Biffi
- IRCCS Policlinico S'Or 25 sola-Malpighi, Bologna, Italy
| | | | | | - Martin Arnold
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Department of Cardiology, Erlangen, Germany
| | | | | | | | - Anthony Chow
- St. Bartholomew's Hospital, London, United Kingdom
| | | | | | | | - Angelo Auricchio
- Fondazione Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
| | - Steven A Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, UK.,Cardiology department, Guy's and St Thomas' NHS Foundation Trust, London, UK
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55
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Elgaard AF, Johansen JB, Nielsen JC, Gerdes C, Riahi S, Philbert BT, Haarbo J, Melchior TM, Larsen JM. Long-term follow-up of abandoned transvenous defibrillator leads: a nationwide cohort study. Europace 2021; 22:1097-1102. [PMID: 32447372 DOI: 10.1093/europace/euaa086] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/27/2019] [Accepted: 03/26/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Commonly, a dysfunctional defibrillator lead is abandoned and a new lead is implanted. Long-term follow-up data on abandoned leads are sparse. We aimed to investigate the incidence and reasons for extraction of abandoned defibrillator leads in a nationwide cohort and to describe extraction procedure-related complications. METHODS AND RESULTS All abandoned transvenous defibrillator leads were identified in the Danish Pacemaker and ICD Register from 1991 to 2019. The event-free survival of abandoned defibrillator leads was studied, and medical records of patients with interventions on abandoned defibrillator leads were audited for procedure-related data. We identified 740 abandoned defibrillator leads. Meantime from implantation to abandonment was 7.2 ± 3.8 years with mean patient age at abandonment of 66.5 ± 13.7 years. During a mean follow-up after abandonment of 4.4 ± 3.1 years, 65 (8.8%) abandoned defibrillator leads were extracted. Most frequent reason for extraction was infection (pocket and systemic) in 41 (63%) patients. Procedural outcome after lead extraction was clinical success in 63 (97%) patients. Minor complications occurred in 3 (5%) patients, and major complications in 1 (2%) patient. No patient died from complication to the procedure during 30-day follow-up after extraction. CONCLUSION More than 90% of abandoned defibrillator leads do not need to be extracted during long-term follow-up. The most common indication for extraction is infection. Abandoned defibrillator leads can be extracted with high clinical success rate and low risk of major complications at high-volume centres.
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Affiliation(s)
- Anders Fyhn Elgaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark
| | | | | | - Christian Gerdes
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | | | - Jens Haarbo
- Department of Cardiology, Gentofte Hospital, Hellerup, Denmark
| | | | - Jacob Moesgaard Larsen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark
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56
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Frydensberg VS, Johansen JB, Möller S, Riahi S, Wehberg S, Haarbo J, Philbert BT, Jørgensen OD, Larsen ML, Nielsen JC, Pedersen SS. Anxiety and depression symptoms in Danish patients with an implantable cardioverter-defibrillator: prevalence and association with indication and sex up to 2 years of follow-up (data from the national DEFIB-WOMEN study). Europace 2021; 22:1830-1840. [PMID: 33106878 DOI: 10.1093/europace/euaa176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/23/2020] [Accepted: 06/02/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS To investigate (i) the prevalence of anxiety and depression and (ii) the association between indication for implantable cardioverter-defibrillator (ICD) implantation and sex in relation to anxiety and depression up to 24 months' follow-up. METHODS AND RESULTS Patients with a first-time ICD, participating in the national, multi-centre, prospective DEFIB-WOMEN study (n = 1496; 18% women) completed the Hospital Anxiety and Depression Scale at baseline, 3, 6, 12, and 24 months. Data were analysed using linear mixed modelling for longitudinal data. Patients with a secondary prophylactic indication (SPI) had higher mean anxiety scores than patients with a primary prophylactic indication (PPI) at baseline, 3, and 12 months and higher mean depression scores at all-time points, except at 24 months. Women had higher mean anxiety scores as compared to men at all-time points; however, only higher mean depression scores at baseline. Overall, women with SPI had higher anxiety and depression symptom scores than men with SPI. Symptoms decreased over time in both women and men. From baseline to follow-up, the prevalence of anxiety (score ≥8) was highest in patients with SPI (13.3-20.2%) as compared to patients with PPI (range 10.0-14.7%). The prevalence of depression was stable over the follow-up period in both groups (range 8.5-11.1%). CONCLUSION Patients with a SPI reported higher anxiety and depression scores as compared to patients with PPI. Women reported higher anxiety scores than men, but only higher depression scores at baseline. Women with SPI reported the highest anxiety and depression scores overall.
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Affiliation(s)
- Vivi Skibdal Frydensberg
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark.,OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | | | - Sören Möller
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Sonja Wehberg
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.,Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Jens Haarbo
- Department of Cardiology, Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Berit Thornvig Philbert
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole Dan Jørgensen
- Department of Heart Lung & Vascular Surgery, Odense University Hospital, Odense, Denmark
| | | | | | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
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57
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Lunde ED, Joensen AM, Fonager K, Lundbye-Christensen S, Johnsen SP, Larsen ML, Lip GYH, Riahi S. Socioeconomic inequality in oral anticoagulation therapy initiation in patients with atrial fibrillation with high risk of stroke: a register-based observational study. BMJ Open 2021; 11:e048839. [PMID: 34059516 PMCID: PMC8169491 DOI: 10.1136/bmjopen-2021-048839] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The study aimed to examine the association between socioeconomic factors (SEFs) and oral anticoagulation (OAC) therapy and whether it was influenced by changing guidelines. We hypothesised that inequities in initiation of OAC reduced over time as more detailed and explicit clinical guidelines were issued. DESIGN Register-based observational study. SETTINGS All Danish patients with an incident hospital diagnosis of atrial fibrillation (AF), aged ≥30 years old and with high risk of stroke from 1 May 1999 to 2 October 2015 were included. Absolute risk differences (RD) (95% CI) were used to measure the association. PARTICIPANTS 154 448 patients (mean age 78.2 years, men 47.3%). EXPOSURE Education, family income and cohabiting status were the SEFs used as exposure. OUTCOME A prescription of OAC within -30 to +90 days of baseline (incident AF). RESULTS During 2002-2007, the crude RD of initiation of OAC for men with high education was 14.9% (12.8 to 16.9). Inequality reduced when new guidelines were published, and in 2013-2016 the crude RD was 5.6% (3.5 to 7.7). After adjusting for age, the RD substantially reduced. The same pattern was seen for cohabiting status, while inequality was smaller and more constant for income. CONCLUSION Patients with low income, low education and living alone were associated with lower chance of being initiated with OAC. For education and cohabiting status, the crude difference reduced around 2011, when more detailed clinical guidelines were implemented in Denmark. Our results indicate that new guidelines might reduce inequality in OAC initiation and that new, high-cost drugs increase inequality.
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Affiliation(s)
- Elin Danielsen Lunde
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Aalborg AF Study Group, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Kirsten Fonager
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Lundbye-Christensen
- Aalborg AF Study Group, Aalborg University Hospital, Aalborg, Denmark
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Aalborg AF Study Group, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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58
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Graversen CB, Valentin JB, Larsen ML, Riahi S, Holmberg T, Zinckernagel L, Johnsen SP. Lower perception of pharmacological treatment increases risk of non-adherence to medication. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.258] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation
Background
A large proportion of patients fail to reach optimal adherence to medication following incident ischemic heart disease (IHD) despite amble evidence of the beneficial effect of medication. Non-adherence to medication increases risk of disease-related adverse outcomes but none has explored how perception about pharmacological treatment detail on non-adherence using register-based follow-up data.
Purpose
To investigate the association between patients’ perception of pharmacological treatment and risk of non-initiation and non-adherence to medication in a population with incident IHD.
Methods
This cohort study followed 871 patients until 365 days after incident IHD. The study combined patient-reported survey data on perception about pharmacological treatment (categorised by ‘To a high level’, ‘To some level’, and ‘To a lesser level’) with register-based data on reimbursed prescription of cardiovascular medication (antithrombotics, statins, ACE-inhibitors/angiotensin receptor blockers, and β-blockers). Non-initiation was defined as no pick-up of medication in the first 180 days following incident IHD and analysed by Poisson regression. Two different measures evaluated non-adherence in patients initiating treatment: 1) proportion of days covered (PDC) analysed by Poisson regression, and 2) risk of discontinuation analysed by Cox proportional hazard regression. All analyses were adjusted for confounding variables (age, sex, ethnicity, income, educational level, civil status, occupation, charlson comorbidity index, supportive relatives, and individual consultation in medication) identified by directed acyclic graph and obtained from national registers and the survey. Item non-response was handled by multiple imputation and item consistency was evaluated by McDonalds omega.
Results
Lower perceptions about pharmacological treatment was associated with increased risk of non-initiation and non-adherence to medication irrespectively of drug class and adherence measure in the multiple adjusted analyses (please see figure illustrating results on antithrombotics). A dose-response relationship was observed both at 180- and 365-days of follow-up, but the steepest decline in adherence differed when comparing the two adherence measures (results not shown). Moderate internal consistency was found for the summed measure of perception (McDonalds omega = 0.67).
Conclusion
Lower perception of pharmacological treatment was associated with subsequent non-initiation and non-adherence to medication, irrespectively of measurement method and drug class.
Abstract Figure. Figre: Multiple adjusted analyses
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Affiliation(s)
- CB Graversen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - JB Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - ML Larsen
- Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - S Riahi
- Department of Cardiology and Department of Clinical Medicine , Aalborg University Hospital and The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - T Holmberg
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - L Zinckernagel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - SP Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
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59
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Bjerre J, Rosenkranz SH, Schou M, Jøns C, Philbert BT, Larroudé C, Nielsen JC, Johansen JB, Riahi S, Melchior TM, Torp-Pedersen C, Hlatky M, Gislason G, Ruwald AC. Driving following defibrillator implantation: a nationwide register-linked survey study. Eur Heart J 2021; 42:3529-3537. [PMID: 33954626 DOI: 10.1093/eurheartj/ehab253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/04/2021] [Accepted: 04/13/2021] [Indexed: 01/09/2023] Open
Abstract
AIMS Patients are restricted from driving following implantable cardioverter defibrillator (ICD) implantation or shock. We sought to investigate how many patients are aware of, and adhere to, the driving restrictions, and what proportion experience an ICD shock or other cardiac symptoms while driving. METHODS AND RESULTS We performed a nationwide survey of all living Danish residents 18 years or older who received a first-time ICD between 2013 and 2016 (n = 3913) and linked their responses with nationwide registers. Of 2741 respondents (47% primary prevention, 83% male, median age 67 years), 2513 (92%) held a valid driver's license at ICD implantation, 175 (7%) of whom had a license for professional driving. Many drivers were unaware of driving restrictions: primary prevention 58%; secondary prevention 36%; post-appropriate shock 28%; professional drivers 55%. Almost all (94%) resumed non-professional driving after ICD implantation, more than one-third during the restricted period; 35% resumed professional driving. During a median follow-up of 2.3 years, 5 (0.2%) reported receiving an ICD shock while driving, one of which resulted in a traffic accident. The estimated risk of harm was 0.0002% per person-year. CONCLUSION In this nationwide study, many ICD patients were unaware of driving restrictions, and more than one third resumed driving during a driving restriction period. However, the rate of reported ICD shocks while driving was very low.
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Affiliation(s)
- Jenny Bjerre
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 6, 3rd Floor, Hellerup 2900, Denmark.,Department of Cardiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Simone Hofman Rosenkranz
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 6, 3rd Floor, Hellerup 2900, Denmark
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 6, 3rd Floor, Hellerup 2900, Denmark
| | - Christian Jøns
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Berit Thornvig Philbert
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Charlotte Larroudé
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 6, 3rd Floor, Hellerup 2900, Denmark
| | - Jens Cosedis Nielsen
- Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Blvd. 82, 8200 Aarhus, Denmark
| | - Jens Brock Johansen
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9200 Aalborg, Denmark
| | - Thomas Maria Melchior
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology and Clinical Research, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Mark Hlatky
- Department of Medicine, Stanford University School of Medicine, 615 Crothers Way Encina Commons, Stanford, CA 94305, USA
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 6, 3rd Floor, Hellerup 2900, Denmark.,Department of Cardiovascular Epidemiology and Research, The Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark
| | - Anne-Christine Ruwald
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 6, 3rd Floor, Hellerup 2900, Denmark.,Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
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Hagengaard L, Andersen MP, Polcwiartek C, Larsen JM, Larsen ML, Skals RK, Hansen SM, Riahi S, Gislason G, Torp-Pedersen C, Søgaard P, Kragholm KH. Socioeconomic differences in outcomes after hospital admission for atrial fibrillation or flutter. Eur Heart J Qual Care Clin Outcomes 2021. [PMID: 31560375 DOI: 10.1093/ehjqcco/qcz053.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIMS To examine socioeconomic differences in care and outcomes in a 1-year period beginning 30 days after hospital discharge for first-time atrial fibrillation or flutter (AF) hospitalization. METHODS AND RESULTS This nationwide register-based follow-up cohort study investigated AF 30-day discharge survivors in Denmark during 2005-2014 and examined associations between patient's socioeconomic status (SES) and selected outcomes during a 1-year follow-up period beginning 30 days post-discharge after first-time hospitalization for AF. Patient SES was defined in four groups (lowest, second lowest, second highest, and highest) according to each patient's equivalized income. SES of the included 150 544 patients was: 27.7% lowest (n = 41 648), 28.1% second lowest (n = 42 321), 23.7% second highest (n = 35 656), and 20.5% highest (n = 30 919). Patients of lowest SES were older and more often women. Within 1-year follow-up, patients of lowest SES were less often rehospitalized or seen in outpatient clinics due to AF, or treated with cardioversion or ablation and were slightly more often diagnosed with stroke and heart failure (HF) and significantly more likely to die (16.1% vs. 14.9%, 11.3% and 8.1%). Hazard ratios for all-cause mortality were 0.64 (95% confidence interval 0.61-0.68) for highest vs. lowest SES, adjusted for CHA2DS2-VASc score, chronic obstructive pulmonary disease, rate- and rhythm-controlling drugs, and cohabitation status. CONCLUSION In 30-day survivors of first-time hospitalization due to AF, lowest SES is associated with increased 1-year all-cause and cardiovascular mortality and fewer cardioversions, ablations, readmissions, and outpatient contacts due to AF. Our findings indicate a need for socially differentiated rehabilitation following hospital discharge for first-time AF.
