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Pathak RK, Abhilash SP, Hendriks JM. A Team-Based Approach Toward Risk Factors of Atrial Fibrillation. Card Electrophysiol Clin 2021; 13:257-262. [PMID: 33516404 DOI: 10.1016/j.ccep.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Atrial fibrillation (AF), being the most common arrhythmia, the service of primary care physicians and internists in preventing, identifying, and treating AF is of paramount importance. There are nonmodifiable, modifiable, and reversible risk factors for AF. The modifiable risk factors include hypertension, obesity, coronary artery disease, heart failure, diabetes mellitus etc. These risk factors should be screened and adequately treated to prevent occurrence of AF at the primary care level itself. This will reduce recurrence rates of AF and will treat underlying conditions predisposing to AF.
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Affiliation(s)
- Rajeev Kumar Pathak
- Australian National University and Canberra Hospital, Canberra, Australian Capital Territory, Australia.
| | | | - Jeroen M Hendriks
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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202
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Hypertension, Prehypertension, Hypertensive Heart Disease, and Atrial Fibrillation. Card Electrophysiol Clin 2021; 13:37-45. [PMID: 33516406 DOI: 10.1016/j.ccep.2020.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hypertension (HT) confers the highest population-attributable risk among factors leading to atrial fibrillation (AF). Data also are accumulating regarding the association between pre-HT, aortic stiffness, and increased incident AF or AF recurrence. Atrial remodeling due to HT is progressive but also reversible. Although inhibition of the renin-angiotensin-aldosterone system has shown the greatest promise in improving AF outcomes, optimal blood pressure targets in individuals with HT and AF remain elusive. AF management demands an integrated care approach. HT is best treated alongside a comprehensive risk factor management program where other AF risk factors are targeted, with involvement of a multidisciplinary team.
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203
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Hyman MC, Levin MG, Gill D, Walker VM, Georgakis MK, Davies NM, Marchlinski FE, Damrauer SM. Genetically Predicted Blood Pressure and Risk of Atrial Fibrillation. Hypertension 2021; 77:376-382. [PMID: 33390040 PMCID: PMC7803440 DOI: 10.1161/hypertensionaha.120.16191] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/18/2020] [Indexed: 01/02/2023]
Abstract
Observational studies have shown an association between hypertension and atrial fibrillation (AF). Aggressive blood pressure management in patients with known AF reduces overall arrhythmia burden, but it remains unclear whether hypertension is causative for AF. To address this question, this study explored the relationship between genetic predictors of blood pressure and risk of AF. We secondarily explored the relationship between genetically proxied use of antihypertensive drugs and risk of AF. Two-sample Mendelian randomization was performed using an inverse-variance weighted meta-analysis with weighted median Mendelian randomization and Egger intercept tests performed as sensitivity analyses. Summary statistics for systolic blood pressure, diastolic blood pressure, and pulse pressure were obtained from the International Consortium of Blood Pressure and the UK Biobank discovery analysis and AF from the 2018 Atrial Fibrillation Genetics Consortium multiethnic genome-wide association studies. Increases in genetically proxied systolic blood pressure, diastolic blood pressure, or pulse pressure by 10 mm Hg were associated with increased odds of AF (systolic blood pressure: odds ratio [OR], 1.17 [95% CI, 1.11-1.22]; P=1×10-11; diastolic blood pressure: OR, 1.25 [95% CI, 1.16-1.35]; P=3×10-8; pulse pressure: OR, 1.1 [95% CI, 1.0-1.2]; P=0.05). Decreases in systolic blood pressure by 10 mm Hg estimated by genetic proxies of antihypertensive medications showed calcium channel blockers (OR, 0.66 [95% CI, 0.57-0.76]; P=8×10-9) and β-blockers (OR, 0.61 [95% CI, 0.46-0.81]; P=6×10-4) decreased the risk of AF. Blood pressure-increasing genetic variants were associated with increased risk of AF, consistent with a causal relationship between blood pressure and AF. These data support the concept that blood pressure reduction with calcium channel blockade or β-blockade could reduce the risk of AF.
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Affiliation(s)
- Matthew C. Hyman
- From the Division of Cardiovascular Medicine (M.C.H., M.G.L., F.E.M.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Michael G. Levin
- From the Division of Cardiovascular Medicine (M.C.H., M.G.L., F.E.M.), University of Pennsylvania Perelman School of Medicine, Philadelphia
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (M.G.L., S.M.D.)
