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Wändell PE, Carlsson AC, Sundquist K, Johansson SE, Sundquist J. Total mortality among levothyroxine-treated women with atrial fibrillation in Swedish primary health care. Int J Cardiol 2011; 152:147-8. [PMID: 21851994 DOI: 10.1016/j.ijcard.2011.07.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 07/15/2011] [Accepted: 07/25/2011] [Indexed: 11/29/2022]
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Mitchell JE, Tam SW, Trivedi K, Taylor AL, O'Neal W, Cohn JN, Worcel M. Atrial fibrillation and mortality in African American patients with heart failure: results from the African American Heart Failure Trial (A-HeFT). Am Heart J 2011; 162:154-9. [PMID: 21742102 DOI: 10.1016/j.ahj.2011.04.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Accepted: 04/24/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is common in patients with heart failure (HF) and portends a worsened prognosis. Because of the low enrollment of African American subjects (AAs) in randomized HF trials, there are little data on AF in AAs with HF. This post hoc analysis reviews characteristics and outcomes of AA patients with AF in A-HeFT. METHODS AND RESULTS A total of 1,050 AA patients with New York Heart Association class III/IV systolic HF, well treated with neurohormonal blockade (87% β-blockers, 93% angiotensin-converting enzyme inhibitor and/or angiotensin receptor blocker), were randomized to an added fixed-dose combination of isosorbide dinitrate/hydralazine (FDC I/H) or placebo. Atrial fibrillation was confirmed in 174 (16.6%) patients at baseline and in an additional 9 patients who developed AF during the study, for a final cohort of 183 (17.4%). Comparison of patients with AF versus no AF revealed the following: mean age 61 ± 12 versus 56 ± 13 years (P < .001), systolic blood pressure (BP) 124 ± 18 versus 127 ± 18 mm Hg (P = .044), diastolic BP 74 ± 11 versus 77 ± 10 mm Hg (P = .002), creatinine level 1.4 ± 0.5 versus 1.2 ± 0.5 mg/dL (P < .001), and brain natriuretic peptide 431 ± 443 versus 283 ± 396 pg/mL (P < .001). No significant difference was observed in ejection fraction, left ventricular end-diastolic diameter, or quality-of-life scores. However, AF increased the risk of mortality significantly among AA patients (P = .018), and the use of FDC I/H reduced the risk of mortality in patients with AF (HR 0.21, P = .002). CONCLUSION African Americans with HF and AF (vs no AF) were older, had lower BP, and had higher creatinine and brain natriuretic peptide levels. Mortality and morbidity were worse when AF was present, and these data suggest that there may be an enhanced survival benefit with the use of FDC I/H in AA patients with HF and AF.
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Affiliation(s)
- Judith E Mitchell
- Medicine/Cardiology, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA.
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203
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Abstract
Stroke is the leading cause of disability in the United States and affects 15 million people worldwide. Studies performed in various parts of the world have found differences between sexes in stroke incidence, prevalence, mortality, and outcomes. Although men are at higher risk of stroke for most age groups below age 85 years, after this age the incidence reverses dramatically, with women being much more at risk. Furthermore, recent studies suggest that women have worse recovery than men post-stroke. Many aspects of recovery may influence this outcome, including sex-specific comorbidities, aggressiveness of acute treatment, prevention therapies, and varying degrees of social support and rates of depression. It is important to further define and investigate sex differences in stroke incidence, care, treatment, and outcomes to improve functional recovery in women.
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Affiliation(s)
- Rebecca W Persky
- Department of Neurology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA
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Potpara TS, Marinkovic JM, Polovina MM, Stankovic GR, Seferovic PM, Ostojic MC, Lip GYH. Gender-related differences in presentation, treatment and long-term outcome in patients with first-diagnosed atrial fibrillation and structurally normal heart: the Belgrade atrial fibrillation study. Int J Cardiol 2011; 161:39-44. [PMID: 21570138 DOI: 10.1016/j.ijcard.2011.04.022] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 03/29/2011] [Accepted: 04/24/2011] [Indexed: 01/24/2023]
Abstract
BACKGROUND Several studies have investigated gender-related differences in atrial fibrillation (AF), but limited data are available in relation to gender-related differences in presentation, treatment and long-term outcomes of patients with first-diagnosed AF and structurally normal heart. OBJECTIVE To compare gender-related clinical characteristics, presentation, treatment and long-term outcomes in a cohort of patients with first-diagnosed non-valvular AF and a structurally normal heart, following a 10-year follow-up. METHODS Observational cohort study of patients with AF between 1992 and 2007. RESULTS Of 862 patients (mean age 52.2±12.1 years), 315 (36.5%) were female. Paroxysmal AF and hypertension were significantly more prevalent in females, while persistent AF was more common amongst males (all p<0.001). Female patients were more symptomatic (p=0.002). After a mean follow-up of 10.1±6.1 years, more male patients developed tachycardiomyopathy (6.0% vs. 1.9%, p=0.02). In multivariate analysis, male gender remained significantly associated with tachycardiomyopathy (HR 3.1, 95% CI: 1.3-7.4, p=0.012). The rate of transition to permanent AF, thromboembolism, hemorrhage, all-cause mortality, cardiovascular and sudden death did not significantly differ between male and female patients. CONCLUSIONS Gender differences are evident in AF. Male patients were less asymptomatic or more frequently developed persistent AF. Male patients were also at higher risk of tachycardiomyopathy, suggesting that these patients require more attention to rate control during follow-up.
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Affiliation(s)
- Tatjana S Potpara
- University Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia.
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205
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Madias C, Trohman RG. The Link between Atrial Fibrillation and Stroke in Women. WOMENS HEALTH 2011; 7:375-82. [DOI: 10.2217/whe.11.29] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Atrial fibrillation (AF) is the most common clinically significant cardiac arrhythmia. The most serious complication of AF is thromboembolic stroke. The individual risk of stroke in the setting of AF varies. Several clinical factors have been identified as independent predictors of stroke in AF, including prior stroke, age, hypertension and diabetes. The bulk of available data identifies female gender as another independent predictor of stroke risk in AF. In this article, we review the link between AF and an elevated stroke risk in women, explore the potential pathophysiologic basis for this association and examine the data regarding the effectiveness of anticoagulation in reducing this risk.