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Affiliation(s)
- Louise Hagengaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Mikkel Porsborg Andersen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark.,Department of Clinical Research, Nordsjællands Hospital, Dyrehvaevej 29, 3400 Hillerød, Denmark
| | - Christoffer Polcwiartek
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark.,Division of Cardiology, Duke University Medical Center, Erwin Road, Durham, NC 27710, USA
| | - Jacob Mosgaard Larsen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Mogens Lytken Larsen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Regitze Kuhr Skals
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Steen Møller Hansen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark.,Department of Clinical Research, Nordsjællands Hospital, Dyrehvaevej 29, 3400 Hillerød, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Kristian Hay Kragholm
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark.,Department of Cardiology, Hjørring Regional Hospital, Bispensgade 37, 9800 Hjørring, Denmark
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Giehm-Reese M, Johansen MN, Kronborg MB, Jensen HK, Gerdes C, Kristensen J, Johannessen A, Jacobsen PK, Djurhuus MS, Hansen PS, Riahi S, Nielsen JC. Discontinuation of oral anticoagulation and risk of stroke and death after ablation for typical atrial flutter: A nation-wide Danish cohort study. Int J Cardiol 2021; 333:110-116. [PMID: 33647366 DOI: 10.1016/j.ijcard.2021.02.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/02/2021] [Accepted: 02/19/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Oral anticoagulation (OAC) is indicated for patients with atrial fibrillation (AF) and atrial flutter (AFL) with a CHA2DS2-VASc score ≥ 2 for men and ≥3 for women. This is regardless of successful catheter ablation for their arrhythmia. Studies have mainly focused on AF, and little is known regarding use of OAC in AFL patients following catheter ablation. PURPOSE To describe discontinuation of OAC in a national cohort of patients who have undergone first-time cavo-tricuspid isthmus ablation (CTIA) for AFL. METHODS We identified patients undergoing first-time CTIA during the period 2010-2016 using the Danish National Ablation Registry. Information on comorbidities and OAC use were gathered using the Danish National Patient Registry and the Danish National Prescription Registry. Patients were followed until March 1st, 2018. RESULTS We identified 2409 consecutive patients. Median age was 66 (IQR 58-72) years, and 1952 (81%) were men. During mean follow-up of 4 ± 1.7 years, 723 (30%) patients discontinued OAC. Patients discontinuing OAC were younger, had less comorbidity, and a lower CHA2DS2-VASc score. During follow-up, 252 (10%) patients died, and 112 (5%) patients had a stroke. Incidence of both these events increased with increasing age and CHA2DS2-VASc score. In adjusted analysis, we observed higher mortality (p < 0.0001) in patients discontinuing OAC, while stroke rate was not significantly higher (p = 0.21). CONCLUSION In this national cohort of patients who have undergone first-time CTIA, patients discontinuing OAC treatment were younger and had less comorbidities. Patients remain at elevated risk of death and stroke/TIA, increasing with their age and CHA2DS2-VASc score.
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Affiliation(s)
| | | | | | | | - Christian Gerdes
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Kristensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Arne Johannessen
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
| | - Peter Karl Jacobsen
- Department of Cardiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | | | | | - Sam Riahi
- AF Study Group, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Ruwald MH, Ruwald AC, Johansen JB, Gislason G, Lindhardt TB, Nielsen JC, Torp-Pedersen C, Riahi S, Vinther M, Philbert BT. Temporal Incidence of Appropriate and Inappropriate Therapy and Mortality in Secondary Prevention ICD Patients by Cardiac Diagnosis. JACC Clin Electrophysiol 2021; 7:781-792. [PMID: 33516705 DOI: 10.1016/j.jacep.2020.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study sought to estimate the temporal development in rates and incidences of appropriate and inappropriate implantable cardioverter-defibrillator (ICD) therapy and shocks by cardiac diagnosis in a real-world population of patients with secondary prevention ICDs. BACKGROUND Data on cardiac diagnoses and temporal development of ICD therapies in patients with secondary prevention ICDs are limited. METHODS Patients (N = 4,587) with a secondary prevention ICD were identified from the Danish Pacemaker and ICD Register (January 1, 2007, to December 31, 2016) and linked to nationwide administrative registers. The outcome of appropriate and inappropriate ICD therapy and all-cause mortality were analyzed by annual event rates, cumulative incidence plots, and Cox regression models. RESULTS During a mean follow-up of 3.6 ± 2.4 years, 1,362 patients (30%) experienced appropriate ICD therapy (16.8% shocks), and 350 patients (7.6%) experienced inappropriate ICD therapy (4.6% shocks). From 2007 to 2016, there was a significant temporal reduction in both appropriate and inappropriate ICD therapy from 28.2 (95% confidence interval [CI]: 21.6 to 37.0) to 7.9 (95% CI: 6.8 to 9.1) and 10.0 (95% CI: 6.4 to 15.5) to 1.0 (95% CI: 0.7 to 1.5) per 100 person-years (p for trends <0.001). Multivariate Cox regression analyses showed that arrhythmogenic right ventricular cardiomyopathy was associated with the highest probability of appropriate ICD therapy (hazard ratio: 2.45; 95% CI: 1.77 to 3.39; p < 0.0001), whereas patients with hypertrophic cardiomyopathy had the lowest probability (hazard ratio: 0.62; 95% CI: 0.42 to 0.93; p = 0.0196) when compared to patients with ischemic heart disease. CONCLUSIONS In this nationwide real-life cohort of patients with secondary prevention ICDs, we observed a significant temporal decline in delivered appropriate and inappropriate shocks and ICD therapies in the last decade. A large proportion of patients still experienced ICD therapy but with significant differences by cardiac diagnosis.
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Affiliation(s)
- Martin H Ruwald
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark.
| | - Anne-Christine Ruwald
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Jens Brock Johansen
- Department of Cardiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark; National Institute of Public Health, Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark
| | - Tommi B Lindhardt
- Department of Cardiology, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | | | - Christian Torp-Pedersen
- Departments of Clinical investigation and Cardiology, North Zealand Hospital, Hillerod, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Michael Vinther
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Berit T Philbert
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
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Riahi S, Patil PN. Testing for central symmetry and symmetry about an axis. COMMUN STAT-SIMUL C 2021. [DOI: 10.1080/03610918.2020.1866204] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- S. Riahi
- Department of Marketing, Quantitative Analysis, and Business Law, Mississippi State University, Starkville, USA
| | - P. N. Patil
- Department of Mathematics and Statistics, Mississippi State University, Starkville, USA
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Affiliation(s)
- Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Wegeberg AM, Lunde ED, Riahi S, Ejskjaer N, Drewes AM, Brock B, Pop-Busui R, Brock C. Cardiac vagal tone as a novel screening tool to recognize asymptomatic cardiovascular autonomic neuropathy: Aspects of utility in type 1 diabetes. Diabetes Res Clin Pract 2020; 170:108517. [PMID: 33096186 DOI: 10.1016/j.diabres.2020.108517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 12/25/2022]
Abstract
AIMS To test the performance of the cardiac vagal tone (CVT) derived from a 5-minute ECG recording compared with the standardized cardiovascular autonomic reflex tests (CARTs). METHODS Cross-sectional study included 56 well-phenotyped adults with type 1 diabetes (19-71 years, 2-54 years disease-duration). Autonomic testing included: standardized CARTs obtained with the VAGUS™, CVT, and indices of heart rate variability (HRV) obtained at 24- and 120-hour, and electrochemical skin conductance assessed with SUDOSCAN®. ROC AUC and cut-off values were calculated for CVT to recognize CAN based on ≥ 2 (established CAN, n = 7) or 1 (borderline CAN, n = 9) abnormal CARTs and compared to HRV indices and electrochemical skin conductance. RESULTS Established CAN: The cut-off CVT value of 3.2LVS showed 67% sensitivity and 87% specificity (p = 0.01). Indices of HRV at either 24-hour (AUC > 0.90) and 120-hour (AUC > 0.88) performed better than CVT. Borderline CAN: The cut-off CVT value of 5.2LVS indicated 88% sensitivity and 63% specificity (p = 0.07). CVT performed better than HRV indices (AUC < 0.72). Electrochemical skin conductance (AUC:0.63-0.72) had lower sensitivity and specificity compared with CVT. CONCLUSIONS Implementation of CVT with a clinically applicable cut-off value may be considered a quicker and accessible screening tool which could ultimately decrease the number of unrecognized CAN and initiate earlier prevention initiatives.
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Affiliation(s)
- Anne-Marie Wegeberg
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, and Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Elin D Lunde
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Sam Riahi
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, and Clinical Institute, Aalborg University, Aalborg, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Niels Ejskjaer
- Steno Diabetes Center North Denmark, Aalborg University Hospital and Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Asbjørn M Drewes
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, and Clinical Institute, Aalborg University, Aalborg, Denmark; Steno Diabetes Center North Denmark, Aalborg University Hospital and Clinical Institute, Aalborg University, Aalborg, Denmark
| | | | - Rodica Pop-Busui
- Department of Internal Medicine, Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, USA
| | - Christina Brock
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, and Clinical Institute, Aalborg University, Aalborg, Denmark; Steno Diabetes Center North Denmark, Aalborg University Hospital and Clinical Institute, Aalborg University, Aalborg, Denmark.
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Andreasen L, Ahlberg G, Hartmann J, Paludan-Mueller C, Jensen H, Riahi S, Hansen J, Sandgaard N, Haunsoe S, Kanters J, Ellervik C, Bundgaard H, Svendsen J, Olesen M. Genome-wide association study of patients with atrioventricular nodal reentry tachycardia. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3687] [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
Supraventricular tachycardias (SVTs) originate from the atria or the area close to the AV node. AV nodal reentry tachycardia (AVNRT) is one of the tachyarrhytmias comprising the group of SVTs. The typical patient is female, young at disease onset, with a structurally normal heart. At present we do not know the etiology of AVNRT. We therefore hypothesized that AVNRT might be caused by changes in the DNA.
Methods
DNA from purified blood was obtained from patients with AVNRT verified by an invasive electrophysiological study. Patients were recruited from five ablation centers in Denmark and individuals from the general population of Denmark (the BEFUS cohort) served as controls. DNA was subjected to chip genotyping, imputation and analyses in a genome-wide association study (GWAS) setup.
Results
A GWAS on 1,143 AVNRT patients and 3,004 controls revealed one locus close to the gene MYH6 to reach genome-wide significance for association with AVNRT (P=4.8x10–8). MYH6 encodes the α-isoform of the protein myosin heavy chain important for the contractile units of the heart, the sarcomeres. The gene is predominantly expressed in the atria. Additional subthreshold loci located close to other plausible arrhythmia genes were identified.
Conclusion
We report the first genetic locus to be associated with AVNRT close to the sarcomere gene MYH6. This is, to our knowledge, the first gene ever associated with AVNRT.
Manhattan plot
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Rigshospitalets Forskningspulje - 3 years PhD salary
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Affiliation(s)
- L Andreasen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - G Ahlberg
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Hartmann
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - C Paludan-Mueller
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - H.K Jensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - S Riahi
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - J Hansen
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - N Sandgaard
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - S Haunsoe
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J.K Kanters
- University of Copenhagen, Department of Biomedical Sciences, Copenhagen, Denmark
| | - C Ellervik
- University of Copenhagen, Department of Clinical Medicine, Copenhagen, Denmark
| | - H Bundgaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J.H Svendsen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M.S Olesen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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Seifert M, Butter C, Reddy V, Neuzil P, Rinaldi A, James S, Turley A, Betts T, Arnold M, Riahi S, Delnoy P, Boersma L, Biffi M, Van Erven L, Schilling R. 863Leadless endocardial pacing improves symptoms in patients with failed conventional CRT implant in long term follow up. Europace 2020. [DOI: 10.1093/europace/euaa162.328] [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: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
EBR Systems, Inc
OnBehalf
WiSE-CRT and LV-SELECT study and POST-M REGISTRY
Background
The WiSE-CRT (Wireless stimulation endocardial) system has advantages over conventional epicardial CRT. Whenever conventional CRT failed to implant or failed to echocardiographic response, the WiSE-CRT was implanted as part of the WiSE CRT study (N = 13), as part of the LV-SELECT study (N = 35) or as part of the POST-M REGISTRY (N = 117) over the last 8 years. All these studies have reported high rates of clinical and echocardiographic response compared to conventional CRT.
Objectives
The purpose of this analysis was to determine the safety and clinical response in the largest available number of implanted patients (pts) with long term follow up of 2 years and the first, second and third generation of WiSE-CRT devices.
Method
All pts undergoing a WiSE-CRT implantation as part of the WiSE CRT study (N = 13), as part of the LV-SELECT study (N = 35) or as part of the POST-M REGISTRY (N = 117) were analysed (N = 165). Pts were followed-up for 24 months and considered CRT responders if an improvement in NYHA ≥ 1 class from baseline (pre-implant) was achieved.