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public Health (D.G.), Imperial College London, United Kingdom
- Department of Medicine, Centre for Pharmacology and Therapeutics, Hammersmith Campus (D.G.), Imperial College London, United Kingdom
- Department of Genetics, Novo Nordisk Research Centre Oxford, Old Road Campus, United Kingdom (D.G.)
- Clinical Pharmacology and Therapeutics Section, Institute of Medical and Biomedical Education and Institute for Infection and Immunity, St George’s, University of London, United Kingdom (D.G.)
- Clinical Pharmacology Group, Pharmacy and Medicines Directorate, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom (D.G.)
| | - Venexia M. Walker
- Department of Surgery (V.M.W., S.M.D.), University of Pennsylvania Perelman School of Medicine, Philadelphia
- Medical Research Council Integrative Epidemiology Unit (V.M.W., N.D.), University of Bristol, United Kingdom
- Bristol Medical School: Population Health Sciences (V.M.W.), University of Bristol, United Kingdom
| | - Marios K. Georgakis
- Institute for Stroke and Dementia Research, University Hospital, Ludwig-Maximilians-University LMU, Munich, Germany (M.K.G.)
| | - Neil M. Davies
- Medical Research Council Integrative Epidemiology Unit (V.M.W., N.D.), University of Bristol, United Kingdom
| | - Francis E. Marchlinski
- From the Division of Cardiovascular Medicine (M.C.H., M.G.L., F.E.M.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Scott M. Damrauer
- Department of Surgery (V.M.W., S.M.D.), University of Pennsylvania Perelman School of Medicine, Philadelphia
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (M.G.L., S.M.D.)
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204
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Lee SR, Park CS, Choi EK, Ahn HJ, Han KD, Oh S, Lip GYH. Hypertension Burden and the Risk of New-Onset Atrial Fibrillation: A Nationwide Population-Based Study. Hypertension 2021; 77:919-928. [PMID: 33486985 DOI: 10.1161/hypertensionaha.120.16659] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The association between the cumulative hypertension burden and the development of atrial fibrillation (AF) is unclear. We aimed to investigate the relationship between hypertension burden and the development of incident AF. Using the Korean National Health Insurance Service database, we identified 3 726 172 subjects who underwent 4 consecutive annual health checkups between 2009 and 2013, with no history of AF. During the median follow-up of 5.2 years, AF was newly diagnosed in 22 012 patients (0.59% of the total study population; 1.168 per 1000 person-years). Using the blood pressure (BP) values at each health checkup, we determined the burden of hypertension (systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg), stratified as 0 to 4 per the hypertension criteria. The subjects were grouped according to hypertension burden scale 1 to 4: 20% (n=742 806), 19% (n=704 623), 19% (n=713 258), 21% (n=766 204), and 21% (n=799 281). Compared with normal people, subjects with hypertension burdens of 1, 2, 3, and 4 were associated with an 8%, 18%, 26%, and 27% increased risk of incident AF, respectively. On semiquantitative analyses with further stratification of stage 1 (systolic BP of 130-139 mm Hg or diastolic BP of 80-89 mm Hg) and stage 2 (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg) hypertension, the risk of AF increased with the hypertension burden by up to 71%. In this study, both a sustained exposure and the degree of increased BP were associated with an increased risk of incident AF. Tailored BP management should be emphasized to reduce the risk of AF.
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Affiliation(s)
- So-Ryoung Lee
- From the Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Republic of Korea (S.-R.L., E.-K.C., H.-J.A., S.O.)
| | - Chan Soon Park
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon (C.S.P.)
| | - Eue-Keun Choi
- From the Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Republic of Korea (S.-R.L., E.-K.C., H.-J.A., S.O.).,Department of Internal Medicine, Seoul National University College of Medicine, Republic of Korea (E.-K.C., S.O., G.Y.H.L.)
| | - Hyo-Jeong Ahn
- From the Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Republic of Korea (S.-R.L., E.-K.C., H.-J.A., S.O.)
| | - Kyung-Do Han
- Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea (K.-D.H.)
| | - Seil Oh
- From the Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Republic of Korea (S.-R.L., E.-K.C., H.-J.A., S.O.)