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Affiliation(s)
- Christopher Madias
- Clinical Cardiac Electrophysiology Service, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Richard G Trohman
- Clinical Cardiac Electrophysiology Service, Department of Medicine, Rush University Medical Center, Chicago, IL, USA
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MOHANTY SANGHAMITRA, MOHANTY PRASANT, DI BIASE LUIGI, RONG BAI, BURKHARDT DAVID, GALLINGHOUSE JOSEPHG, HORTON RODNEY, SANCHEZ JAVIERE, BAILEY SHANE, ZAGRODZKY JASON, NATALE ANDREA. Baseline B-Type Natriuretic Peptide: A Gender-Specific Predictor of Procedure-Outcome in Atrial Fibrillation Patients Undergoing Catheter Ablation. J Cardiovasc Electrophysiol 2011; 22:858-65. [DOI: 10.1111/j.1540-8167.2011.02036.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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207
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Abstract
BACKGROUND Care for falls and urinary incontinence (UI) among older patients is inadequate. One possible explanation is that physicians provide less recommended care to patients who are not as concerned about their falls and UI. OBJECTIVE To test whether patient-reported severity for 2 geriatric conditions, falls, and UI, is associated with quality of care. RESEARCH DESIGN Prospective cohort study of elders with falls and/or fear of falling (n = 384) and UI (n = 163). SUBJECTS Participants in the Assessing Care of Vulnerable Elders-2 Study (2002-2003), which evaluated an intervention to improve the care for falls and UI among older (age, ≥ 75) ambulatory care patients with falls/fear of falling or UI. MEASURES Falls Efficacy Scale (FES) and the Incontinence Quality of Life surveys measured at baseline, quality of care measured by a 13-month medical record abstraction. RESULTS There was a small difference in falls quality scores across the range of FES, with greater patient-perceived falls severity associated with better odds of passing falls quality indicators (OR: 1.11 [95% CI: 1.02-1.21] per 10-point increment in FES). Greater patient-perceived UI severity (Incontinence Quality of Life score) was not associated with better quality of UI care. CONCLUSIONS Although older persons with greater patient-perceived falls severity receive modestly better quality of care, those with more distressing incontinence do not. For both conditions, however, even the most symptomatic patients received less than half of recommended care. Low patient-perceived severity of condition is not the basis of poor care for falls and UI.
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208
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Antiarrhythmic use from 1991 to 2007: Insights from the Canadian Registry of Atrial Fibrillation (CARAF I and II). Heart Rhythm 2010; 7:1171-7. [DOI: 10.1016/j.hrthm.2010.04.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 04/14/2010] [Indexed: 12/22/2022]
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Abstract
Women have a 20% lifetime risk of stroke. In addition, the majority of stroke-related deaths occur in women. Reducing the burden of stroke in women through prevention would positively affect public health. Unfortunately, most of the data used to develop specific evidence-based guidelines for stroke prevention in women were derived from coronary heart disease studies. Stroke was a secondary and less common outcome, if it was included at all. In addition, women have traditionally been underrepresented in stroke prevention trial cohorts. Stroke prevention in women offers many challenges, not only related to data extrapolated from clinical trials primarily composed of men, but also because physicians may underestimate cardiovascular risk in women, and therefore prevention strategies may not be appropriately undertaken. The opportunities to improve stroke prevention in women include increasing patient and physician awareness of risk and optimizing management of key modifiable risk factors (eg, hypertension, hyperlipidemia, physical inactivity, obesity, and diabetes).
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Affiliation(s)
- Cheryl Bushnell
- Wake Forest University Health Sciences, Medical Center Boulevard, Winston-Salem, NC, USA.
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211
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Aves T, Dorian P. Paroxysmal atrial fibrillation and health-related quality of life: the importance of keeping score. Europace 2010; 12:606-7. [PMID: 20228396 DOI: 10.1093/europace/euq071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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213
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Atrial fibrillation prevalence, incidence and risk of stroke and all-cause death among Chinese. Int J Cardiol 2010; 139:173-80. [DOI: 10.1016/j.ijcard.2008.10.045] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Revised: 07/15/2008] [Accepted: 10/12/2008] [Indexed: 11/17/2022]
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214
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Inoue H, Nozawa T, Hirai T, Goto S, Origasa H, Shimada K, Uchiyama S, Hirabayashi T, Koretsune Y, Ono S, Hasegawa T, Sasagawa Y, Kaneko Y, Ikeda Y. Sex-related differences in the risk factor profile and medications of patients with atrial fibrillation recruited in J-TRACE. Circ J 2010; 74:650-4. [PMID: 20173301 DOI: 10.1253/circj.cj-09-0802] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Clinical characteristics, including risk factors for thromboembolism, and medications differ between men and women with atrial fibrillation (AF) in Western countries. Whether such a difference exists for Japanese patients with AF is unclear, so data from J-TRACE were used to investigate this issue. METHODS AND RESULTS A total of 2,892 patients (2,028 men, 864 women; 70.3 years old) with AF were analyzed for the respective prevalences of risk factors and medications. CHADS2 score was calculated to determine thromboembolic risk level. Women were older (P<0.001), and more frequently had heart failure (P<0.001), and hypertension (P=0.051) than men. The proportion of subjects aged 75 years or older was higher among women than among men (P<0.001). CHADS2 score was therefore significantly higher in women than in men (2.05+/-1.29 vs 1.88+/-1.33, P<0.001). Sex-related differences were not observed for the prevalence of diabetes mellitus, myocardial infarction or ischemic stroke, nor did warfarin usage differ between men and women. CONCLUSIONS Sex-related differences were observed in the risk factor profile and medications of Japanese patients with AF. CHADS2 score was higher in women than in men.
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Affiliation(s)
- Hiroshi Inoue
- Department of Internal Medicine, University of Toyama, Toyama, Japan.
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215
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Bunch TJ, Weiss JP, Crandall BG, May HT, Bair TL, Osborn JS, Anderson JL, Lappe DL, Muhlestein JB, Nelson J, Day JD. Long-Term Clinical Efficacy and Risk of Catheter Ablation for Atrial Fibrillation in Octogenarians. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:146-52. [PMID: 19889181 DOI: 10.1111/j.1540-8159.2009.02604.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- T Jared Bunch
- Intermountain Heart Rhythm Specialists, Intermountain Medical Center, Eccles Outpatient Care Center, 5169 Cottonwood St., Murray, UT 84107, USA.
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Patel D, Mohanty P, Di Biase L, Wang Y, Shaheen MH, Sanchez JE, Horton RP, Gallinghouse GJ, Zagrodzky JD, Bailey SM, Burkhardt JD, Lewis WR, Diaz A, Beheiry S, Hongo R, Al-Ahmad A, Wang P, Schweikert R, Natale A. The impact of statins and renin-angiotensin-aldosterone system blockers on pulmonary vein antrum isolation outcomes in post-menopausal females. Europace 2010; 12:322-30. [PMID: 20064822 DOI: 10.1093/europace/eup387] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Dimpi Patel
- St David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX, USA
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Patel D, Mohanty P, Di Biase L, Sanchez JE, Shaheen MH, Burkhardt JD, Bassouni M, Cummings J, Wang Y, Lewis WR, Diaz A, Horton RP, Beheiry S, Hongo R, Gallinghouse GJ, Zagrodzky JD, Bailey SM, Al-Ahmad A, Wang P, Schweikert RA, Natale A. Outcomes and complications of catheter ablation for atrial fibrillation in females. Heart Rhythm 2009; 7:167-72. [PMID: 20022814 DOI: 10.1016/j.hrthm.2009.10.025] [Citation(s) in RCA: 190] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 10/19/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Most atrial fibrillation (AF) ablation studies have consisted predominantly of males; accordingly, there is a paucity of information on the safety and efficacy of catheter ablation in a large cohort of female AF patients. OBJECTIVE The purpose of this study was to evaluate catheter ablation for AF in female patients. METHODS From January 2005 to May 2008, 3265 females underwent pulmonary vein antrum isolation. Success rates, patient profiles, and complications were collected. RESULTS Approximately 16% of our population was female (P <.001). Females were older (59 +/- 13 vs. 56 +/- 19 years; P <.01) and had a lower prevalence of paroxysmal atrial fibrillation (PAF; 46% vs. 55%; P <.001). Females failed more antiarrhythmics (4 +/- 1 vs. 2 +/- 3; P = .04) and were referred later for catheter ablation (6.51 +/- 7 vs. 4.85 +/- 6.5 years; P = .02) than males. More females failed ablation (31.5% vs. 22.5%; P = .001) and had nonantral sites of firing than males (P <.001). Female patients had 11 (2.1%) hematomas versus 27 (0.9%) in males. CONCLUSIONS Five times as many males underwent catheter ablation than females. Females failed more ablations possibly because of a higher prevalence of nonantral firing, non-PAF, and longer history of AF. Females had more bleeding complications than males.