Results
In total, 165 pts were implanted, demographics include: 68.2 ± 9.6 year’s old, 81.8% male, 49.7% with history of AFib and 54.5% non-ischaemic aetiology. The mean intrinsic QRS duration was 165.0 ± 32.3 msec (28 pts pace-maker dependent). 161 pts had the system successfully implanted with no major complications, 3 (1.8%) pts developed a pericardial effusion and 1 (0.6%) electrode was lost during implantation and recovered surgically. During the 24-month follow-up period, 20 (12.1%) pts died from any cause, 4 (2.4%) pts developed TIA or Stroke and 15 (9.1%) pts had pocket or transmitter infection. There was a significant improvement in NYHA functional class in 63.6% pts and an average improvement of -26.1 (-45.1, -7.1) msec in QRS duration.
Conclusion
Despite a history of failed conventional CRT implantation, pts undergoing CRT upgrades with a WiSE-CRT have a high success rate and a complication rate similar to previously described. In addition endocardial LV pacing led to symptomatic improvements in 64% of patients reaching the 24 month of follow up.
Abstract Figure 1: Forest Plot NYHA Responder Rat
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Affiliation(s)
- M Seifert
- Heart Center Brandenburg and Immanuel Klinikum, Bernau (Berlin), Germany
| | - C Butter
- Heart Center Brandenburg and Immanuel Klinikum, Bernau (Berlin), Germany
| | - V Reddy
- Mount Sinai Hospital, New York, United States of America
| | - P Neuzil
- Na Homolce Hospital, Prague, Czechia
| | - A Rinaldi
- Guy"s & St Thomas" NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - S James
- James Cook University Hospital, Middlesbrough, United Kingdom of Great Britain & Northern Ireland
| | - A Turley
- James Cook University Hospital, Middlesbrough, United Kingdom of Great Britain & Northern Ireland
| | - T Betts
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - M Arnold
- University hospital Erlangen, Erlangen, Germany
| | - S Riahi
- Aalborg University Hospital, Aalborg, Denmark
| | - P Delnoy
- Isala Hospital, Zwolle, Netherlands (The)
| | - L Boersma
- Diakonessenhuis, Utrecht, Netherlands (The)
| | - M Biffi
- Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - L Van Erven
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - R Schilling
- St Bartholomew"s Hospital, London, United Kingdom of Great Britain & Northern Ireland
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Zaremba T, Tayal B, Thogersen AM, Riahi S, Sogaard P. P536Reverse remodeling after cardiac resynchronization therapy is associated with improvement of contractile asymmetry in the area of left ventricular lead position. Europace 2020. [DOI: 10.1093/europace/euaa162.314] [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
Background
One third of patients receiving cardiac resynchronization therapy (CRT) do not respond to the treatment, possibly due to suboptimal lead position and persistent dyssynchronous left ventricular (LV) contraction.
Purpose
To assess the influence of LV lead position on improvement of contractile asymmetry and its significance for LV reverse remodeling after CRT.
Methods
Patients with heart failure and left bundle branch block undergoing CRT implantation were studied retrospectively. Assessment of mechanical delay within the LV was assessed using a recently developed index of contractile asymmetry (ICA). ICA was calculated as standard deviation of differences in systolic strain rate in the opposing LV walls derived from curved anatomical M-mode plots. LV was divided into 12 equally sized 30-degree sectors. Spline interpolation was used to estimate ICA in six opposing sector pairs permitting quantification of regional contractile asymmetry in the entire LV. Position of LV lead tip was assessed by thoracic computed tomography (CT). Response to CRT was defined as a reduction of LV end-systolic volume (ESV) ≥15% after 6 months.
Results
Study population (n= 26) consisted of 65.4% males, 68 ± 10 years, ischemic etiology in 42.3%, LV ejection fraction 24.1 ± 5.8%, QRS duration 171 ± 22 ms. CRT response was present in 18 (69.2%) patients. Pre-implantation ICA in the LV sector containing LV lead was 0.75 ± 0.24 s-1 in responders vs. 0.46 ± 0.16 s-1 in non-responders (p = 0.003). Reduction of ICA in the LV sector with LV lead was directly correlated with reduction of LV ESV after CRT (r = 0.46, p = 0.02) (Figure 1). ICA reduction in the LV sector with LV lead was -0.24 ± 0.28 s-1 in responders and -0.05 ± 0.16 s-1 in non-responders (p = 0.03). Meanwhile, reduction of ICA in the LV sectors located 60 degrees clockwise and 60 degrees counterclockwise away from the LV sector with LV lead (remote LV sectors) did not differ significantly between responders and non-responders: -0.12 ± 0.15 s-1 vs. -0.06 ± 0.1 s-1 (p = 0.28). Likewise, no significant correlation between reduction of ICA in remote LV sectors and LV ESV reduction was observed (p = 0.11).
Conclusion
Pre-implantation contractile asymmetry in the LV lead target area is associated with a positive response to CRT. Simultaneously, the degree of LV reverse remodeling after CRT seems to correlate with the magnitude of improvement of contractile asymmetry specifically in the region of LV lead location.
Abstract Figure 1
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Affiliation(s)
- T Zaremba
- Aalborg University Hospital, Aalborg, Denmark
| | - B Tayal
- Aalborg University Hospital, Aalborg, Denmark
| | | | - S Riahi
- Aalborg University Hospital, Aalborg, Denmark
| | - P Sogaard
- Aalborg University Hospital, Aalborg, Denmark
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69
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Sidhu BS, Porter B, Gould J, Sieniewicz B, Elliott M, Mehta V, Delnoy PPHM, Deharo JC, Butter C, Seifert M, Boersma LVA, Riahi S, James S, Turley AJ, Auricchio A, Betts TR, Niederer S, Sanders P, Rinaldi CA. Leadless left ventricular endocardial pacing in nonresponders to conventional cardiac resynchronization therapy. Pacing Clin Electrophysiol 2020; 43:966-973. [PMID: 32330307 DOI: 10.1111/pace.13926] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/23/2020] [Accepted: 04/19/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Endocardial pacing may be beneficial in patients who fail to improve following conventional epicardial cardiac resynchronization therapy (CRT). The potential to pace anywhere inside the left ventricle thus avoiding myocardial scar and targeting the latest activating segments may be particularly important. The WiSE-CRT system (EBR systems, Sunnyvale, CA) reliably produces wireless, endocardial left ventricular (LV) pacing. The purpose of this analysis was to determine whether this system improved symptoms or led to LV remodeling in patients who were nonresponders to conventional CRT. METHOD An international, multicenter registry of patients who were nonresponders to conventional CRT and underwent implantation with the WiSE-CRT system was collected. RESULTS Twenty-two patients were included; 20 patients underwent successful implantation with confirmation of endocardial biventricular pacing and in 2 patients, there was a failure of electrode capture. Eighteen patients proceeded to 6-month follow-up; endocardial pacing resulted in a significant reduction in QRS duration compared with intrinsic QRS duration (26.6 ± 24.4 ms; P = .002) and improvement in left ventricular ejection fraction (LVEF) (4.7 ± 7.9%; P = .021). The mean reduction in left ventricular end-diastolic volume was 8.3 ± 42.3 cm3 (P = .458) and left ventricular end-systolic volume (LVESV) was 13.1 ± 44.3 cm3 (P = .271), which were statistically nonsignificant. Overall, 55.6% of patients had improvement in their clinical composite score and 66.7% had a reduction in LVESV ≥15% and/or absolute improvement in LVEF ≥5%. CONCLUSION Nonresponders to conventional CRT have few remaining treatment options. We have shown in this high-risk patient group that the WiSE-CRT system results in improvement in their clinical composite scores and leads to LV remodeling.
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Affiliation(s)
- Baldeep S Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,Guy's and St Thomas' Hospital, London, UK
| | - Bradley Porter
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,Guy's and St Thomas' Hospital, London, UK
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,Guy's and St Thomas' Hospital, London, UK
| | - Benjamin Sieniewicz
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,Guy's and St Thomas' Hospital, London, UK
| | - Mark Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,Guy's and St Thomas' Hospital, London, UK
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,Guy's and St Thomas' Hospital, London, UK
| | | | | | - Christian Butter
- Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany
| | - Martin Seifert
- Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany
| | - Lucas V A Boersma
- St Antonius Ziekenhuis, Nieuwegein, Utrecht, the Netherlands.,Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Sam Riahi
- Aalborg University Hospital, Aalborg, Denmark
| | - Simon James
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Andrew J Turley
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | | | - Timothy R Betts
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,Guy's and St Thomas' Hospital, London, UK
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70
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Graversen CB, Johansen MB, Eichhorst R, Johnsen SP, Riahi S, Holmberg T, Larsen ML. Influence of socioeconomic status on the referral process to cardiac rehabilitation following acute coronary syndrome: a cross-sectional study. BMJ Open 2020; 10:e036088. [PMID: 32276957 PMCID: PMC7170636 DOI: 10.1136/bmjopen-2019-036088] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To evaluate the association between socioeconomic status (SES) and referral to cardiac rehabilitation (CR) after incident acute coronary syndrome (ACS) by dividing the referral process into three phases: (1) informed about CR, (2) willingness to participate in CR, (3) and assigned CR setting. DESIGN Cross-sectional study. SETTING Department of Cardiology at a Danish University Hospital from 1 January 2011 to 31 December 2014. PARTICIPANTS A total of 1229 patients assessed for CR during hospitalisation with ACS were prospectively registered in the Rehab-North Register from 2011 to 2014. SES was assessed using data from national registers, concerning: personal income, occupational status, educational level and civil status. Patients were excluded if one of the following criteria was fulfilled: (1) missing data on SES, or (2) acceptable reason for not informing patients about CR (treatment with coronary artery bypass grafting, transfer to another hospital, still under treatment or death). MAIN OUTCOME MEASURES Outcomes were defined by dividing the referral process into three phases: (1) informed about CR, (2) willingness to participate, and (3) assigned CR setting (in-hospital/community centre) after ACS. RESULTS A total of 854 (69.5 %) patients were referred to CR. After adjustment for age, gender, ACS diagnosis (ST-elevated myocardial infarction, non-ST-elevated myocardial infarction, unstable angina pectoris) and comorbidity, high income had the strongest association of referral to CR in all three phases (informed about CR: OR 2.17, 95% CI 1.01 to 4.64; willingness to participate in CR: OR 1.55, 95% CI 1.02 to 2.35; assigned in-hospital CR: OR 1.47, 95% CI 0.91 to 2.36). Educational level showed similar tendencies, however not statistically significant. The results did not vary according to gender. CONCLUSION This is the first study to investigate the referral process to CR using a three-phase structure. It suggests income and education to influence all phases in the referral process to CR after ACS.
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Affiliation(s)
| | | | | | - Søren Paaske Johnsen
- Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Teresa Holmberg
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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71
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Sieniewicz BJ, Betts TR, James S, Turley A, Butter C, Seifert M, Boersma LVA, Riahi S, Neuzil P, Biffi M, Diemberger I, Vergara P, Arnold M, Keane DT, Defaye P, Deharo JC, Chow A, Schilling R, Behar J, Rinaldi CA. Real-world experience of leadless left ventricular endocardial cardiac resynchronization therapy: A multicenter international registry of the WiSE-CRT pacing system. Heart Rhythm 2020; 17:1291-1297. [PMID: 32165181 PMCID: PMC7397503 DOI: 10.1016/j.hrthm.2020.03.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 03/02/2020] [Indexed: 01/28/2023]
Abstract
Background Biventricular endocardial pacing (BiV ENDO) is a therapy for heart failure patients who cannot receive transvenous epicardial cardiac resynchronization therapy (CRT) or have not responded adequately to CRT. BiV ENDO CRT can be delivered by a new wireless LV ENDO pacing system (WiSE-CRT system; EBR Systems, Sunnyvale, CA), without the requirement for lifelong anticoagulation. Objective The purpose of this study was to assess the safety and efficacy of the WiSE-CRT system during real-world clinical use in an international registry. Methods Data were prospectively collected from 14 centers implanting the WiSE-CRT system as part of the WiCS-LV Post Market Surveillance Registry. (ClinicalTrials.gov Identifier: NCT02610673). Results Ninety patients from 14 European centers underwent implantation with the WiSE-CRT system. Patients were predominantly male, age 68.2 ± 10.5 years, left ventricular ejection fraction 30.6% ± 8.9%, mean QRS duration 180.7 ± 27.0 ms, and 40% with ischemic etiology. Successful implantation and delivery of BiV ENDO pacing was achieved in 94.4% of patients. Acute (<24 hours), 1- to 30-day, and 1- to 6-month complications rates were 4.4%, 18.8%, and 6.7%, respectively. Five deaths (5.6%) occurred within 6 months (3 procedure related). Seventy percent of patients had improvement in heart failure symptoms. Conclusion BiV ENDO pacing with the WiSE-CRT system seems to be technically feasible, with a high success rate. Three procedural deaths occurred during the study. Procedural complications mandate adequate operator training and implantation at centers with immediately available cardiothoracic and vascular surgical support.