| | - Gregory Y H Lip
- Department of Internal Medicine, Seoul National University College of Medicine, Republic of Korea (E.-K.C., S.O., G.Y.H.L.).,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom (G.Y.H.L.).,Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
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205
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Goldenthal IL, Ciaccio EJ, Sciacca RR, Garan H, Biviano AB. Increased body mass index, age, and left atrial size are associated with altered intracardiac atrial electrograms in persistent atrial fibrillation patients. J Interv Card Electrophysiol 2021; 62:569-577. [PMID: 33432475 DOI: 10.1007/s10840-020-00933-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 12/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are limited studies evaluating whether atrial fibrillation (AF) patients with increased BMI, age, and left atrial (LA) size have altered intracardiac electrogram (EGM) morphology. METHODS We analyzed left atrial intracardiac EGMs acquired during invasive electrophysiology study in 54 patients with AF. EGM correlations were assessed among AF risk factors including age, left atrial size, and BMI. RESULTS BMI correlated positively with DF (r2 = 0.17, p = 0.009) and MP (r2 = 0.16, p = 0.01) with dominant frequency (DF) and mean spectral profile (MP) greater among obese individuals. Age was negatively associated with mean amplitude (r2 = 0.42, p < 0.001) and width (r2 = 0.32, p < 0.001); age was positively correlated with MP (r2 = 0.24, p < 0.001). LA size was negatively correlated with mean amplitude (r2 = 0.18, p = 0.03) and width (r2 = 0.23, p = 0.01); LA size was positively correlated with DF (r2 = 0.22, p = 0.01) and MP (r2 = 0.23, p = 0.01). Mean amplitude and width were decreased among subjects with a severely enlarged LA; DF and MP were increased in those with severely enlarged LA. The associations with BMI and LA size remained significant in multiple regression models that included age, male gender, time since AF diagnosis, and LVEF. CONCLUSIONS EGM morphology of AF patients with increased BMI, older age, and an enlarged LA possessed decreased amplitude and decreased width and increased DF and MP. These findings suggest that atrial remodeling due to increased age, LA size, and BMI is associated with differences in local atrial activation, decreased refractoriness, and more heterogeneous activation. These novel findings point out clinical risk factors for atrial fibrillation that may affect electrogram characteristics.
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Affiliation(s)
- Isaac L Goldenthal
- Internal Medicine, Division of Cardiology, Columbia University Irving Medical Center, 622 W 168th St, New York, NY, 10032, USA
| | - Edward J Ciaccio
- Internal Medicine, Division of Cardiology, Columbia University Irving Medical Center, 622 W 168th St, New York, NY, 10032, USA
| | - Robert R Sciacca
- Internal Medicine, Division of Cardiology, Columbia University Irving Medical Center, 622 W 168th St, New York, NY, 10032, USA
| | - Hasan Garan
- Internal Medicine, Division of Cardiology, Columbia University Irving Medical Center, 622 W 168th St, New York, NY, 10032, USA
| | - Angelo B Biviano
- Internal Medicine, Division of Cardiology, Columbia University Irving Medical Center, 622 W 168th St, New York, NY, 10032, USA.
- Columbia University Irving Medical Center, 161 Fort Washington Ave #546, New York, NY, 10032, USA.
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206
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Bahloul A, Bouattour N, Triki F, Hammami R, Charfeddine S, Ellouze T, Mhiri C, Abid L, Kammoun S. [Observational study of the prevalence of non-valvular atrial fibrillation and ischemic stroke and the factors associated with non-valvular atrial fibrillation in hypertensive patients: about 2887 cases]. Pan Afr Med J 2021; 38:31. [PMID: 33777299 PMCID: PMC7955596 DOI: 10.11604/pamj.2021.38.31.25569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/20/2020] [Indexed: 01/18/2023] Open
Abstract
Introduction high blood pressure (HBP), atrial fibrillation (AF) and ischemic stroke are three public health problems. The purpose of this study was to determine the prevalence of AF and ischemic stroke in hypertensive patients and the factors associated with the occurrence of non-valvular AF in these patients. Methods we used data collected in the Department of Cardiology at the University Hospital of Sfax as a part of National Tunisian Registry of Hypertension. We examined the associations between different socio-demographic, clinical, paraclinical, and therapeutic variables and AF in hypertensive patients using logistic regression models. Results our sample consisted of 2887 patients with a sex ratio of 0.95. The average age of patients was 65 years (±11). AF was found in 230 patients (8%), while ischemic stroke was found in 152 patients (5.3%). Multivariate analysis highlighted that independent factors associated with an increase in the prevalence of AF were: advanced age (p = 0,001, Odds Ratio (OR) = 1,647, 95% confidence interval ( CI): 1,1227-2,213), the detection of left ventricular hypertrophy (LVH) on cardiac ultrasound (p= 0,004, OR= 2,140, 5%CI 9: 1,281-3,576), and left ventricular ejection fraction (LVEF) < 50% (p<0,001, OR=4,677, 95% CI: 2,715 and 8.057). Conclusion this study confirms that there is a direct and independent relationship between high blood pressure, advanced age, LVH and AF. AF in patients with high blood pressure is a disease progression leading to an increased risk of ischemic stroke. Optimal high blood pressure control is a priority in hypertensive patients, especially in the elderly, aiming at preventing the risk of AF and ischemic stroke.