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Affiliation(s)
- Dimpi Patel
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX, USA
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219
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Volgman AS, Manankil MF, Mookherjee D, Trohman RG. Women with atrial fibrillation: Greater risk, less attention. ACTA ACUST UNITED AC 2009; 6:419-32. [DOI: 10.1016/j.genm.2009.09.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2009] [Indexed: 12/21/2022]
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220
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What affects anticoagulation control in patients taking warfarin? Br J Gen Pract 2009; 59:590-4. [PMID: 22751234 DOI: 10.3399/bjgp09x453800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 09/17/2008] [Accepted: 03/11/2009] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The ageing population is taking an increasing number of both prescribed and non-prescribed medication. Little is known of the potential for adverse drug reactions between these. Warfarin is a commonly prescribed medication, well known for its potential to cause serious adverse reactions in combination with many prescription medicines. It has been suggested that herbal medicines such as garlic, either as a dietary supplement or in cooking, may also interact with warfarin, resulting in poor international normalised ratio (INR) control. AIM To determine whether, for patients who take garlic as well as warfarin, the proportion of the INR tests in range is lower than in comparable patients who do not take garlic. DESIGN OF THE STUDY Retrospective study of patients taking prescribed warfarin. SETTING Primary care practices in Somerset and Devon. METHOD Three controls (not taking garlic) matched for age, sex, and general practice were compared with each patient self-reporting taking garlic as a supplement. INR results were assessed for the preceding 12 months. Potentially confounding factors were considered, for example diabetes mellitus; all prescribed medication; any bleeding episodes. RESULTS No evidence was found to suggest that garlic consumption either as a supplement or in cooking is associated with more frequent haemorrhagic complications or less control of INR. Poor INR control may, however, be associated with taking larger numbers of prescription medicines, particularly during prescription changes. CONCLUSION Further research would be warranted into whether increased INR monitoring is needed when drug changes are made. These data render clinically significant interactions between warfarin and garlic intake unlikely.
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221
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Automatic real time detection of atrial fibrillation. Ann Biomed Eng 2009; 37:1701-9. [PMID: 19533358 DOI: 10.1007/s10439-009-9740-z] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2008] [Accepted: 06/06/2009] [Indexed: 10/20/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with significant morbidity and mortality. Timely diagnosis of the arrhythmia, particularly transient episodes, can be difficult since patients may be asymptomatic. In this study, we describe a robust algorithm for automatic detection of AF based on the randomness, variability and complexity of the heart beat interval (RR) time series. Specifically, we employ a new statistic, the Turning Points Ratio, in combination with the Root Mean Square of Successive RR Differences and Shannon Entropy to characterize this arrhythmia. The detection algorithm was tested on two databases, namely the MIT-BIH Atrial Fibrillation Database and the MIT-BIH Arrhythmia Database. These databases contain several long RR interval series from a multitude of patients with and without AF and some of the data contain various forms of ectopic beats. Using thresholds and data segment lengths determined by Receiver Operating Characteristic (ROC) curves we achieved a high sensitivity and specificity (94.4% and 95.1%, respectively, for the MIT-BIH Atrial Fibrillation Database). The algorithm performed well even when tested against AF mixed with several other potentially confounding arrhythmias in the MIT-BIH Arrhythmia Database (Sensitivity = 90.2%, Specificity = 91.2%).
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Oertelt-Prigione S, Regitz-Zagrosek V. Gender Aspects in Cardiovascular Pharmacology. J Cardiovasc Transl Res 2009; 2:258-66. [DOI: 10.1007/s12265-009-9114-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Accepted: 05/22/2009] [Indexed: 02/02/2023]
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Du X, Ninomiya T, de Galan B, Abadir E, Chalmers J, Pillai A, Woodward M, Cooper M, Harrap S, Hamet P, Poulter N, Lip GYH, Patel A. Risks of cardiovascular events and effects of routine blood pressure lowering among patients with type 2 diabetes and atrial fibrillation: results of the ADVANCE study. Eur Heart J 2009; 30:1128-35. [PMID: 19282274 DOI: 10.1093/eurheartj/ehp055] [Citation(s) in RCA: 159] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIMS The aim of this study was to investigate serious clinical outcomes associated with atrial fibrillation (AF) and the effects of routine blood pressure lowering on such outcomes in the presence or absence of AF, among individuals with type 2 diabetes. METHODS AND RESULTS About 11 140 patients with type 2 diabetes (7.6% of whom had AF at baseline) were randomized to a fixed combination of perindopril and indapamide or placebo in the Action in Diabetes and Vascular Disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study. We compared total mortality and cardiovascular disease outcomes and effects of randomized treatment for 4.3 years on such outcomes between patients with and without AF at baseline. After multiple adjustments, AF was associated with a 61% (95% confidence interval 31-96, P < 0.0001) greater risk of all-cause mortality and comparable higher risks of cardiovascular death, stroke, and heart failure (all P < 0.001). Routine treatment with a fixed combination of perindopril and indapamide produced similar relative, but greater absolute, risk reductions for all-cause and cardiovascular mortalities in patients with AF, compared with those without AF. The number of patients needed to be treated with perindopril-indapamide for 5 years to prevent one cardiovascular death was 42 for patients with AF and 120 for patients without AF at baseline. CONCLUSION Atrial fibrillation is relatively common in type 2 diabetes and is associated with substantially increased risks of death and cardiovascular events in patients with type 2 diabetes. This arrhythmia identifies individuals who are likely to obtain greater absolute benefits from blood pressure-lowering treatment. Atrial fibrillation in diabetic patients should be regarded as a marker of particularly adverse outcome and prompt aggressive management of all risk factors.