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Affiliation(s)
- Benjamin J Sieniewicz
- Division of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom; Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Timothy R Betts
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Simon James
- The James Cook Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Andrew Turley
- The James Cook Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Christian Butter
- Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany
| | - Martin Seifert
- Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany
| | - Lucas V A Boersma
- St. Antonius Ziekenhuis, Nieuwegein, Utrecht, Netherlands/AUMC, Amsterdam, Netherlands
| | - Sam Riahi
- Aalborg University Hospital, Aalborg, Denmark
| | | | | | | | | | - Martin Arnold
- University Hospital Erlangen, Department of Cardiology, Erlangen, Germany
| | | | | | | | - Anthony Chow
- St. Bartholomew's Hospital, London, United Kingdom
| | | | | | - Christopher A Rinaldi
- Division of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom; Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, United Kingdom
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72
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Giehm-Reese M, Kronborg MB, Lukac P, Kristiansen SB, Nielsen JM, Johannessen A, Jacobsen PK, Djurhuus MS, Riahi S, Hansen PS, Nielsen JC. Recurrent atrial flutter ablation and incidence of atrial fibrillation ablation after first-time ablation for typical atrial flutter: A nation-wide Danish cohort study. Int J Cardiol 2020; 298:44-51. [DOI: 10.1016/j.ijcard.2019.07.077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/16/2019] [Accepted: 07/24/2019] [Indexed: 12/01/2022]
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73
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Lunde ED, Joensen AM, Lundbye-Christensen S, Fonager K, Paaske Johnsen S, Larsen ML, Berg Johansen M, Riahi S. Socioeconomic position and risk of atrial fibrillation: a nationwide Danish cohort study. J Epidemiol Community Health 2019; 74:7-13. [PMID: 31619458 DOI: 10.1136/jech-2019-212720] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 05/28/2019] [Revised: 08/28/2019] [Accepted: 09/16/2019] [Indexed: 11/04/2022]
Abstract
AIM To examine the association between socioeconomic position and the risk of atrial fibrillation (AF) in different stages of life in a population of Danish citizens. METHODS Register-based study. We followed all individuals turning 35, 50, 65 or 80 years from 1 January 1996 to 31 December 2005 until AF, death, emigration or the end of study period (31 December 2015). Exposure was education and income. We used Cox regression for the HRs (95% CI) and the pseudo-observation method for the adjusted risk difference (RD) (%). RESULTS A total of 2 173 857 participants were enrolled and 151 340 incident cases of AF occurred over a median of 13.6 years of follow-up. Adjusted HR (95% CI) of incident AF for the youngest age group with the highest education (ref lowest) was 0.62 (0.50 to 0.77) (women) and 0.85 (0.76 to 0.96) (men). The associations attenuated with increasing age, that is, HRs for the oldest age group were 1.04 (0.97 to 1.10) and 0.98 (0.96 to 1.04), respectively. The corresponding adjusted RDs (%) were: -0.28 (-0.43 to -0.14), -0.18 (-0.36 to -0.01), 3.04 (-0.55 to 6.64) and -0.74 (-3.38 to 2.49), respectively. Similar but weaker associations were found for income. CONCLUSION Higher level of education and income was associated with a lower risk of being diagnosed with AF in young individuals but the association decreased with increasing age and was almost absent for the oldest age cohort. However, since AF is relatively rare in the youngest the RDs were low.
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Affiliation(s)
- Elin Danielsen Lunde
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark .,Aalborg AF Study Group, Aalborg University Hospital, Aalborg, Denmark.,Danish Centre against Inequality in Health (DACUS), Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Søren Lundbye-Christensen
- Aalborg AF Study Group, Aalborg University Hospital, Aalborg, Denmark.,Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Kirsten Fonager
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Mogens Lytken Larsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Danish Centre against Inequality in Health (DACUS), Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Aalborg AF Study Group, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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74
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Bjerre J, Rosenkranz SM, Schou M, Jons C, Philbert BT, Larroude C, Nielsen JC, Johansen JB, Melchior T, Riahi S, Torp-Pedersen C, Gislason G, Hlatky MA, Ruwald AC. 5968Adherence to driving restrictions among patients with an implantable cardioverter defibrillator: insights from a nationwide register-linked survey study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0109] [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
Patients with an implantable cardioverter defibrillator (ICD) are restricted from driving following initial implantation or ICD shock. It is unclear how many patients are aware of, and adhere to, these restrictions.
Purpose
To investigate knowledge of, and adherence to, private and professional driving restrictions in a nationwide cohort of ICD patients.
Methods
A questionnaire was distributed to all living Danish residents ≥18 years who received a first-time ICD between 2013 and 2016 (n=3,913). During this period, Danish guidelines recommended 1 week driving restriction following ICD implantation for primary prevention, and 3 months following either ICD implantation for secondary prevention or appropriate ICD shock, and permanent restriction of professional driving and driving of large vehicles (>3.5 metric tons). Questionnaires were linked with relevant nationwide registries. Logistic regression was applied to identify factors associated with non-adherence.
Results
Of 2,741 questionnaire respondents, 92% (n=2,513) held a valid private driver's license at time of ICD implantation (85% male; 46% primary prevention indication; median age: 67 years (IQR: 59–73)). Of these, 7% (n=175) were actively using a professional driver's license for truck driving (n=73), bus driving (n=45), taxi driving (n=22), large vehicle driving for private use (n=54), or other purposes (n=32) (multiple purposes allowed).
Only 42% of primary prevention patients, 63% of secondary prevention patients, and 72% of patients who experienced an appropriate ICD shock, recalled being informed of any driving restrictions. Only 45% of professional drivers recalled being informed about specific professional driving restrictions (Figure). Most patients (93%, n=2,344) resumed private driving after ICD implantation, more than 30% during the driving restriction period: 34% of primary prevention patients resumed driving within 1 week, 43% of secondary prevention patients resumed driving within 3 months, and 30% of patients who experienced an appropriate ICD shock resumed driving within 3 months. Professional driving was resumed by 35%. Patients who resumed driving within the restricted periods were less likely to report having received information about driving restrictions (all p<0.001) (Figure).
In a multiple logistic regression model, non-adherence was predicted by reporting non-receipt of information about driving restrictions (OR: 3.34, CI: 2.27–4.03), as well as male sex (OR: 1.53, CI: 1.17–2.01), age ≥60 years (OR: 1.20, CI: 1.02–1.64), receipt of a secondary prevention ICD (OR: 2.2, CI: 1.80–2.62), and being the only driver in the household (OR: 1.29, CI: 1.05–1.57).
Conclusion
In this nationwide survey study, many ICD patients were unaware of the driving restrictions, and many ICD patients, including professional drivers, resumed driving within the restricted periods. More focus on communicating driving restrictions might improve adherence.
Acknowledgement/Funding
Danish Heart Foundation, Arvid Nilsson Foundation, Fraenkels Mindefond
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Affiliation(s)
- J Bjerre
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - S M Rosenkranz
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Schou
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - C Jons
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - B T Philbert
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - C Larroude
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J C Nielsen
- Skejby University Hospital, Department of Cardiology, Aarhus, Denmark
| | - J B Johansen
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - T Melchior
- Zealand University Hospital, Department of Cardiology, Roskilde, Denmark
| | - S Riahi
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - C Torp-Pedersen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - G Gislason
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M A Hlatky
- School of Medicine, Health Research and Policy, Stanford, United States of America
| | - A C Ruwald
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
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75
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Giehm-Reese M, Kronborg MB, Lukac P, Kristiansen SB, Nielsen JM, Johannessen A, Jacobsen PK, Djurhuus MS, Riahi S, Hansen PS, Nielsen JC. P2845Recurrent atrial flutter and incidence of atrial fibrillation ablation after first-time ablation for typical atrial flutter: a nation-wide Danish cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1155] [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
Cavo tricuspid isthmus ablation (CTIA) is an effective first-line treatment for typical atrial flutter (AFL). However, many patients develop atrial fibrillation (AF) after successful CTIA. Knowledge about recurrent arrhythmia after CTIA mainly comes from small cohort studies with limited follow-up.
Purpose
To describe incidences of AFL re-ablation and AF-ablation after first-time CTIA in a nation-wide cohort.
Method
In the Danish National Ablation Registry we identified patients undergoing first-time CTIA during 2010–2016. Subsequent CTIA and AF-ablation procedures were identified until March 1st, 2018. We gathered information on patient comorbidities in the Danish National Patient Registry.
Results
We identified 2409 patients undergoing first-time CTIA. Median age was 66 (IQR 58–72) years, and 1952 (81%) were men. 78 (3%) had a history of AF. Acute procedural succes was achieved in 2288 (95%) patients. During mean follow-up of 4±1.7 years, 242 (10%) patients underwent CTI re-ablation and 326 (13.5%) ablation for AF. Baseline characteristics associated with CTI re-ablation included prolonged procedural time, unsuccessful first CTIA, age<75 years and CHA2DS2-VASc score<2. Hypertension, history of AF, age<65 years and CHA2DS2-VASc score<2 were associated with later AF-ablation (Table).
Predictive characteristics Characteristics associated with CTI re-ablation HR 95% CI p-value Procedural time 1.003 (1.001–1.006) 0.01 Unsuccesful first CTIA procedure 3.42 (2.10–5.55) <0.0001 Age <75 years 1.52 (1.03–2.26) 0.04 CHA2DS-VAS2c score <2 1.45 (1.11–1.90) 0.01 Characteristics associated with later AF-ablation Hypertension 1.31 (1.02–1.69) 0.04 History of AF 1.70 (1.07–2.71) 0.03 Age <65 years 2.38 (1.89–3.01) <0.0001 CHA2DS-VAS2c score <2 1.77 (1.40–2.45) <0.0001 AF: Atrial fibrillation; HR: Hazard ratio. All HR's are adjusted for age, gender, hypertension, diabetes, heart failure, iscemic heart disease, valvular heart disease, chronic obstructive lung disease, chronic kidney disease and history of AF using Cox regression analysis.
Conclusion
In a nation-wide cohort undergoing CTIA for AFL, 10% of patients underwent CTI re-ablation and 13.5% were ablated for AF during mean follow-up of 4±1.7 years. Probability of undergoing a second ablation procedure was higher in younger patients with less comorbidity.
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Affiliation(s)
- M Giehm-Reese
- Skejby University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M B Kronborg
- Skejby University Hospital, Department of Cardiology, Aarhus, Denmark
| | - P Lukac
- Skejby University Hospital, Department of Cardiology, Aarhus, Denmark
| | - S B Kristiansen
- Skejby University Hospital, Department of Cardiology, Aarhus, Denmark
| | - J M Nielsen
- Skejby University Hospital, Department of Cardiology, Aarhus, Denmark
| | - A Johannessen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - P K Jacobsen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M S Djurhuus
- Odense University Hospital, Department of Cardiology-B, Odense, Denmark
| | - S Riahi
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - P S Hansen
- Mølholm Private Hospital, Department of Cardiology, Vejle, Denmark
| | - J C Nielsen
- Skejby University Hospital, Department of Cardiology, Aarhus, Denmark
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76
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Glud Heiredal S, Schou M, Gislason G, Johansen JB, Philpert BT, Vinther M, Haarbo J, Torp-Pedersen C, Riahi S, Nielsen JC, Ruwald AC. 4178Insulin treatment is associated with increased risk of device-treated ventricular tachyarrhythmia in patients with diabetes and heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0124] [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
It is debated whether insulin use is associated with a pro-arrhythmic effect. There is paucity of studies investigating this aspect in patients with heart failure (HF), where use of insulin is associated with an increased mortality risk.
Purpose
We aimed to investigate whether patients receiving insulin had higher risk of device-treated ventricular tachyarrhythmia (VTA) in a population of HF patients with medically treated diabetes and primary prevention implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy with defibrillator (CRT-D).
Methods
Information on ICD/CRT-D implantation and therapy, comorbidities, diabetes, diabetes-related complications and medication were obtained through Danish nationwide registers. From 2007 through 2016 we identified all primary prevention ICD/CRT-D implantations in HF patients with diabetes, defined as treatment with antidiabetic medication within one year prior to implantation. Patients were divided into two groups; Insulin treated vs. non-insulin treated patients. Endpoints of interest were VTA, defined as appropriate ICD therapy, and all-cause mortality. Cumulative incidence curves and adjusted Cox proportional Hazards regression analyses were used to assess risk of outcomes. Adjustment variables included age, gender, ischemic heart disease (IHD), left ventricular ejection fraction (LVEF), ICD vs. CRT-D, diuretic use (as a proxy for severity of HF), prior VTA and diabetes-related complications, identified from diagnosis codes for diabetic nephro-, retino-, and neuropathy, multiple diabetic complications and unspecified diabetic complications.
Results
We identified 1240 patients with HF and diabetes with a primary prevention ICD/CRT-D. The majority of patients had type 2 diabetes (94%). Of these 479 patients (39%) were treated with insulin and 761 (61%) were not. Patients were primarily male (85%) with mean age of 66.9±8.3 years, mean LVEF of 25.6±7.5%, 42% had CRT-D and 58% ICD, without differences between the groups. The insulin-treated group had a higher occurrence of diabetes-related complications (81% vs. 42%, p<0.01) and IHD (95% vs. 90%, p<0.01).
During a mean follow-up of 3.1±2.1 years, 74 insulin treated patients (16%) and 86 non-insulin treated patients (11%) experienced VTA (p=0.034), with higher 5-year cumulative incidence of VTA in the insulin group.
Insulin treatment was associated with significantly increased risk of VTA (HR = 1.45; 95% CI [1.04–2.03], p=0.031) and all-cause mortality (HR=1.27; 95% CI [1.03–1.58], p=0.027), as compared with non-insulin treated patients.
Figure 1
Conclusion
In HF patients with diabetes implanted with a primary prevention ICD/CRT-D, treatment with insulin was associated with a significant 45% increased risk of device-treated ventricular tachyarrhythmias and 27% increased risk of all-cause mortality. These findings support further clinical trials to evaluate the safety of insulin in patients with HF and type 2 diabetes.
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Affiliation(s)
- S Glud Heiredal
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Schou
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - G Gislason
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J B Johansen
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - B T Philpert
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Vinther
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Haarbo
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - C Torp-Pedersen
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - S Riahi
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - J C Nielsen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - A C Ruwald
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
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Graversen CB, Johansen MB, Johnsen SP, Riahi S, Holmberg T, Larsen ML. P631Socioeconomic status; how does it influence referral to cardiac rehabilitation after acute myocardial infarction? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0239] [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 low socioeconomic status who are referred to cardiac rehabilitation (CR) has been documented to be relative lower than patients with high SES among all patients hospitalised with acute myocardial infarction (AMI).
Purpose
The aims of this study were to evaluate the referral process to CR and how it is influenced by socioeconomic variables.