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Affiliation(s)
- Amine Bahloul
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Nadia Bouattour
- Service de Neurologie, Centre Hospitalo-Universitaire Habib Bourguiba, Sfax, Tunisie
| | - Faten Triki
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Rania Hammami
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Selma Charfeddine
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Tarek Ellouze
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Chokri Mhiri
- Service de Neurologie, Centre Hospitalo-Universitaire Habib Bourguiba, Sfax, Tunisie
| | - Leila Abid
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Samir Kammoun
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
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207
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Comparative Effectiveness and Safety of Direct Oral Anticoagulants in Obese Patients with Atrial Fibrillation. Cardiovasc Drugs Ther 2021; 35:261-272. [PMID: 33404923 DOI: 10.1007/s10557-020-07126-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Unlike warfarin direct oral anticoagulants (DOACs) are administered in fixed doses, which raises concerns of its effectiveness on larger patients. Data from randomized trials are limited on the safety and efficacy of DOACs in morbidly obese individuals with atrial fibrillation (AF). METHODS We analyzed a cohort of obese (≥ 120 kg) and morbidly obese (BMI > 40 kg/m2) patients from the Veterans Health Administration system with AF who initiated apixaban, rivaroxaban, dabigatran, or warfarin between years 2012 and 2018. We used inverse probability of treatment weighting (IPTW) and Cox proportional hazards regression models to evaluate the relative hazard of death, myocardial infarction (MI), ischemic stroke, heart failure (HF), and bleeding events between oral anticoagulant (OAC) groups while censoring for medication cessation. RESULTS We identified 6052 obese patients on apixaban, 4233 on dabigatran, 4309 on rivaroxaban, and 13,417 on warfarin (mean age 66.7 years, 91% males, 80.4% whites). At baseline patients on apixaban had the lowest glomerular filtration rate and highest rates of previous stroke and MI compared to other OACs. Among patients with weight ≥ 120 kg and those with BMI > 40 kg/m2, all DOACs were associated with lower risk of any hemorrhage, hemorrhagic stroke, and gastrointestinal (GI) bleeding. Patients with BMI > 40 kg/m2 treated with DOACs had similar ischemic stroke risk with those on warfarin. CONCLUSIONS In this large cohort of obese Veterans Health Administration system patients, the use of DOACs resulted in lower hemorrhagic complications than warfarin while maintaining efficacy on ischemic stroke prevention.
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208
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Dewal RS, Greer-Short A, Lane C, Nirengi S, Manzano PA, Hernández-Saavedra D, Wright KR, Nassal D, Baer LA, Mohler PJ, Hund TJ, Stanford KI. Phospho-ablation of cardiac sodium channel Na v1.5 mitigates susceptibility to atrial fibrillation and improves glucose homeostasis under conditions of diet-induced obesity. Int J Obes (Lond) 2021; 45:795-807. [PMID: 33500550 PMCID: PMC8005377 DOI: 10.1038/s41366-021-00742-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/19/2020] [Accepted: 01/04/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common sustained arrhythmia, with growing evidence identifying obesity as an important risk factor for the development of AF. Although defective atrial myocyte excitability due to stress-induced remodeling of ion channels is commonly observed in the setting of AF, little is known about the mechanistic link between obesity and AF. Recent studies have identified increased cardiac late sodium current (INa,L) downstream of calmodulin-dependent kinase II (CaMKII) activation as an important driver of AF susceptibility. METHODS Here, we investigated a possible role for CaMKII-dependent INa,L in obesity-induced AF using wild-type (WT) and whole-body knock-in mice that ablates phosphorylation of the Nav1.5 sodium channel and prevents augmentation of the late sodium current (S571A; SA mice). RESULTS A high-fat diet (HFD) increased susceptibility to arrhythmias in WT mice, while SA mice were protected from this effect. Unexpectedly, SA mice had improved glucose homeostasis and decreased body weight compared to WT mice. However, SA mice also had reduced food consumption compared to WT mice. Controlling for food consumption through pair feeding of WT and SA mice abrogated differences in weight gain and AF inducibility, but not atrial fibrosis, premature atrial contractions or metabolic capacity. CONCLUSIONS These data demonstrate a novel role for CaMKII-dependent regulation of Nav1.5 in mediating susceptibility to arrhythmias and whole-body metabolism under conditions of diet-induced obesity.