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Affiliation(s)
- Xin Du
- The George Institute for International Health, University of Sydney, Level 10, King George V Building, Royal Prince Alfred Hospital, PO Box M201, Missenden Road, Camperdown, Sydney, NSW 2050, Australia
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Hansen ML, Gadsbøll N, Rasmussen S, Gislason GH, Folke F, Andersen SS, Schramm TK, Sørensen R, Fosbøl EL, Abildstrøm SZ, Madsen M, Poulsen HE, Køber L, Torp-Pedersen C. Clinical consequences of hospital variation in use of oral anticoagulant therapy after first-time admission for atrial fibrillation. J Intern Med 2009; 265:335-44. [PMID: 19141096 DOI: 10.1111/j.1365-2796.2008.02061.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyse how hospital factors influence the use of oral anticoagulants (OAC) in atrial fibrillation (AF) patients and address the clinical consequences of hospital variation in OAC use. DESIGN AND SUBJECTS By linkage of nationwide Danish administrative registers we conducted an observational study including all patients with a first-time hospitalization for AF between 1995 and 2004 as well as prescription claims for OAC. Multivariable logistic regression analysis was used to evaluate hospital factors associated with prescription of OAC therapy. Cox proportional-hazard models were used to estimate the risk of re-hospitalization for thromboembolism and haemorrhagic stroke with respect to discharge from a low, intermediate, or high OAC use hospital. RESULTS Overall 40,133 (37%) out of 108,504 patients received OAC; ranging from 17% to 50% between the hospitals with the lowest and highest OAC use, respectively. Cardiology departments had the highest use of OAC, but neither tertiary university hospitals nor high volume hospitals had higher OAC use than local community hospitals and low volume hospitals. Risk of a thromboembolic event was significantly increased amongst patients from hospitals with a low OAC use (hazard ratio 1.16, confidence interval 1.10-1.22). Notably, higher OAC use was not associated with a higher risk of haemorrhagic stroke. CONCLUSION In Denmark between 1995 and 2004, there was a major hospital variation in AF patients receiving OAC, and consequently, more thromboembolic events were observed amongst patients from low OAC use hospitals. Our study emphasizes the need for a continued vigilance on implementation of international AF management guidelines.
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Affiliation(s)
- M L Hansen
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark.
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Pellegrini CN, Vittinghoff E, Lin F, Hulley SB, Marcus GM. Statin use is associated with lower risk of atrial fibrillation in women with coronary disease: the HERS trial. Heart 2009; 95:704-8. [PMID: 19176561 DOI: 10.1136/hrt.2008.154054] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the efficacy of statin treatment in atrial fibrillation (AF) prevention in women. DESIGN Cohort study using data obtained in the Heart and Estrogen/Progestin Replacement Study (HERS). SETTING Secondary analysis of a multicentre, randomised controlled clinical trial. PATIENTS 2673 Postmenopausal women with coronary disease. MAIN OUTCOME MEASURES AF prevalence at baseline and incident AF over a mean follow-up of 4.1 years. RESULTS 88 Women with AF were identified: 29 at baseline and 59 during follow-up. Women with AF were significantly less likely to be taking a statin at study enrollment than those without AF (22% vs 37%, p = 0.003). Baseline statin use was associated with a 65% lower odds of having AF at baseline after controlling for age, race, history of myocardial infarction or revascularisation and history of heart failure (odds ratio 0.35, 95% confidence interval (CI) 0.13 to 0.93, p = 0.04). The risk of developing AF during the study among those free from AF at baseline, adjusted for the same covariates, was 55% less for those receiving statin treatment (hazard ratio 0.45, 95% CI 0.26 to 0.78, p = 0.004). CONCLUSIONS Statin treatment is associated with a lower prevalence and incidence of AF after adjustment for potential confounders in postmenopausal women with coronary disease.
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Affiliation(s)
- C N Pellegrini
- Division of Cardiology, Electrophysiology Section, University of California, San Francisco, California, USA
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Abstract
Women and men differ in drug needs and drug metabolism. Usually women are smaller and lighter and have a higher body fat percentage and lower kidney function. Primary drug-metabolizing enzymes in the intestinal wall and liver, which are part of the cytochrome P450 family, have different activities in men and women. Their substrates (beta-blockers, blockers of calcium channels such as nifedipine and verapamil, cyclosporine, and many others) are metabolized differently. Sex differences were observed after administration of digitalis, which is often overdosed in women. Furthermore, beta-blockers are found at higher plasma levels in women and ACE inhibitors cause more side effects in women than in men. In women, acetylsalicylic acid provides effective primary prophylaxis against stroke but not myocardial infarction. In men, these drugs have opposite effects. Anticoagulants and thrombolytics often lead to bleeding complications in women, QT prolonging drugs produce more frequently arrhythmia. It is therefore very important to control drugs following approval and to look out for these differences between men and women.
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227
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English J, Smith W. Cardio-embolic stroke. HANDBOOK OF CLINICAL NEUROLOGY 2009; 93:719-749. [PMID: 18804677 DOI: 10.1016/s0072-9752(08)93036-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Joey English
- Department of Neurology, University of California, San Francisco, CA 94143, USA
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228
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Anthony M, Lee KY, Bertram CT, Abarca J, Rehfeld RA, Malone DC, Freeman M, Woosley RL. Gender and age differences in medications dispensed from a national chain drugstore. J Womens Health (Larchmt) 2008; 17:735-43. [PMID: 18537477 DOI: 10.1089/jwh.2007.0731] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Our objective was to compare sex and age differences in the medications dispensed in pharmacies from a large national drugstore chain. METHODS Using a list for the 200 most commonly prescribed medicines, we assessed prescriptions dispensed by a large national chain drug store over 1 year (2002-2003). The analysis used U.S. census data adjusted for the population by sex and age and weighted by the number of pharmacies per state. Results are reported as an odds ratio (OR) of prescriptions dispensed to females and males. RESULTS Under age 18, 24 drug classes were dispensed more commonly to females (OR > 1) and 18 drug classes more commonly to males (OR < 1). In the 18-24 age group, 48 of 53 drug classes were dispensed more frequently to females. Across other adult groups, females were dispensed more medications than males for 156 of 180 medications. There was greater dispensing to females of antibiotics (OR = 1.74, 95% confidence interval [CI] 1.74-1.74), analgesics (OR = 1.70, 95% CI 1.70-1.70), antihistamines and sympathomimetics (OR = 1.46, 95% CI 1.45-1.46), benzodiazapines (OR = 2.08, 95% CI 2.07-2.08), antidepressants (OR = 2.40, 95% CI 2.39-2.40), diuretics (OR = 1.9328, 95% CI 1.93-1.94), and thyroid drugs (OR = 4.80, 95% CI 4.78-4.82). However, males had higher dispensing of antianginal drugs (OR = 0.84, 95% CI 0.83-0.85), anticoagulants (OR = 0.89, 95% CI 0.88-0.90), glycosides (OR = 0.80, 95% CI 0.79-0.81), and antihypertensives (OR = 0.91, 95% CI 0.91-0.91). More females were dispensed propoxyphene with acetaminophen (OR = 2.23, 95% CI 2.23-2.24), which has been associated with adverse outcomes (hospitalizations, emergency department visits, and deaths). CONCLUSIONS Females, especially during the reproductive years, are dispensed more medications than males.
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Abstract
Stroke is a major public health problem. The female population carries a higher stroke burden than the male population, both because females have a longer life expectancy and because most stroke deaths occur in women. Differences between the sexes in relation to stroke are increasingly being recognized; for example, among stroke survivors, women tend to have worse outcomes than men, as indicated by more-severe disability and an increased likelihood of institutionalization in women. Women and men with stroke also differ in their risk factor profiles, and they respond differently to primary-prevention and acute stroke treatment. Women experience variations in endogenous estrogens throughout their life cycle and might also be exposed to exogenous estrogens, both of which markedly affect the brain. An understanding of the effects of endogenous and exogenous estrogens on cerebral hemodynamics could guide research into explaining how hormone therapy increases the risk of stroke in postmenopausal women. This Review summarizes the sex differences related to stroke, and the effect of endogenous and exogenous hormones on the cerebrovasculature of the female brain. It also proposes potential research approaches, the results of which could fill in gaps in our knowledge regarding the mechanism of action of estrogen in the brain.