Methods
In 2011–2014, 1229 patients were hospitalised with AMI at Department of Cardiology of our University Hospital, Denmark. All were evaluated for participation to CR. Socioeconomic status was measured by personal income, educational level, marital status, and employment and obtained from national registers. Multiple logistic regression assessed socioeconomic determinants in three phases of the referral process to CR: 1. information about CR, 2. wish to participate in CR, and 3. referral to specialiced- or municipality-based CR. All analyses were adjusted for sex, age, and comorbidities.
Results
A total of 1123 (91.4%) patients received information regarding CR. Of these, 854 (69.5%) patients wished to participate in the programme. Income was the most important socioeconomic variable when looking at who were informed about CR (OR 2.17, 95%-CI: 1.0- 4.64) and who wished to participate in CR (OR 1.55, 95%-CI: 1.02–2.35).
Characteristics of study participants Characteristics All participants STEMI NSTEMI UAP n=1229 n=402 n=711 n=116 Male (n, %) 907 (73.8) 322 (80.1) 503 (70.7) 82 (70.7) Age Group (yrs) <65 591 (48.1) 227 (56.5) 308 (43.3) 56 (48.3) 65–74 371 (30.2) 116 (28.9) 215 (30.2) 40 (34.5) ≥75 267 (21.7) 59 (14.7) 188 (26.4) 20 (17.2) Baseline Comorbidity Hypertension 241 (19.6) 62 (15.4) 148 (20.8) 31 (26.7) Diabetes 14 (1.1) <5 (<1) 8 (1.1) <5 (<1) Charlson Comorbidity Index Low (0 points) 1088 (88.5) 358 (89.1) 630 (88.6) 100 (86.2) Moderate/High (>0) 141 (11.5) 44 (10.9) 81 (11.4) 16 (13.8) Civil status (n, %) Married/Partnership 793 (64.5) 253 (62.9) 449 (63.2) 91 (78.4) Divorced/Unmarried/Widow 436 (35.5) 149 (37.1) 262 (36.8) 25 (21.6) Occupational status (n, %) Employed 479 (39.0) 195 (48.5) 240 (33.8) 44 (37.9) Unemployed/Retired 750 (61.0) 207 (51.5) 471 (66.2) 72 (62.1) Educational status (n, %) Low 516 (42.0) 144 (35.8) 322 (45.3) 50 (43.1) Medium 539 (43.9) 201 (50.0) 293 (41.2) 45 (38.8) High 174 (14.2) 57 (14.2) 96 (13.5) 21 (18.1) Gross income, tertile (n, %) Low 405 (33.0) 113 (28.1) 251 (35.3) 41 (35.3) Medium 406 (33.0) 124 (30.8) 247 (34.7) 35 (30.2) High 418 (34.0) 165 (41.0) 213 (30.0) 40 (34.5) STEMI: ST-elevated myocardial infarction; NSTEMI: non-ST-elevated myocardial infarction; UAP: unstable angina pectoris.
Conclusion
Two out of three patients received referral to CR. However, higher income was proportional with the likelihood of receiving information about CR and willingness to participate in the programme.
Acknowledgement/Funding
the Danish Heart Foundation
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Affiliation(s)
- C B Graversen
- Aalborg University Hospital, Cardiology, Aalborg, Denmark
| | - M B Johansen
- Aalborg University Hospital, Unit of Clinical Biostatistics, Aalborg, Denmark
| | - S P Johnsen
- Aalborg University, Department of Clinical Medicine, Aalborg, Denmark
| | - S Riahi
- Aalborg University Hospital, Cardiology, Aalborg, Denmark
| | - T Holmberg
- National Institute of Public Health, Copenhagen, Denmark
| | - M L Larsen
- Aalborg University Hospital, Cardiology, Aalborg, Denmark
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Hagengaard L, Andersen MP, Polcwiartek C, Larsen JM, Larsen ML, Skals RK, Hansen SM, Riahi S, Gislason G, Torp-Pedersen C, Søgaard P, Kragholm KH. Socioeconomic differences in outcomes after hospital admission for atrial fibrillation or flutter. European Heart Journal - Quality of Care and Clinical Outcomes 2019; 7:295-303. [PMID: 31560375 DOI: 10.1093/ehjqcco/qcz053] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/06/2019] [Accepted: 09/23/2019] [Indexed: 12/31/2022]
Abstract
Abstract
Aims
To examine socioeconomic differences in care and outcomes in a 1-year period beginning 30 days after hospital discharge for first-time atrial fibrillation or flutter (AF) hospitalization.
Methods and results
This nationwide register-based follow-up cohort study investigated AF 30-day discharge survivors in Denmark during 2005–2014 and examined associations between patient’s socioeconomic status (SES) and selected outcomes during a 1-year follow-up period beginning 30 days post-discharge after first-time hospitalization for AF. Patient SES was defined in four groups (lowest, second lowest, second highest, and highest) according to each patient’s equivalized income. SES of the included 150 544 patients was: 27.7% lowest (n = 41 648), 28.1% second lowest (n = 42 321), 23.7% second highest (n = 35 656), and 20.5% highest (n = 30 919). Patients of lowest SES were older and more often women. Within 1-year follow-up, patients of lowest SES were less often rehospitalized or seen in outpatient clinics due to AF, or treated with cardioversion or ablation and were slightly more often diagnosed with stroke and heart failure (HF) and significantly more likely to die (16.1% vs. 14.9%, 11.3% and 8.1%). Hazard ratios for all-cause mortality were 0.64 (95% confidence interval 0.61–0.68) for highest vs. lowest SES, adjusted for CHA2DS2-VASc score, chronic obstructive pulmonary disease, rate- and rhythm-controlling drugs, and cohabitation status.
Conclusion
In 30-day survivors of first-time hospitalization due to AF, lowest SES is associated with increased 1-year all-cause and cardiovascular mortality and fewer cardioversions, ablations, readmissions, and outpatient contacts due to AF. Our findings indicate a need for socially differentiated rehabilitation following hospital discharge for first-time AF.
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Affiliation(s)
- Louise Hagengaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Mikkel Porsborg Andersen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark
- Department of Clinical Research, Nordsjællands Hospital, Dyrehvaevej 29, 3400 Hillerød, Denmark
| | - Christoffer Polcwiartek
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
- Division of Cardiology, Duke University Medical Center, Erwin Road, Durham, NC 27710, USA
| | - Jacob Mosgaard Larsen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Mogens Lytken Larsen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Regitze Kuhr Skals
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Steen Møller Hansen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark
- Department of Clinical Research, Nordsjællands Hospital, Dyrehvaevej 29, 3400 Hillerød, Denmark
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Kristian Hay Kragholm
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark
- Department of Cardiology, Hjørring Regional Hospital, Bispensgade 37, 9800 Hjørring, Denmark
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79
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Rantanen JM, Riahi S, Schmidt EB, Johansen MB, Søgaard P, Christensen JH. Arrhythmias in Patients on Maintenance Dialysis: A Cross-sectional Study. Am J Kidney Dis 2019; 75:214-224. [PMID: 31542235 DOI: 10.1053/j.ajkd.2019.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 02/04/2019] [Accepted: 06/29/2019] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Patients with kidney failure treated with maintenance dialysis experience a high rate of mortality, in part due to sudden cardiac death caused by arrhythmias. The prevalence of arrhythmias, including the subset that are clinically significant, is not well known. This study sought to estimate the prevalence of arrhythmias, characterize the pattern of arrhythmic events in relation to dialysis treatments, and identify associated clinical characteristics. STUDY DESIGN Cross-sectional study. SETTING & PARTICIPANTS 152 patients with kidney failure treated with maintenance dialysis in Denmark. EXPOSURES Dialysis treatment; clinical characteristics; cardiac output and preload defined using echocardiography. OUTCOMES Prevalence and pattern of arrhythmias on 48-hour Holter monitoring; odds ratios for arrhythmias. ANALYTICAL APPROACH Descriptive analysis of the prevalence of arrhythmias. Pattern of arrhythmias described using a repeated-measures negative binomial regression model. Associations between clinical characteristics and echocardiographic findings with arrhythmias were assessed using logistic regression. RESULTS Among the 152 patients studied, 83.6% were treated with in-center dialysis; 10.5%, with home hemodialysis; and 5.9%, with peritoneal dialysis. Premature atrial and ventricular complexes were seen in nearly all patients and 41% had paroxysmal supraventricular tachycardia. Clinically significant arrhythmias included persistent atrial fibrillation observed among 8.6% of patients, paroxysmal atrial fibrillation among 3.9%, nonsustained ventricular tachycardia among 19.7%, bradycardia among 4.6%, advanced second-degree atrioventricular block among 1.3%, and third-degree atrioventricular block among 2.6%. Premature ventricular complexes were more common on dialysis days, while tachyarrhythmias were more often observed during dialysis and in the immediate postdialytic period. Older age (OR per 10 years older, 1.53; 95% CI, 1.15-2.03; P=0.003), elevated preload (OR, 4.02; 95% CI, 1.05-15.35; P=0.04), and lower cardiac output (OR per 1L/min greater, 0.66; 95% CI, 0.44-1.00; P=0.05) were independently associated with clinically significant arrhythmias. LIMITATIONS Arrhythmia monitoring limited to 48 hours; small sample size; heterogeneous nature of the population, risk for residual confounding. CONCLUSIONS Arrhythmias, including clinically significant abnormal rhythms, were common. Tachyarrhythmias were more frequent during dialysis and the immediate postdialytic period. The relevance of these findings to clinical outcomes requires additional study.
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Affiliation(s)
- Jesper Moesgaard Rantanen
- Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Sam Riahi
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; AF Study Group, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Erik Berg Schmidt
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; AF Study Group, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Peter Søgaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jeppe Hagstrup Christensen
- Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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80
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Joensen AM, Dinesen PT, Svendsen LT, Hoejbjerg TK, Fjerbaek A, Andreasen J, Sottrup MB, Lundbye-Christensen S, Vadmann H, Riahi S. Effect of patient education and physical training on quality of life and physical exercise capacity in patients with paroxysmal or persistent atrial fibrillation: A randomized study. J Rehabil Med 2019; 51:442-450. [PMID: 30931484 DOI: 10.2340/16501977-2551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine the effect of a rehabilitation programme on quality of life and physical capacity in patients with atrial fibrillation. METHODS Patients with paroxysmal or persistent atrial fibrillation were randomized to either a 12-week rehabilitation programme with education and physical training (intervention group) or standard care (control group). At baseline, after 3, 6 and 12 months participants completed 5 different quality of life questionnaires (Quality of Life in patients with Atrial Fibrillation (AF-QoL-18), Atrial Fibrillation Effect on QualiTy of Life (AFEQT), Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder Assessment (GAD-7) and EuroQol 5D (EQ-5D)), and physical exercise tests. Differences in mean] scores between groups were analysed by repeated measures analysis of variance (ANOVA). RESULTS Fifty-eight patients (age range 43-78 years, 31% female) were included. In the intervention group the AF-QoL-18 score increased from baseline (48.4 (standard deviation (SD) 22.8)) to 6 months (68.0 (SD 15.2)) compared with the control group (baseline 51.6 (SD 22.3), 6 months 59.2 (SD 27.3)). After 12 months, there was no difference. Similar patterns were found for the other questionnaires. Maximum exercise capacity improved in the intervention group from baseline (176 W (SD 48)) to 6 months (190 W (SD 55)). There was no change in the control group. CONCLUSION Education and physical training may have a short-term (but no long-term) beneficial effect on quality of life and physical exercise capacity in patients with atrial fibrillation.
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Affiliation(s)
- Albert M Joensen
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
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81
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Brock C, Hansen CS, Karmisholt J, Møller HJ, Juhl A, Farmer AD, Drewes AM, Riahi S, Lervang HH, Jakobsen PE, Brock B. Liraglutide treatment reduced interleukin-6 in adults with type 1 diabetes but did not improve established autonomic or polyneuropathy. Br J Clin Pharmacol 2019; 85:2512-2523. [PMID: 31338868 PMCID: PMC6848951 DOI: 10.1111/bcp.14063] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [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] [Received: 04/11/2019] [Revised: 06/30/2019] [Accepted: 07/08/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS Type 1 diabetes can be complicated with neuropathy that involves immune-mediated and inflammatory pathways. Glucagon-like peptide-1 receptor agonists such as liraglutide, have shown anti-inflammatory properties, and thus we hypothesized that long-term treatment with liraglutide induced diminished inflammation and thus improved neuronal function. METHODS The study was a randomized, double-blinded, placebo-controlled trial of adults with type 1 diabetes and confirmed symmetrical polyneuropathy. They were randomly assigned (1:1) to receive either liraglutide or placebo. Titration was 6 weeks to 1.2-1.8 mg/d, continuing for 26 weeks. The primary endpoint was change in latency of early brain evoked potentials. Secondary endpoints were changes in proinflammatory cytokines, cortical evoked potential, autonomic function and peripheral neurophysiological testing. RESULTS Thirty-nine patients completed the study, of whom 19 received liraglutide. In comparison to placebo, liraglutide reduced interleukin-6 (-22.6%; 95% confidence interval [CI]: -38.1, -3.2; P = .025) with concomitant numerical reductions in other proinflammatory cytokines. However neuronal function was unaltered at the central, autonomic or peripheral level. Treatment was associated with -3.38 kg (95% CI: -5.29, -1.48; P < .001] weight loss and a decrease in urine albumin/creatinine ratio (-40.2%; 95% CI: -60.6, -9.5; P = .02). CONCLUSION Hitherto, diabetic neuropathy has no cure. Speculations can be raised whether mechanism targeted treatment, e.g. lowering the systemic level of proinflammatory cytokines may lead to prevention or treatment of the neuroinflammatory component in early stages of diabetic neuropathy. If ever successful, this would serve as an example of how fundamental mechanistic principles are translated into clinical practice similar to those applied in the cardiovascular and nephrological clinic.