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231
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Reynolds MR, Ellis E, Zimetbaum P. Quality of life in atrial fibrillation: measurement tools and impact of interventions. J Cardiovasc Electrophysiol 2008; 19:762-8. [PMID: 18266667 DOI: 10.1111/j.1540-8167.2007.01091.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Quality of life (QoL) is of central importance in atrial fibrillation as both a treatment goal and an endpoint in the evaluation of new therapies. QoL appears to be impaired in the majority of patients with AF. A number of interventions for AF have been shown to improve QoL, including pharmacologic and nonpharmacologic rate control, antiarrhythmic drugs, and nonpharmacologic rhythm control strategies. This paper will review the rationale, design, strengths, and limitations of the questionnaires most commonly used to assess QoL in AF studies, and present QoL outcomes from major studies of AF interventions.
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232
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Humphries KH, Lee M, Sheldon R, Ramanathan K, Dorian P, Green M, Kerr CR. Statin use and recurrence of atrial fibrillation after successful cardioversion. Am Heart J 2007; 154:908-13. [PMID: 17967597 DOI: 10.1016/j.ahj.2007.07.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Accepted: 07/24/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Statins have important pleiotropic effects and have been shown to reduce vascular inflammation and the incidence of atrial fibrillation (AF) after cardiac surgery. The role of statins in patients with existing AF is poorly understood. We examined the effect of statins on recurrence of AF in patients after successful cardioversion. METHODS Statin use and documented recurrence of AF after successful cardioversion were evaluated in 625 patients with new onset AF who were followed prospectively in the Canadian Registry of Atrial Fibrillation. Logistic regression was used to model the effect of statin use on the recurrence of AF at 1 year while adjusting for potential confounders including concurrent medications. RESULTS In a predominantly male population (62%) with median age 63 years, 12.3% were on statins at baseline. Overall, 32.5% had documented recurrence of AF at 1 year; 23.4% in patients on statins compared to 33.8% in those not on statins (P = .07). After adjustment for baseline differences and concomitant beta-blocker use, statin use was associated with a 74% reduction in AF recurrence, but only in statin users on beta-blockers (OR 0.26, 95% CI 0.10-0.66); statin users not on beta-blockers (OR 1.07, 95% CI 0.44-2.58). CONCLUSIONS In an observational study of patients with new onset AF, statin use was associated with a significant 74% reduction in the odds of recurrent AF, but only in patients also taking beta-blockers. Importantly, statin without concomitant beta-blocker use was not associated with any changes in AF recurrence.
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Affiliation(s)
- Karin H Humphries
- Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, British Columbia, Canada.
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233
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Tveit A, Abdelnoor M, Enger S, Smith P. Atrial Fibrillation and Antithrombotic Therapy in a 75-Year-Old Population. Cardiology 2007; 109:258-62. [PMID: 17873490 DOI: 10.1159/000107789] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Accepted: 02/09/2007] [Indexed: 11/19/2022]
Abstract
AIMS To find the true prevalence of diagnosed and undiagnosed atrial fibrillation (AF) in a population aged 75 years in 2 municipalities in Norway, and to study the use of antithrombotic therapy in this group. METHODS All 1,117 citizens in Asker and Baerum municipalities in eastern Norway born in 1930 were invited to participate in a prevalence study of AF. Nine hundred and sixteen subjects (82%) were examined by electrocardiogram, and blood pressure and pulse rate were measured. Comorbidity and current medication were recorded. RESULTS AF was present in 92 subjects (10%; 95% CI 8.2-12.1%), including 33 with ECG-documented, paroxysmal AF. In addition, 8 subjects had a history of a single, transient episode of AF. AF was previously undiagnosed in 10 out of 916 (1.1%). In 77 of 82 patients with previously diagnosed AF (93.9%), antithrombotic therapy was compliant with international guidelines. CONCLUSION Ten percent (95% CI 8.2-12.2%) in this 75-year-old population had AF. Compliance with international guidelines regarding antithrombotic therapy was high. Previously undiagnosed AF was found in only 10 out of 916 (1.1%).
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Affiliation(s)
- Arnljot Tveit
- Department of Internal Medicine, Asker and Baerum Hospital, Rud, Norway.
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234
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Lee CH, Liu PY, Tsai LM, Tsai WC, Ho MT, Chen JH, Lin LJ. Characteristics of hospitalized patients with atrial fibrillation in Taiwan: a nationwide observation. Am J Med 2007; 120:819.e1-7. [PMID: 17765053 DOI: 10.1016/j.amjmed.2006.10.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Revised: 10/03/2006] [Accepted: 10/05/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of the study is to describe the nationwide epidemiological data for hospitalized patients with atrial fibrillation in Taiwan. METHODS We collected information on hospitalized patients with discharge-diagnosed atrial fibrillation from 1997 through 2002 from the Taiwan National Health Insurance database. Patients were examined for temporal trends in the frequency of the disease, clinical characteristics, and in-hospital mortality. RESULTS Of 162,340 patients (mean age, 73.8 years), 55.3% were men and 38.6% had a primary diagnosis of atrial fibrillation. The mean annual frequency of diagnosed atrial fibrillation was 127 per 100,000 persons. The frequency of atrial fibrillation rose from 91 (1997) to 150 (2002) per 100,000 persons (P <.001); it significantly increased directly with age from 4 per 100,000 in patients <50 years to 1571 per 100,000 in patients > or =80 years. The frequency was significantly higher in men than in women (137 vs 116 per 100,000; P <.001). The average in-hospital mortality rate was 9.3%. In-hospital mortality rate showed a decreasing trend (9.9% vs 7.6%; P = .003). Comorbidities of ischemic heart disease, valvular heart disease, hypertension, ischemic stroke, and congestive heart failure were predictors of higher mortality. CONCLUSIONS This Taiwanese study showed a 1.65-fold increase in the frequency of diagnosed atrial fibrillation during the study period. The in-hospital mortality rate, however, declined. The frequency of atrial fibrillation was higher in men and the elderly. We should be more concerned about negative outcomes in hospitalized patients with atrial fibrillation and other coexisting cardiovascular conditions.
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Affiliation(s)
- Cheng-Han Lee
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
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235
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Falagas ME, Vardakas KZ, Vergidis PI. Under-diagnosis of common chronic diseases: prevalence and impact on human health. Int J Clin Pract 2007; 61:1569-79. [PMID: 17686096 DOI: 10.1111/j.1742-1241.2007.01423.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIMS The disability-adjusted life years (DALY) and its components, namely the years lived with disability and the years of life lost, are measures of the impact of disease on human health. Our impression was that several common chronic diseases responsible for many DALYs are frequently under-diagnosed. METHODS We attempted to summarise data regarding the under-diagnosis of common chronic diseases of the developed world, which are associated with considerable mortality and/or disability. We searched PubMed and Current Contents to identify relevant studies (1980-2005). Two reviewers extracted data concerning DALYs and prevalence of under-diagnosis of common chronic diseases. RESULTS Studies regarding the first 15 diseases (or group of diseases) based on DALYs were reviewed. The under-diagnosis of common chronic diseases in the developed world ranges from about 20% for dementia and cirrhosis to 90% for depression and osteoarthritis. The delay in the prompt diagnosis and initiation of treatment is associated with increased morbidity and mortality for most of the reviewed diseases. CONCLUSION The available evidence suggests that the prevalence of under-diagnosis of common chronic diseases is considerable. Physicians should be aware of the prevalence of under-diagnosis of chronic diseases and its impact on human health.
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Affiliation(s)
- M E Falagas
- Alfa Institute of Biomedical Sciences, Athens, Greece.
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236
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Khaykin Y, Morillo CA, Skanes AC, McCracken A, Humphries K, Kerr CR. Cost Comparison of Catheter Ablation and Medical Therapy in Atrial Fibrillation. J Cardiovasc Electrophysiol 2007; 18:907-13. [PMID: 17666065 DOI: 10.1111/j.1540-8167.2007.00902.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION There is emerging evidence for clinical superiority of catheter ablation over rate and rhythm control strategies in paroxysmal atrial fibrillation (PAF). The objective of this study was to compare costs related to medical therapy versus catheter ablation for PAF in Ontario (Canada). METHODS Costs related to medical therapy in the analysis included the cost of anticoagulation, rate and rhythm control medications, noninvasive testing, physician follow-up visits, and hospital admissions, as well as the cost of complications related to this management strategy. Costs related to catheter ablation were assumed to include the cost of the ablation tools (electroanatomic mapping or intracardiac echocardiography-guided pulmonary vein ablation), hospital and physician billings, and costs related to periprocedural medical care and complications. Costs related to these various elements were obtained from the Canadian Registry of Atrial Fibrillation (CARAF), government fee schedules, and published data. Sensitivity analyses looking at a range of initial success rates (50-75%) and late attrition rates (1-5%), prevalence of congestive heart failure (CHF) (20-60%), as well as discounting varying from 3% to 5% per year were performed. RESULTS The cost of catheter ablation ranged from $16,278 to $21,294, with an annual cost of $1,597 to $2,132. The annual cost of medical therapy ranged from $4,176 to $5,060. Costs of ongoing medical therapy and catheter ablation for PAF equalized at 3.2-8.4 years of follow-up. CONCLUSION Catheter ablation is a fiscally sensible alternative to medical therapy in PAF with cost equivalence after 4 years.
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Affiliation(s)
- Yaariv Khaykin
- Southlake Regional Health Center, Newmarket, Ontario, Canada.
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237
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Abstract
The market for molecular diagnostic tests is predicted to grow at extraordinary rates over the next 10 years, fueled by pharmacogenetics and the elusive dream of personalized medicine. The challenge is managing the expectations of the medical community and the public at large that have already been set by speculation, promises, and the repeated exposure to headlines about genetic discoveries. Personalized medicine is a paradigm that exists more in conceptual terms than in reality, with only a few marketed drug-test companion products and not very many actual clinical practices set up to personalize medicine in the way that supporters have intended. Nevertheless, the reality of personalized medicine has become more imminent because of the increased awareness of the shortcomings in the delivery of drugs with adequate benefit/risk to patients, a better molecular understanding of how to optimize drug selection and dosing, and an increased demand for integrating more clinically relevant genetic information into the drug development process to improve both innovation and productivity. This paper focuses on personalized medicine by (1) looking at some converging changes taking place in the health-care landscape that are creating a scientific and social infrastructure to enable personalized medicine, (2) considering challenges that need to be addressed with regard to clinical evidence standards for validating genotype-phenotype associations, and (3) considering how clinical pharmacology can help construct a rational personalized medicine framework. As therapeutic experts, clinical pharmacologists can work to assure that "good therapeutics follows good diagnostics". They are well equipped to provide timely genetic education to others and to interpret genetic data so that actionable decisions, especially about drug dosing in individual patients, can be implemented in clinical practice.
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Affiliation(s)
- L J Lesko
- Office of Clinical Pharmacology, FDA, Silver Spring, MD, USA.
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238
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Forleo GB, Tondo C, De Luca L, Dello Russo A, Casella M, De Sanctis V, Clementi F, Fagundes RL, Leo R, Romeo F, Mantica M. Gender-related differences in catheter ablation of atrial fibrillation. ACTA ACUST UNITED AC 2007; 9:613-20. [PMID: 17636302 DOI: 10.1093/europace/eum144] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS Women have an increased risk for atrial fibrillation (AF)-related complications and there is evidence towards a reduced efficacy of the rhythm control strategy than men. A catheter-based strategy is therefore widely attractive, but the impact of gender on catheter ablation (CA) of AF remains undefined. METHODS AND RESULTS We included 221 consecutive patients (150 men) who underwent CA of drug-refractory AF. Gender differences in clinical presentation and outcomes were compared. Women were older (P = 0.002), had a longer history of AF (P = 0.04), and were more likely to have hypertension (P = 0.04). Moreover, a concomitant valvular heart disease tended to be more common in women (32.4 vs. 23.3%; P = 0.28) and left atrium dimensions were significantly larger (P = 0.003). However, acute success rate and complications rate were similar between genders. After 22.5 +/- 11.8 months of follow-up, the overall freedom from arrhythmia recurrences was similar (83.1 vs. 82.7% in men), and a similar improvement in SF-36 quality of life scores was achieved in both groups. CONCLUSION Women are referred for AF ablation later with a more complex clinical pre-operative presentation. Despite this higher risk profile in women, no differences were detected in clinical outcomes. Our findings indicate that CA of AF appears to be safe and effective in women as in men.
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Affiliation(s)
- Giovanni B Forleo
- Arrhythmia and Electrophysiology Center, St Ambrogio Clinical Institute, Via Luigi Faravelli, 16-20149 Milan, Italy.
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239
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Abstract
Cardiovascular nursing practice includes accountability for the clinical and organizational processes to ensure positive outcomes for patients having cardiac dysrhythmias. For patients with supraventricular dysrhythmias, nurses have studied patient outcomes related to mortality, morbidity, quality of life, psychological and physical functioning, and symptoms. Nurses have also explored these same outcomes associated with the management of supraventricular dysrhythmias. In addition, nurses have contributed to understanding organizational outcomes such as healthcare utilization and costs associated with these patients. For patients with atrial fibrillation after cardiac surgery, nurses have studied patient and organizational outcomes related to mortality, morbidity, symptoms, psychological and physical functioning, and economic outcomes. This research has included numerous interdisciplinary studies, and most of it has been descriptive or observational in design. Areas for future nursing outcomes research, including more interventional studies, are discussed.