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Affiliation(s)
- Christina Brock
- Mech-Sense, Department of Gastroenterology and Hepatology Aalborg University Hospital & Clinical Institute, Aalborg University, Aalborg, Denmark.,Department of Pharmacotherapy and Development, University of Copenhagen, Copenhagen, Denmark
| | | | - Jesper Karmisholt
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.,Steno Diabetes Center North, Denmark
| | - Holger Jon Møller
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Juhl
- Department of Neurophysiology, Aalborg University Hospital, Denmark
| | - Adam Donald Farmer
- Centre for Neuroscience and Trauma, Wingate Institute of Neurogastroenterology, Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK.,Department of Gastroenterology, University Hospitals of North Midlands, Stoke on Trent, Staffordshire, UK
| | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology Aalborg University Hospital & Clinical Institute, Aalborg University, Aalborg, Denmark.,Steno Diabetes Center North, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital and Department of Clinical Medicine, Aalborg University, Denmark
| | | | - Poul Erik Jakobsen
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.,Steno Diabetes Center North, Denmark
| | - Birgitte Brock
- Steno Diabetes Center Copenhagen, Region Hovedstaden, Gentofte, Denmark.,Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
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82
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Tayal B, Fruelund P, Sogaard P, Riahi S, Polcwiartek C, Atwater BD, Gislason G, Risum N, Torp-Pedersen C, Kober L, Kragholm KH. Incidence of heart failure after pacemaker implantation: a nationwide Danish Registry-based follow-up study. Eur Heart J 2019; 40:3641-3648. [DOI: 10.1093/eurheartj/ehz584] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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] [Received: 11/23/2018] [Revised: 02/25/2019] [Accepted: 07/30/2019] [Indexed: 01/14/2023] Open
Abstract
Abstract
Aims
The objective of the current study is to investigate the risk of heart failure (HF) after implantation of a pacemaker (PM) with a right ventricular pacing (RVP) lead in comparison to a matched cohort without a PM and factors associated with this risk.
Methods and results
All patients without a known history of HF who had a PM implanted with an RVP lead between 2000 and 2014 (n = 27 704) were identified using Danish nationwide registries. An age- and gender-matched control cohort (matched 1:5, n = 138 520) without PM and HF was identified to compare the risk. Outcome was the cumulative incidence of HF including fatal HF within the first 2 years of PM implantation, with all-cause mortality and myocardial infarction (MI) as competing risks. Due to violation of proportional hazards, the follow-up period was divided into three time-intervals: <30 days, 30–180 days, and >180 days–2 years. The cumulative incidence of HF including fatal HF was observed in 2937 (10.6%) PM patients. Risks for the three time-intervals were <30 days [hazard ratio (HR) 5.98, 95% CI 5.19–6.90], 30–180 days (HR 1.84, 95% CI 1.71–1.98), and >180 days (HR 1.11, 95% CI 1.04–1.17). Among patients with a PM device, factors associated with increased risk of HF were male sex (HR 1.33, 95% CI 1.24–1.43), presence of chronic kidney disease (CKD) (HR 1.64, 95% CI 1.29–2.09), and prior MI (1.77, 95% 1.50–2.09).
Conclusions
Pacemaker with an RVP lead is strongly associated with risk of HF specifically within the first 6 months. Patients with antecedent history of MI and CKD had substantially increased risk.
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Affiliation(s)
- Bhupendar Tayal
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
| | - Patricia Fruelund
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
| | - Peter Sogaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
| | - Christoffer Polcwiartek
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Brett D Atwater
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Gunnar Gislason
- Department of Medicine, Zealand University Hospital, Køge, Denmark
- Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Denmark
- Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Niels Risum
- Department of Clinical Investigation and Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
- Department of Clinical Investigation and Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
| | - Lars Kober
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
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83
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Sidhu BS, Gould J, Porter B, Diemberger I, Biffi M, Seifert M, Butter C, Boersman LVA, Riahi S, Neuzil P, Vergara P, Defaye P, Arnold M, Keane D, Deharo JC, Schilling R, Chow A, James S, Turley A, Betts TI, Rinaldi CA. The WiSE-CRT System Results in Left Ventricular Remodelling and Improved Symptoms in Patients Undergoing CRT Upgrades. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sidhu BS, Gould J, Porter B, Diemberger I, Biffi M, Seifert M, Butter C, Boersma LVA, Riahi S, Neuzil P, Vergara P, Defaye P, Arnold M, Keane DT, Deharo JC, James S, Turley A, Betts T, Chow A, Schilling R, Rinaldi CA. Patients Undergoing High-Risk CRT Upgrades with a WiSE-CRT System Have at Trend towards Improved Left Ventricular Remodelling Compared with Epicardial CRT Upgrades. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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85
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Sidhu BS, Gould J, Porter B, Turley A, Diemberger I, Biffi M, Seifert M, Butter C, Boersma LVA, Riahi S, Neuzil P, Vergara P, Defaye P, Arnold M, Keane DT, James S, Schilling R, Deharo JC, Chow A, Betts T, Rinaldi CA. The WiSE-CRT System Leads to Left Ventricular Remodeling and Improved Symptoms in Patients Who are Non-Responders to Epicardial CRT. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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86
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Ruwald AC, Gislason GH, Vinther M, Johansen JB, Nielsen JC, Philbert BT, Torp-Pedersen C, Riahi S, Jøns C. Importance of beta-blocker dose in prevention of ventricular tachyarrhythmias, heart failure hospitalizations, and death in primary prevention implantable cardioverter-defibrillator recipients: a Danish nationwide cohort study. Europace 2019; 20:f217-f224. [PMID: 29684191 DOI: 10.1093/europace/euy077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/20/2018] [Indexed: 12/28/2022] Open
Abstract
Aims There is a paucity of studies investigating a dose-dependent association between beta-blocker therapy and risk of outcome. In a nationwide cohort of primary prevention implantable cardioverter-defibrillator (ICD) patients, we aimed to investigate the dose-dependent association between beta-blocker therapy and risk of ventricular tachyarrhythmias (VT/VF), heart failure (HF) hospitalizations, and death. Methods and results Information on ICD implantation, endpoints, comorbidities, beta-blocker usage, type, and dose were obtained through Danish nationwide registers. The two major beta-blockers carvedilol and metoprolol were examined in three dose levels; low (metoprolol ≤ 25 mg; carvedilol ≤ 12.5 mg), intermediate (metoprolol 26-199 mg; carvedilol 12.6-49.9 mg), and high (metoprolol ≥ 200 mg; carvedilol ≥ 50 mg). Time to events was investigated utilizing multivariate Cox models with beta-blocker as a time-dependent variable. From 2007 to 2012, 2935 first-time ICD devices were implanted. During follow-up, 399 patients experienced VT/VF, 728 HF hospitalizations and 361 died. As compared with patients not on beta-blockers, low, intermediate, and high dose had significantly reduced risk of HF hospitalizations {hazard ratio (HR) = 0.68 [0.54-0.87], P = 0.002; HR = 0.53 [0.42-0.66], P < 0.001; HR = 0.43 [0.34-0.54], P < 0.001} and death (HR = 0.47 [0.35-0.64], P < 0.001; HR = 0.29 [0.22-0.39], P = 0.001; HR = 0.24 [0.18-0.33], P < 0.001). For the endpoint of VT/VF, only intermediate and high dose beta-blocker was associated with significantly reduced risk (HR = 0.58 [0.43-0.79], P < 0.001; HR = 0.53 [0.39-0.72], P < 0.001). No significant difference was found between comparable doses of carvedilol and metoprolol on any endpoint (P = 0.06-0.94). Conclusion In primary prevention ICD patients, beta-blocker therapy was associated with significantly reduced risk of all endpoints, as compared with patients not on beta-blocker, with the suggestion of a dose-dependent effect. No detectable difference was found between comparable doses of carvedilol and metoprolol.
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Affiliation(s)
- A C Ruwald
- Department of Medicine, Sjaellands University Hospital, Sygehusvej 10, Roskilde, Denmark.,Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegaardsvej 28, Hellerup, Denmark
| | - G H Gislason
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegaardsvej 28, Hellerup, Denmark.,National Institute of Public Health, Øster Farimagsgade 5 A, Copenhagen, Denmark.,Department of Cardiology, University of Southern Denmark, Sdr. Boulevard 29, Odense, Denmark.,The Danish Heart Foundation, Vognmagergade 7, 3. sal, Copenhagen, Denmark
| | - M Vinther
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegaardsvej 28, Hellerup, Denmark
| | - J B Johansen
- Department of Cardiology, Odense University Hospital, Kløvervænget 47, Odense, Denmark
| | - J C Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, Denmark
| | - B T Philbert
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark
| | - C Torp-Pedersen
- Institute of Health, Science and Technology, Aalborg University, Niels Jernes Vej 10, Aalborg and Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark
| | - S Riahi
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
| | - C Jøns
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark
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87
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Ben Haj Ali E, Messelmani M, Riahi S, Zaouali J, Mrissa R. Manifestations psychiatriques au cours de la maladie de Behçet : aspects cliniques et profils évolutifs. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.03.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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88
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Twomey DJ, Riahi S, Turley AJ, James S. Left Ventricular Endocardial Pacing With a Novel Wireless CRT System Pacing Threshold Trend. JACC Clin Electrophysiol 2019; 5:635-636. [DOI: 10.1016/j.jacep.2019.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/31/2019] [Indexed: 11/27/2022]
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89
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Riddersholm S, Tayal B, Kragholm K, Andreasen JJ, Rasmussen BS, Søgaard P, Torp-Pedersen C, Riahi S. Incidence of Stroke After Pneumonectomy and Lobectomy. Stroke 2019; 50:1052-1059. [DOI: 10.1161/strokeaha.118.024496] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Signe Riddersholm
- From the Department of Cardiology (S. Riddersholm, B.T., K.K., P.S., S. Riahi), Aalborg University Hospital, Denmark
- Department of Anaesthesiology and Intensive Care Medicine (S. Riddersholm, B.S.R.), Aalborg University Hospital, Denmark
| | - Bhupendar Tayal
- From the Department of Cardiology (S. Riddersholm, B.T., K.K., P.S., S. Riahi), Aalborg University Hospital, Denmark
| | - Kristian Kragholm
- From the Department of Cardiology (S. Riddersholm, B.T., K.K., P.S., S. Riahi), Aalborg University Hospital, Denmark
| | - Jan Jesper Andreasen
- Department of Cardiothoracic Surgery (J.J.A.), Aalborg University Hospital, Denmark
| | - Bodil Steen Rasmussen
- Department of Anaesthesiology and Intensive Care Medicine (S. Riddersholm, B.S.R.), Aalborg University Hospital, Denmark
- Clinical Institute (B.S.R., S. Riahi), Aalborg University Hospital, Denmark
| | - Peter Søgaard
- From the Department of Cardiology (S. Riddersholm, B.T., K.K., P.S., S. Riahi), Aalborg University Hospital, Denmark
| | | | - Sam Riahi
- From the Department of Cardiology (S. Riddersholm, B.T., K.K., P.S., S. Riahi), Aalborg University Hospital, Denmark
- Clinical Institute (B.S.R., S. Riahi), Aalborg University Hospital, Denmark
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90
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Ruwald MH, Ruwald AC, Johansen JB, Gislason G, Nielsen JC, Philbert B, Riahi S, Vinther M, Lindhardt TB. Incidence of appropriate implantable cardioverter-defibrillator therapy and mortality after implantable cardioverter-defibrillator generator replacement: results from a real-world nationwide cohort. Europace 2019; 21:1211-1219. [DOI: 10.1093/europace/euz121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 04/02/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
The safety of omitting implantable cardioverter-defibrillator (ICD) generator replacement in patients with no prior appropriate therapy, comorbid conditions, and advanced age is unclear. The aim was to investigate incidence of appropriate ICD therapy after generator replacement.
Methods and results
We identified patients implanted with a primary prevention ICD (n = 4630) from 2007 to 2016, who subsequently underwent an elective ICD generator replacement (n = 670) from the Danish Pacemaker and ICD Register. The data were linked to other databases and evaluated the outcomes of appropriate therapy and death. Predictors of ICD therapy were identified using multivariate Cox regression analyses. A total of 670 patients underwent elective ICD generator replacement. Of these, 197 (29.4%) patients had experienced appropriate therapy in their 1st generator period. During follow-up of 2.0 ± 1.6 years, 95 (14.2%) patients experienced appropriate therapy. Predictors of appropriate therapy in 2nd generator period was low initial left ventricular ejection fraction (≤25%) [hazard ratio (HR) 1.87, confidence interval (CI) 1.13–1.95] and appropriate therapy in 1st generator period (HR 3.95, CI 2.57–6.06). For patients with appropriate therapy in 1st generator period, 4-year incidence of appropriate therapy was 50.6% vs. 16.4% in those without (P < 0.001). Among patients >80 years with no prior appropriate therapy 8.8% of patients experienced appropriate therapy after replacement. Comorbidity burden and advanced age were associated with reduced device utilization after replacement and a high competing risk of death without preceding appropriate therapy.
Conclusion
A significant residual risk of appropriate therapy in the 2nd generator was present even among patients with advanced age and with a full prior generator period without any appropriate ICD events.
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Affiliation(s)
- Martin H Ruwald
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegaardsvej 28,2900 Hellerup, Denmark
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Anne-Christine Ruwald
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegaardsvej 28,2900 Hellerup, Denmark
| | - Jens Brock Johansen
- Department of Cardiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegaardsvej 28,2900 Hellerup, Denmark
- National Institute of Public Health, Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
| | | | - Berit Philbert
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Michael Vinther
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Tommi B Lindhardt
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegaardsvej 28,2900 Hellerup, Denmark
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Brahem A, Riahi S, Chouchane A, Kacem I, Maalel OE, Maoua M, Guedri SE, Kalboussi H, Chatti S, Debbabi F, Mrizek N. [Impact of occupational noise in the development of arterial hypertension: A survey carried out in a company of electricity production]. Ann Cardiol Angeiol (Paris) 2019; 68:168-174. [PMID: 30683483 DOI: 10.1016/j.ancard.2018.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 10/16/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Noise pollution is one of the major environmental pollutants that can adversely affect public health. Cardiovascular diseases are the primary out-auditory adverse outcome caused by occupational noise exposure. AIMS To investigate the association between occupational exposure to high level of noise and blood pressure among a group of workers in a company of electricity production in the Centre of Tunisia. MATERIAL AND METHODS A total of 120 occupational noise-exposed workers and 120 non-exposed employees were recruited to conduct a cross-sectional survey exploring the association between occupational noise-exposed and arterial hypertension. Data collection was based on a questionnaire, a clinical exam and biomarkers. Blood pressure was measured using a mercury sphygmomanometer following a standard protocol. The occupational noise level was measured with a portable calibrated sound meter. Multiple logistic regression was used to calculate the odds ratio (OR) and 95 % confidence interval (CI) of noise exposure adjusted by potential confounders. RESULTS The noise level to which our population was exposed ranged from 75dB to 103dB with an average noise level of 89dB. Mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and the prevalence of hypertension were significantly higher in exposed individuals than in non-exposed. In multivariate analysis, elevated SBP in exposed workers was associated with high-salt diet (OR adjusted=1.71, 95% CI adjusted [1.14-1.98]) and occupational seniority more than 8 years (adjusted OR=5.31, 95% CI [2.22-12.72]). The factors associated with high BP in the exposed group were diabetes (OR adjusted to 15.31; 95% adjusted CI [2.61-89.58]), history of hypertension in the family (OR adjusted to 11.46; 95% adjusted CI [5.18-83][1.58-83.05]), mean of age (OR adjusted to 6.65; 95% adjusted CI [1.87-23.59]) and high-salt diet (OR adjusted to 0.29; 95% adjusted CI [0.09-0.95]). CONCLUSION Occupational chronic noise exposure was associated with higher levels of SBP, DBP, and the risk of hypertension. These findings indicate that effective and feasible measures should be implemented to reduce the risk of hypertension caused by occupational noise exposure in companies of electricity production.
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Affiliation(s)
- A Brahem
- Service de médecine du travail et de pathologies professionnelles, CHU Farhat Hached, Sousse, Tunisie; Faculté de médecine de Sousse, Université de Sousse, Tunisie.
| | - S Riahi
- Laboratoire d'hématologie et Banque du Sang, CHU Sahloul, Sousse, Tunisie
| | - A Chouchane
- Service de médecine du travail et de pathologies professionnelles, CHU Farhat Hached, Sousse, Tunisie
| | - I Kacem
- Service de médecine du travail et de pathologies professionnelles, CHU Farhat Hached, Sousse, Tunisie
| | - O El Maalel
- Service de médecine du travail et de pathologies professionnelles, CHU Farhat Hached, Sousse, Tunisie
| | - M Maoua
- Service de médecine du travail et de pathologies professionnelles, CHU Farhat Hached, Sousse, Tunisie
| | - S El Guedri
- Service de médecine du travail et de pathologies professionnelles, CHU Farhat Hached, Sousse, Tunisie
| | - H Kalboussi
- Service de médecine du travail et de pathologies professionnelles, CHU Farhat Hached, Sousse, Tunisie
| | - S Chatti
- Service de médecine du travail et de pathologies professionnelles, CHU Farhat Hached, Sousse, Tunisie
| | - F Debbabi
- Service de médecine du travail et de pathologies professionnelles, CHU Farhat Hached, Sousse, Tunisie
| | - N Mrizek
- Service de médecine du travail et de pathologies professionnelles, CHU Farhat Hached, Sousse, Tunisie
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92
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Christensen AM, Bjerre J, Schou M, Jons C, Vinther M, Gislason GH, Johansen JB, Nielsen JC, Petersen HH, Riahi S, Ruwald AC. Clinical outcome in patients with implantable cardioverter-defibrillator and cancer: a nationwide study. Europace 2018; 21:465-474. [DOI: 10.1093/europace/euy268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/20/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anne M Christensen
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegårdsvej 28, Copenhagen, Hellerup, Denmark
| | - Jenny Bjerre
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegårdsvej 28, Copenhagen, Hellerup, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegårdsvej 28, Copenhagen, Hellerup, Denmark
| | - Christian Jons
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Michael Vinther
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegårdsvej 28, Copenhagen, Hellerup, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegårdsvej 28, Copenhagen, Hellerup, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
- National Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, University of Southern Denmark, Odense, Denmark
| | - Jens B Johansen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jens C Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Anne-Christine Ruwald
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegårdsvej 28, Copenhagen, Hellerup, Denmark
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
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Aarab J, Abbess I, Abdalla F, Abdelaziz Z, Abdelfattah S, Abdelli I, Abdelmajid K, Abdelsselem Z, Abdelwahed N, Abdessayed N, Abid B, Abid K, Abidi R, Abudabbous A, Abujanah S, Aburwais A, Acacha E, Acharfi N, Affes N, Aftis R, Ahalli I, Aid M, Aissaoui D, Alaoui A, Alaoui M, Albatran S, Mamdouh A, Alkikkli R, Allam A, Aloulou S, Alqawi O, Alragig MA, Alsharksi A, Amaadour KOL, Amaadour L, Ameziane N, Ammari A, Ammour H, Amrane R, Annad N, Aouati E, Aouichat S, Aouragh S, Arifi S, Astra M, Atassi M, Ati N, Atoui K, Atreche L, Ayachi S, Ayadi I, Ayadi MA, Ayadi M, Ayari J, Ayed H, Ayed K, Ayedi H, Ayedi I, Azegrar M, Azzouz H, Babdalla F, Bachiri R, Bachiri Z, Baghdad M, Bahloul R, Bahouli A, Bahri M, Baississ I, Bakkali H, Balti M, Baraket O, Bargaoui H, Batti R, Bedioui A, Begag R, Behourah Z, Belaid I, Belaïd A, Ben Abdallah A, Ben Abdallah I, Ben Ahmed S, Ben Ahmed T, Ben Azaiz M, Ben Chehida MA, Ben Fatma L, Ben Ghachem D, Ben Ghachem T, Ben Hassouna J, Ben Hmida S, Ben Nasr S, Ben Nejima D, Ben Rahal K, Ben Rejeb M, Ben Rhouma S, Ben Safta I, Ben Salem A, Ben Zargouna Y, Benabdallah I, Benabdella H, Benabdessalem MZ, Benahmed K, Benahmed S, Benameur H, Benasr S, Benbrahim F, Benbrahim W, Benbrahim Z, Benchehida M, Bencheikh Y, Bendhiab T, Benfatma L, Bengueddach A, Benhami M, Benhassouna J, Benhbib W, Benjaafar N, Benkali R, Benkridis W, Benlaloui A, Benmaitig M, Benmansour A, Benmouhoub M, Benna F, Benna H, Benna M, Benna M, Bennabdellah H, Benrahal K, Bensafta I, Bensalah H, Bensalem A, Bensaud M, Benslama R, Benyoub M, Benzid K, Bergaoui H, Beroual M, Berrad S, Berrazaga Y, Bezzaz Z, Bhiri H, Bibi M, Binous MY, Blel A, Boder JM, Bouaouina N, Bouaziz H, Bouchoucha S, Boudawara T, Boudawara Z, Bouderbala A, Bouhali R, Bouhani M, Boujarnija R, Boujelben S, Boujelbene N, Boukerzaza I, Boukhari H, Boulfoul W, Boulma R, Boumansour N, Bouned A, Bounedjar A, Bouraoui I, Bouraoui S, Bourigua R, Bourmech M, Bousaffa H, Bousahba A, Bousrih C, Boussarsar A, Boussen H, Boutayeb S, Bouzaidi K, Bouzaiene F, Bouzaiene H, Bouzerzour Z, Bouzid K, Bouzid N, Bouzidi D, Bouzidi W, Bouzouita A, Brahimi S, Brahmia A, Buhmeida A, Chaaben K, Chaabouni H, Chaabouni M, Chaabène K, Chaari H, Chaari I, Chaari M, Chabchoub I, Chabeene K, Chaker K, Chakroun M, Charfi M, Charfi S, Chargui R, Charles M, Chebil M, Cheikchouk K, Chelly B, Chelly I, Cheraiet N, Cherif A, Cherif M, Cherifi A, Chikhrouhou T, Chikouche A, Chirouf A, Chraiet N, Collan Y, Cui Z, Dabbebi H, Daldoul A, Damouche I, Daoud H, Daoud N, Daoued J, Darif K, Darwish DO, Derbouz Z, Derouiche A, Dhibe TT, Dhibet T, Djallaoui A, Djami N, Djebbes K, Djedi H, Djeghim S, Djellali L, Djellaoui A, Djilat K, Djouabi R, Doumbia H, Drah M, Dridi M, Hsairi M, Elabbassi S, Elallia F, Elati Z, Elattassi M, Elbenna H, Elfagieh MA, Elfaitori O, Elfannas H, Elghali A, Elghali MA, Elgonti S, Elhadj OE, Elhazzaz R, Elkacemi H, Elkinany K, Elkissi Y, Elloumi F, Elmaalel O, Elmajjaou IS, Elmajjaoui S, Elmhabrech H, Elmrabet F, Elsaghayer WA, Elzagheid A, Emaetig F, Erraichi H, Essid M, Ewshah N, Ezzairi F, Faleh R, Fallah S, Farag AL, Farhat L, Fehri R, Feki J, Fendri S, Fendri S, Fessi Z, Filali T, Fissah A, Fourati M, Fourati N, Frikha M, Fuchs CS, Gabssi A, Gachi F, Gadria S, Gammoudi A, Ganzoui I, Gargoura A, Ghaddabb I, Gharbi I, Gharbi M, Ghazouani E, Gheriani N, Ghorbel A, Ghorbel L, Ghozi A, Ghrissi R, Gouader A, Goucha A, Guebsi A, Guellil I, Guermazi F, Guesmi S, Guetari W, Habak N, Haddad A, Haddad S, Haddaoui A, Hadef I, Hader AF, Hadiji A, Hadjarab F, Hadoussa M, Hadoussa N, Hafsa C, Hafsia M, Hajji A, Hajmansour M, Hamdi S, Hamici Z, Hamida S, Hamila F, Hamissa S, Hammouda B, Haouet S, Harhira I, Haroun A, Hassouni K, Hdiji A, Hechiche M, Hejjane L, Hellal C, Henni M, Herbegue K, Hichami L, Hikem M, Hmad A, Hmida L, Hmissa S, Hochlaf M, Houas A, Houhani M, Huwidi A, Ian C, Ibrahim BN, Ibrahim NY, Idir H, Issaoui D, Itaimi A, Izem AE, Jaidane O, Jamel D, Jamous H, Jarrar M, Jarrar MS, Jarray S, Jebsi M, Jmal H, Juwid A, Kaabia O, Kablouti A, Kacem I, Kacem K, Kaid MY, Kallel M, Kallel R, Kammoun H, Kari S, Karrit S, Kchir H, Kchir N, Kebdani T, Kechad N, Kehili H, Kerboua E, Keskes H, Kessi NN, Khababa N, Khaldi H, Khanfir A, Khater B, Khelif A, Khemiri S, Khennouf K, Khouni H, Khrouf S, Kmira Z, Kochbati L, Korbi A, Kouadri N, Kouhen F, Krarti M, Handoussa M, Hsu Y, Laakom O, Laato M, Labidi S, Lahlali F, Lahmidi A, Lalaoui A, Lamia N, Lamri A, Letaief F, Letaief MR, Aldehmani M, Rafael A, Liepa AM, Limaiem F, Limam K, Loughlimi H, Ltaief F, Maamouri N, Mabrouk M, Madouri R, Mahjoub N, Mahjoubi Z, Mahrsi M, Makrem H, Mallek W, Manitta M, Mansoura L, Mansouri H, Maoua M, Maoui W, Marouene C, Marzouk K, Masmoudi S, May F, Meddeb I, Meddeb K, Meddour S, Medhioub F, Mejri N, Melizi MR, Mellas N, Melliti R, Melzi A, Merair N, Merrouki FZ, Mersali C, Messalbi O, Messaoudi L, Messioud S, Messoudi K, Mestiri S, Mezlini A, Mezlini A, Mghirbi F, Mhabrech H, Mhiri A, Midoun N, Milud R, Missaoui B, Mnasser A, Mnejja W, Mokni M, Mokrani A, Mokrani M, Moujahed R, Moukasse Y, Mouzount A, Mrad K, Mraidha MH, Mrizak N, Mzali R, Mzid Y, M'ghirbi F, Nakhli A, Nasr C, Nasri S, Noubigh G, Nouha D, Nouia L, Nouira Y, Noureddine A, Nouri O, Ohtsu A, Ouahbi H, Oualla K, Ouanes Y, Ouaz H, Ouikene A, Ouldbessi N, Parker I, Pyrhonen S, Rachdi H, Rahal K, Rahal K, Rahoui M, Raies H, Rameh S, Reguieg K, Rejab H, Rejiba R, Rhim MS, Riahi S, Rouimel N, Saad Saoud N, Saadi K, Saadi M, Sadou A, Saguem I, Sahnoun T, Sahnoune H, Sakhri S, Sallemi A, Sassi A, Sbika W, Sedkaoui C, Sefiane S, Sellami A, Seppo P, Sfaoua H, Sghaier S, Shagan A, Siala W, Slim I, Slimene M, Soltani S, Souilah S, Souissi M, Sriha Badreddine B, Swaisi Y, Taibi A, Taktak T, Talbi G, Talha SW, Talima SM, Tbessi S, Tebani N, Tebra S, Tebramrad S, Telaijia D, Tenni A, Tolba A, Topov Y, Touil K, Toumi N, Toumi W, Tounsi N, Trigui A, Trigui R, Triki W, Walha M, Werda I, Yacoub H, Yahyaoui Y, Yaich A, Yaici R, Yamouni M, Yeddes I, Yekrou D, Yousfi M, Yousfi N, Youssfi MA, Zaabar L, Zaied S, Zaim I, Zakhama W, Zayed S, Zehani A, Zemni I, Zenzri Y, Zeraoula S, Zouiten O, Zoukar O, Zrafi W, Zribi A, Zubia N. Poster abstracts of the 18th Pan Arab Cancer Congress. TUNISIA. April 19-21, 2018. Tunis Med 2018; 96:177-182. [PMID: 30430520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 09/28/2022]
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Skjøth F, Vadmann H, Hjortshøj SP, Riahi S, Lip GYH, Larsen TB. Disease progression after ablation for atrial flutter compared with atrial fibrillation: A nationwide cohort study. Int J Clin Pract 2018; 72:e13258. [PMID: 30222238 DOI: 10.1111/ijcp.13258] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/14/2018] [Indexed: 11/30/2022] Open
Abstract
AIMS The aim of this study was to study the risk of death and development of arrhythmia and/or subsequently heart failure after an atrial flutter ablation procedure compared with an atrial fibrillation (AF) ablation procedure. METHODS This observational study is based on data from Danish nationwide health databases. Patients with a first-time ablation procedure for either atrial flutter or AF in the period 2000-2016 were included. Rates of renewed arrhythmia, heart failure or death were compared and reported as adjusted hazard ratios (HR). RESULTS The study population consisted of 2,004 and 3,803 patients with an incident atrial flutter or AF ablation procedure, respectively. All-cause mortality among atrial flutter patients was significantly higher compared with the AF group (HR 1.80, 95% confidence interval [CI] 1.39-2.35). The incidence of renewed arrhythmia without heart failure was lower in atrial flutter (HR 0.76, 95% CI 0.69-0.84). Renewed atrial flutter ablation and pacemaker implantations were significantly more frequent (HR 2.42, 95% CI 2.02-2.91 and HR 1.42, 95% CI 1.13-1.79, respectively) in atrial flutter compared with AF. The risk of heart failure was higher for atrial flutter, both after the initial ablation (HR 1.48, 95% CI 1.08-2.03), and after a further arrhythmia management event (HR 1.98, 95% CI 1.33-2.94). CONCLUSION There was a higher mortality risk after atrial flutter ablation procedures compared with patients undergoing AF ablation. Rates of heart failure and further renewed (non-AF) arrhythmia management were higher in atrial flutter.