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Affiliation(s)
- Marjorie Funk
- Yale University School of Nursing, New Haven, CT, USA
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Dagres N, Nieuwlaat R, Vardas PE, Andresen D, Lévy S, Cobbe S, Kremastinos DT, Breithardt G, Cokkinos DV, Crijns HJGM. Gender-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe: a report from the Euro Heart Survey on Atrial Fibrillation. J Am Coll Cardiol 2007; 49:572-7. [PMID: 17276181 DOI: 10.1016/j.jacc.2006.10.047] [Citation(s) in RCA: 287] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Revised: 09/29/2006] [Accepted: 10/16/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study sought to investigate gender-related differences in patients with atrial fibrillation (AF) in Europe. BACKGROUND Gender-related differences may play a significant role in AF. METHODS We analyzed the data of 5,333 patients (42% female) enrolled in the Euro Heart Survey on Atrial Fibrillation. RESULTS Compared with men, the women were older, had a lower quality of life (QoL), had more comorbidities, more often had heart failure (HF) with preserved left ventricular systolic function (18% vs. 7%, p < 0.001), and less often had HF with systolic dysfunction (17% vs. 26%, p < 0.001). Among patients with typical AF symptoms (56% of women, 49% of men), there was no gender-related difference in the choice of rate or rhythm control. Among patients with atypical or no symptoms (44% of women, 51% of men), women less frequently underwent rhythm control (39% vs. 51%, p < 0.001) than did men. Women underwent less electrical cardioversion (22% vs. 28%, p < 0.001). Prescription of oral anticoagulants was identical (65%) in both genders. One-year outcome was similar except that women had a higher chance for stroke (odds ratio 1.83 in multivariable regression analysis, p = 0.019). CONCLUSIONS Women with AF had more comorbidities, more HF with preserved systolic function, and a lower QoL than men. In the large group with atypical or no symptoms, women were treated appropriately more conservatively with less rhythm control than men. Women had a higher chance for stroke. Long-term QoL changes and other morbidities and mortality were similar.
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Affiliation(s)
- Nikolaos Dagres
- University of Athens, Second Cardiology Department, Attikon University Hospital, Athens, Greece.
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241
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Gerstenfeld EP, Callans D, Dixit S, Lin D, Cooper J, Russo AM, Verdino R, Weiner M, Zado E, Marchlinski FE. Characteristics of Patients Undergoing Atrial Fibrillation Ablation: Trends Over a Seven-Year Period 1999?2005. J Cardiovasc Electrophysiol 2007; 18:23-8. [PMID: 17081205 DOI: 10.1111/j.1540-8167.2006.00662.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Catheter ablation procedures for treating atrial fibrillation (AF) have dramatically increased since triggers of AF were first described in 1998. OBJECTIVE We explored changes in patient characteristics in patients referred for catheter ablation of AF over a seven-year period from 1999 through 2005. METHODS Patient characteristics were examined for all patients undergoing AF ablation from 1999 through 2005 at the University of Pennsylvania Health System (UPHS). The gender of patients undergoing ablation was also compared with outpatients seen at UPHS with a primary diagnosis of AF. RESULTS From 1999 to 2005 the number of patients undergoing ablation has increased steadily, from 29 patients in 1999 to 265 patients in 2005 (P < 0.01). Patients have become older (47 to 56 years; P < 0.01), with more persistent or permanent AF (17% to 45%; P < 0.01), larger left atrial size (4.0 to 4.4 cm; P < 0.01), and fewer antiarrhythmic drugs used prior to ablation (3.9 to 2.0 drugs; P < 0.01). Patients undergoing ablation have been predominantly male, with a significantly higher male prevalence than patients seen in the UPHS outpatient primary care clinic with AF (77% vs 59% male; P < 0.001). CONCLUSIONS Patients undergoing AF ablation from 1999 to 2005 are older, with larger left atrial size, more persistent/permanent AF, and fewer prior antiarrhythmic agents used. Compared with the gender-specific rates of AF in the population, the majority of patients referred for ablation are men, suggesting a referral bias against this invasive procedure for women. These findings are important for interpreting the outcome of ablation in the current era, and for designing prospective randomized trials.
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Affiliation(s)
- Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
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242
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Reynolds MR, Lavelle T, Essebag V, Cohen DJ, Zimetbaum P. Influence of age, sex, and atrial fibrillation recurrence on quality of life outcomes in a population of patients with new-onset atrial fibrillation: the Fibrillation Registry Assessing Costs, Therapies, Adverse events and Lifestyle (FRACTAL) study. Am Heart J 2006; 152:1097-103. [PMID: 17161061 PMCID: PMC1820843 DOI: 10.1016/j.ahj.2006.08.011] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Accepted: 08/03/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most quality of life (QoL) data in AF have been collected from clinical trial patients. We sought to characterize symptoms and QoL in a large inception cohort of unselected patients with AF and explore the impact of age, sex, and AF clinical course on QoL measures over time. METHODS We collected symptom and QoL data on 963 patients with new onset AF enrolled in a multicenter observational registry. Patients were primarily managed with pharmacologic therapy and cardioversion. Quality of life instruments including the Medical Outcomes Study Short Form-12, University of Toronto AF Severity Scale, and the AF Symptom Checklist were completed at baseline and repeated over 2.5 years. Time-weighted QoL summary scores over the first year were calculated for each patient. Factors associated with those summary scores were explored in multivariable analyses. RESULTS Quality of life was moderately impaired at baseline, but quickly approached population norms and remained stable thereafter. After multivariable adjustment, female sex was strongly associated with higher symptom scores and lower QoL scores. Older (age >65 years) patients reported less prominent disease-specific impairment in QoL than younger patients. In part because 73% of patients appeared to maintain sinus rhythm for the first year, AF clinical course had a comparatively small impact on QoL during this timeframe. CONCLUSIONS Quality of life is impaired in newly diagnosed patients with AF, but improves to normal levels with standard treatments. Within the first year after diagnosis, sex, age, and comorbid conditions are more strongly associated with QoL outcomes than the clinical course of AF itself.
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Affiliation(s)
- Matthew R Reynolds
- Division of Cardiology, Beth Israel Deaconess Medical Center, 185 Pilgrim Road/Baker 4, Boston, MA 02215, USA.
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243
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Correa-De-Araujo R. Serious Gaps: How the Lack of Sex/Gender-Based Research Impairs Health. J Womens Health (Larchmt) 2006; 15:1116-22. [PMID: 17199452 DOI: 10.1089/jwh.2006.15.1116] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rosaly Correa-De-Araujo
- Office of the Americas, Office of the Secretary, Office of Global Health Affairs, Department of Health and Human Services, 5600 Fishers Lane, Rockville, MD 20857, USA.
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244
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Hummel JD. Looking over our seven-year shoulder: lessons learned from a single-center experience with atrial fibrillation ablation. J Cardiovasc Electrophysiol 2006; 18:29-30. [PMID: 17096651 DOI: 10.1111/j.1540-8167.2006.00668.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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245
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Farré J. Siete reflexiones sobre un primer episodio de fibrilación auricular solitaria. Rev Esp Cardiol 2006. [DOI: 10.1157/13095776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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246
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Wachtell K, Devereux RB, Lyle PA. Use of beta-blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers to prevent atrial fibrillation. Curr Cardiol Rep 2006; 8:356-64. [PMID: 16956451 DOI: 10.1007/s11886-006-0075-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Atrial fibrillation, the most common cardiac arrhythmia in clinical practice, causes significant burden to patients and health care systems worldwide. Attention is being paid to prevention of atrial fibrillation using drugs that retard or prevent atrial fibrosis and arrhythmogenic remodeling, which lead to this arrhythmia. Agents that work through the renin-angiotensin-receptor system, the angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, are showing promise in animal and human studies.