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Affiliation(s)
- Flemming Skjøth
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Vadmann
- Department of Cardiology, Atrial Fibrillation Study Group, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Pihlkjaer Hjortshøj
- Department of Cardiology, Atrial Fibrillation Study Group, Aalborg University Hospital, Aalborg, Denmark
| | - Sam Riahi
- Department of Cardiology, Atrial Fibrillation Study Group, Aalborg University Hospital, Aalborg, Denmark
| | - Gregory Y H Lip
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Torben Bjerregaard Larsen
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
- Department of Cardiology, Atrial Fibrillation Study Group, Aalborg University Hospital, Aalborg, Denmark
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Boriani G, Proietti M, Laroche C, Diemberger I, Popescu MI, Riahi S, Shantsila A, Dan GA, Tavazzi L, Maggioni AP, Lip GY. Changes to oral anticoagulant therapy and risk of death over a 3-year follow-up of a contemporary cohort of European patients with atrial fibrillation final report of the EURObservational Research Programme on Atrial Fibrillation (EORP-AF) pilot general registry. Int J Cardiol 2018; 271:68-74. [DOI: 10.1016/j.ijcard.2018.05.034] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/22/2018] [Accepted: 05/10/2018] [Indexed: 12/20/2022]
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Lunde ED, Nielsen PB, Riahi S, Larsen TB, Lip GYH, Fonager K, Larsen ML, Joensen AM. Associations between socioeconomic status, atrial fibrillation, and outcomes: a systematic review. Expert Rev Cardiovasc Ther 2018; 16:857-873. [PMID: 30293472 DOI: 10.1080/14779072.2018.1533118] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/01/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is a growing epidemic and evidence of a relationship to socioeconomic status (SES) is inconsistent. We aimed to summarize the literature about SES and AF and defined two objectives: (1) To examine the association between SES and the risk of AF; (2) To examine the association between SES and AF-related outcomes in an AF-population. METHODS We performed a separate search for each objective in Ovid-MEDLINE and Ovid-Embase. For objective 1, the population included was healthy participants and outcome of interest was AF. For objective 2, the population included were patients with AF and outcome of interest was mortality, treatment, ablation for AF, knowledge about AF, and morbidity. RESULTS For objective 1, 12 studies were included. No consistent pattern for an association between SES and the risk of AF was discovered. For objective 2, 39 studies comprising 42 outcomes were included. The majority of studies showed an association between low SES and increased mortality and morbidity. CONCLUSION Low SES was associated with poorer outcomes when AF was present. These findings may imply that health-care professionals and policy interventions should focus on the promotion of AF-education and management among patients with AF and low SES.
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Affiliation(s)
| | - Peter Brønnum Nielsen
- a Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
- b Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health , Aalborg University , Aalborg , Denmark
| | - Sam Riahi
- a Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
- c Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
- d Atrial Fibrillation Study Group , Aalborg University Hospital , Aalborg , Denmark
| | - Torben Bjerregaard Larsen
- a Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
- b Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health , Aalborg University , Aalborg , Denmark
- d Atrial Fibrillation Study Group , Aalborg University Hospital , Aalborg , Denmark
| | - Gregory Y H Lip
- b Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health , Aalborg University , Aalborg , Denmark
- e Institute of Cardiovascular Sciences , University of Birmingham , UK
| | - Kirsten Fonager
- c Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
- f Department of Social Medicine , Aalborg University Hospital , Aalborg , Denmark
| | - Mogens Lytken Larsen
- a Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
- c Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
- g Danish Centre of Inequality in Health, Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
| | - Albert Marni Joensen
- a Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
- c Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
- d Atrial Fibrillation Study Group , Aalborg University Hospital , Aalborg , Denmark
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Sindby JE, Vadmann H, Lundbye-Christensen S, Riahi S, Hjortshøj S, Boersma LVA, Andreasen JJ. Percutaneous versus thoracoscopic ablation of symptomatic paroxysmal atrial fibrillation: a randomised controlled trial - the FAST II study. J Cardiothorac Surg 2018; 13:101. [PMID: 30285795 PMCID: PMC6171190 DOI: 10.1186/s13019-018-0792-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/25/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The most efficient first-time invasive treatment, for achieving sinus rhythm, in symptomatic paroxysmal atrial fibrillation has not been established. We aimed to compare percutaneous catheter and video-assisted thoracoscopic pulmonary vein radiofrequency ablation in patients referred for first-time invasive treatment due to symptomatic paroxysmal atrial fibrillation. The primary outcome of interest was the prevalence of atrial fibrillation with and without anti-arrhythmic drugs at 12 months. METHODS Ninety patients were planned to be randomised to either video-assisted thoracoscopic radiofrequency pulmonary vein ablation with concomitant left atrial appendage excision or percutaneous catheter pulmonary vein ablation. Episodes of atrial fibrillation were defined as more than 30 s of atrial fibrillation observed on Holter monitoring/telemetry or clinical episodes documented by ECG. RESULTS The study was terminated prematurely due to a lack of eligible patients. Only 21 patients were randomised and treated according to the study protocol. Thoracoscopic pulmonary vein ablation was performed in 10 patients, and 11 patients were treated with catheter ablation. The absence of atrial fibrillation without the use of anti-arrhythmic drugs throughout the follow-up was observed in 70% of patients following thoracoscopic pulmonary vein ablation and 18% after catheter ablation (p < 0.03). CONCLUSION Thoracoscopic pulmonary vein ablation may be superior to catheter ablation for first-time invasive treatment of symptomatic paroxysmal atrial fibrillation with regard to obtaining sinus rhythm off anti-arrhythmic drugs 12 months postoperative. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01336075 . Registered April 15th, 2011.
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Affiliation(s)
- Jesper Eske Sindby
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Henrik Vadmann
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Hjortshøj
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Atrial Fibrillation Study Group, Aalborg University Hospital, Aalborg, Denmark
| | - Lucas V A Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
- AMC Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Jesper Andreasen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
- Atrial Fibrillation Study Group, Aalborg University Hospital, Aalborg, Denmark
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Glover BM, Hong KL, Dagres N, Arbelo E, Laroche C, Riahi S, Bertini M, Mikhaylov EN, Galvin J, Kiliszek M, Pokushalov E, Kautzner J, Calvo N, Blomström-Lundqvist C, Brugada J. Impact of body mass index on the outcome of catheter ablation of atrial fibrillation. Heart 2018; 105:244-250. [DOI: 10.1136/heartjnl-2018-313490] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/21/2018] [Accepted: 08/23/2018] [Indexed: 11/04/2022] Open
Abstract
ObjectivesThe association between obesity and atrial fibrillation (AF) is well-established. We aimed to evaluate the impact of index body mass index (BMI) on AF recurrence at 12 months following catheter ablation using propensity-weighted analysis. In addition, periprocedural complications and fluoroscopy details were examined to assess overall safety in relationship to increasing BMI ranges.MethodsBaseline, periprocedural and follow-up data were collected on consecutive patients scheduled for AF ablation. There were no specific exclusion criteria. Patients were categorised according to baseline BMI in order to assess the outcomes for each category.ResultsAmong 3333 patients, 728 (21.8%) were classified as normal (BMI <25.0 kg/m2), 1537 (46.1%) as overweight (BMI 25.5–29.0 kg/m2) and 1068 (32.0%) as obese (BMI ≥30.0 kg/m2). Procedural duration and radiation dose were higher for overweight and obese patients compared with those with a normal BMI (p=0.002 and p<0.001, respectively). An index BMI ≥30 kg/m2 led to a 1.2-fold increased likelihood of experiencing recurrent AF at 12-months follow-up as compared with overweight patients (HR 1.223; 95% CI 1.047 to 1.429; p=0.011), while no significant correlation was found between overweight and normal BMI groups (HR 0.954; 95% CI 0.798 to 1.140; p=0.605) and obese versus normal BMI (HR 1.16; 95% CI 0.965 to 1.412; p=0.112).ConclusionsPatients with a baseline BMI ≥30 kg/m2 have a higher recurrence rate of AF following catheter ablation and therefore lifestyle modification to target obesity preprocedure should be considered in these patients.
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Kronborg MB, Johansen JB, Haarbo J, Riahi S, Philbert BT, Jørgensen OD, Nielsen JC. Association between implantable cardioverter-defibrillator therapy and different lead positions in patients with cardiac resynchronization therapy. Europace 2018; 20:e133-e139. [PMID: 29036292 DOI: 10.1093/europace/eux296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/28/2017] [Indexed: 11/14/2022] Open
Abstract
Aims To evaluate the impact of different right and left ventricular lead positions (RV-LP and LV-LP) on the risk of therapy for ventricular tachycardia/ventricular fibrillation in patients with a cardiac resynchronization therapy device (CRT-D). Methods and results We performed a large nationwide cohort study on patients in Denmark receiving a CRT-D device from 2008 to 2012 from the Danish Pacemaker and implantable cardioverter defibrillator (ICD) registry. Lead positions were registered during the implantation and categorized as anterior/lateral/posterior and basal/mid-ventricular/apical for the LV-LP, and as apical/non-apical for the RV-LP. Appropriate and inappropriate therapies were registered during follow-up via remote monitoring or at device interrogations. Time to event was summarized with Kaplan-Meier plots, and competed risk regression analysis was used to calculate adjusted hazard ratios (aHR) with 95% confidence intervals (CI). Following variables were included in the analysis: gender, age, heart failure aetiology, New York heart association class, left ventricular ejection fraction, QRS duration, indication (secondary or primary prophylactic), RV-LP, LV-LP, and antiarrhythmic therapy. We included 1643 patients [mean age 68 (±10) years, 1343 (83%) men]. After a mean of 2.0 years, 322 (20%) patients received appropriate and 66 (4%) patients received inappropriate therapy. The aHR for appropriate therapy with a non-apical RV-LP was 0.70 95% CI (0.55-0.87, P = 0.002) as compared with an apical. We observed no significant association between appropriate therapy and LV-LP in left anterior oblique or right anterior oblique views or inappropriate therapy between any lead positions. Conclusion An apical RV-LP is associated with an increased risk of appropriate therapy for ventricular tachyarrhythmia in patients with a CRT-D device.
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Affiliation(s)
- Mads Brix Kronborg
- Department of Cardiology, Aarhus University Hospital, Palle-Juul Jensens Boulevard 99, Aarhus N, Denmark
| | | | - Jens Haarbo
- Department of Cardiology, Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Berit Thornvig Philbert
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole Dan Jørgensen
- Department of Heart, Lung and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle-Juul Jensens Boulevard 99, Aarhus N, Denmark
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Tayal B, Fruelund P, Sogaard P, Riahi S, Torp-Pedersen C, Kober L, Kragholm K. 5304Risk of pacemaker-induced heart failure: a nationwide Danish registry-based follow-up study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5304] [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)
- B Tayal
- Aalborg University Hospital, Cardiology, Aalborg, Denmark
| | - P Fruelund
- Aalborg University Hospital, Cardiology, Aalborg, Denmark
| | - P Sogaard
- Aalborg University Hospital, Cardiology, Aalborg, Denmark
| | - S Riahi
- Aalborg University Hospital, Cardiology, Aalborg, Denmark
| | | | - L Kober
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - K Kragholm
- Vendsyssel Hospital, Internal Medicine, Hjorring, Denmark
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