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Affiliation(s)
- Kristian Wachtell
- Rigshospitalet, Department of Cardiology B2142, The Heart Center, 9 Blegdamsvej, DK-2100 Copenhagen, Denmark.
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Choudhry NK, Soumerai SB, Normand SLT, Ross-Degnan D, Laupacis A, Anderson GM. Warfarin prescribing in atrial fibrillation: the impact of physician, patient, and hospital characteristics. Am J Med 2006; 119:607-15. [PMID: 16828633 DOI: 10.1016/j.amjmed.2005.09.052] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Accepted: 09/21/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE The study investigated the determinants of warfarin use in patients with atrial fibrillation (AF). METHODS We assembled a retrospective cohort of community-dwelling elderly patients (aged > or = 66 years) with AF using linked administrative databases. We identified the physicians responsible for the ambulatory care of these patients using physician service claims and compared patients who did and did not have an identifiable provider. For those patients with an identifiable provider, we assessed the association between patient, physician, and hospital factors and warfarin use. RESULTS Our cohort consisted of 140,185 patients, of whom 116,200 (83%) had an identifiable cardiac provider. Patients without a provider were significantly more likely to have comorbid conditions that increase their risk of warfarin-associated bleeding. After adjustment for clinical factors, patients without a provider were significantly less likely to receive warfarin (odds ratio 0.37, 95% confidence interval: 0.36-0.38). Of patients with providers, 50,551 patients (43.5%) received warfarin within 180 days after hospital discharge. Warfarin use was positively associated with AF-associated stroke risk factors (eg, prior stroke, congestive heart failure) and negatively associated with warfarin-associated bleeding risk factors (eg, history of intracerebral hemorrhage). After controlling for patient and hospital factors, patients cared for by noncardiologist physicians with cardiology consultation were more likely to receive warfarin then patients treated in noncollaborative environments. CONCLUSIONS Warfarin continues to be substantially underprescribed to patients who are at high risk for AF-associated cardioembolic stroke. Our findings highlight the need for targeted quality improvement interventions and suggest preferred models of AF care involving routine collaboration between cardiologists and other physicians.
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Affiliation(s)
- Niteesh K Choudhry
- Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts, USA.
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Kapral MK. Stroke management in women. WOMEN'S HEALTH (LONDON, ENGLAND) 2006; 2:597-603. [PMID: 19803967 DOI: 10.2217/17455057.2.4.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Stroke is among the most important causes of death and disability for both women and men worldwide. Although stroke and cardiovascular disease are often considered primarily conditions of men, more women than men die from stroke each year, and women who survive have worse outcomes than men. Fortunately, clinical trials have shown that there are a variety of interventions that can improve stroke outcomes and reduce the risk of recurrent stroke, and the majority of these are effective in both women and men. Certain causes of stroke are unique to women (strokes in pregnancy) or more common in women (strokes associated with migraine headaches); however, a detailed discussion of these specific causes of stroke is beyond the scope of this review. The focus of this article is an overview of some of the key issues related to the management of stroke in women.
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Affiliation(s)
- Moira K Kapral
- University of Toronto, Toronto General Hospital, 200 Elizabeth St. 14EN-215, Toronto, Ontario, M5G 2C4, Canada.
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Frost L, Vukelic Andersen L, Vestergaard P, Husted S, Mortensen LS. Trends in Risk of Stroke in Patients with a Hospital Diagnosis of Nonvalvular Atrial Fibrillation: National Cohort Study in Denmark, 1980–2002. Neuroepidemiology 2006; 26:212-9. [PMID: 16645320 DOI: 10.1159/000092795] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AIM We examined trends in incidence of stroke of any nature (ischemic and/or hemorrhagic) in subjects with a hospital diagnosis of nonvalvular atrial fibrillation or flutter in Denmark from 1980 to 2002 by sex, age and conditions of comorbidity. METHODS We identified all individuals, aged 40-89 years, with an incident hospital diagnosis of atrial fibrillation or flutter and no history of stroke or heart valve disease in the Danish National Registry of Patients, and subjects were followed in the Danish National Registry of Patients for occurrence of an incident diagnosis of stroke of any nature (ischemic and/or hemorrhagic) and in the Danish Civil Registration System (emigration and vital status). We used multivariate Cox proportional hazard regression analysis to estimate trends in incidence of stroke. RESULTS Nonvalvular atrial fibrillation or flutter was diagnosed in 141,493 subjects (75,126 men and 66,367 women), and during follow-up 15,964 subjects had an incident diagnosis of stroke. The hazard ratios for stroke in the last 3-year period compared to the first 5-year period, adjusted for 10-year age group, conditions of comorbidity, and general stroke trend in the Danish population were 0.78 (95% CI 0.70-0.86) in men, and 0.80 (95% CI 0.72-0.88) in women. The reduction in risk of stroke by calendar year was most prominent in patients aged 40-74 years. CONCLUSION We observed a modest decrease in risk of stroke in subject with atrial fibrillation in Denmark during calendar years 1980-2002. However, we could not control for any changes in diagnostic performance, admission practice, and medical management of patients with atrial fibrillation.
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Affiliation(s)
- Lars Frost
- Department of Cardiology A, Aarhus University Hospital, Denmark.
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Hagens VE, Van Veldhuisen DJ, Crijns HJGM, Van Gelder IC. Implication from randomized trials of rate and rhythm controls on management of patients with persistent atrial fibrillation. Ann Noninvasive Electrocardiol 2006; 11:170-86. [PMID: 16630092 PMCID: PMC6932388 DOI: 10.1111/j.1542-474x.2006.00099.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Recently, several randomized trials were published on the issue of rate or rhythm control for patients with atrial fibrillation (AF). Patients were typically minor symptomatic, relatively old, with age above 70, presenting with a recurrence of AF and suffering from only mild to moderate underlying heart disease. The main outcome of these trials is that rate control is not inferior to rhythm control for the management of patients with AF concerning morbidity and mortality. Also patients' quality of life did not differ significantly in follow-up in these trials. However, rhythm control is not redundant in the treatment of AF. Focus is now on subgroups of patients who could still have benefit being in sinus rhythm. For severely symptomatic patients, patients presenting with the first episode of AF and probably those with severe congestive heart failure, to restore and maintain sinus rhythm should still be the goal. With the failure of antiarrhythmic therapy, nonpharmacological approaches such as pulmonary vein isolation can be performed. Another finding of the randomized trials is that being in sinus rhythm does not prevent from the occurrence of thromboembolic complications. This means that for patients with AF, with risk factors for thromboembolic events, adequate anticoagulant therapy is indicated irrespective of the current heart rhythm. As with antiarrhythmic therapy, the search for new and safer anticoagulant therapy is underway. This review will focus on the key aspects we have learned from the randomized trials on rate and rhythm controls for patients with AF.
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Affiliation(s)
- Vincent E. Hagens
- Department of Cardiology, University Medical Center Groningen, the Netherlands
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