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Affiliation(s)
- Revati S. Dewal
- grid.412332.50000 0001 1545 0811Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Center for Diabetes and Metabolism Research Center, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Amara Greer-Short
- grid.261331.40000 0001 2285 7943Department of Biomedical Engineering, The Ohio State University, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Cemantha Lane
- grid.261331.40000 0001 2285 7943Department of Biomedical Engineering, The Ohio State University, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Shinsuke Nirengi
- grid.412332.50000 0001 1545 0811Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Center for Diabetes and Metabolism Research Center, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Pedro Acosta Manzano
- grid.412332.50000 0001 1545 0811Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Center for Diabetes and Metabolism Research Center, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Diego Hernández-Saavedra
- grid.412332.50000 0001 1545 0811Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Center for Diabetes and Metabolism Research Center, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Katherine R. Wright
- grid.412332.50000 0001 1545 0811Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Center for Diabetes and Metabolism Research Center, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Drew Nassal
- grid.261331.40000 0001 2285 7943Department of Biomedical Engineering, The Ohio State University, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Lisa A. Baer
- grid.412332.50000 0001 1545 0811Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Center for Diabetes and Metabolism Research Center, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Peter J. Mohler
- grid.412332.50000 0001 1545 0811Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Thomas J. Hund
- grid.261331.40000 0001 2285 7943Department of Biomedical Engineering, The Ohio State University, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Frick Center for Heart Failure and Arrhythmia, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Kristin I. Stanford
- grid.412332.50000 0001 1545 0811Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Center for Diabetes and Metabolism Research Center, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH USA
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209
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Berger JS, Laliberté F, Kharat A, Lejeune D, Moore KT, Jung Y, Lefebvre P, Ashton V. Healthcare resource utilization and costs of rivaroxaban versus warfarin among non-valvular atrial fibrillation (NVAF) patients with obesity in a US population. J Med Econ 2021; 24:550-562. [PMID: 33910464 DOI: 10.1080/13696998.2021.1915627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AIM To assess the real-world healthcare resource utilization (HRU) and costs of patients with non-valvular atrial fibrillation (NVAF) and obesity newly initiated on rivaroxaban or warfarin in the US. METHODS This retrospective study used IQVIA PharMetrics Plus data (01/2010-09/2019) to evaluate patients (≥18 years) with NVAF and obesity (body mass index ≥30 kg/m2) initiated on rivaroxaban or warfarin (on or after 01/2013). Inverse probability of treatment weighting (IPTW) was used to adjust for confounding between cohorts. HRU and costs were assessed post-treatment initiation. Weighted cohorts were compared using Poisson regression models and cost differences, with 95% confidence intervals (CIs) and p values generated using non-parametric bootstrap procedures. RESULTS After IPTW, 10,555 and 5,080 patients were initiated on rivaroxaban and warfarin, respectively (mean age: 59 years). At 12 months follow-up, the rivaroxaban cohort had lower all-cause HRU, including fewer hospitalizations (rate ratio [RR]: 0.80, 95% CI: 0.74, 0.87), emergency room visits (RR: 0.89, 95% CI: 0.83, 0.97), and outpatient visits (RR: 0.72, 95% CI: 0.69, 0.77; all p < .05). Medical costs were also reduced in the rivaroxaban cohort (mean difference: -$6,759, 95% CI: -$9,814, -$3,311) due to reduced hospitalization costs (mean difference: -$5,967, 95% CI: -$8,721, -$3,327), resulting in lower total all-cause healthcare costs compared to the warfarin cohort (mean difference: -$4,579, 95% CI: -$7,609, -$1,052; all p < .05). The rivaroxaban cohort also had lower NVAF-related HRU and medical costs driven by lower hospitalization at 12 months post-treatment initiation. HRU and cost reductions associated with rivaroxaban persisted up to 36 months of follow-up. LIMITATIONS Claims data may have contained inaccuracies and obesity was classified based on ICD diagnosis codes given that patient BMI values were not available. CONCLUSIONS Rivaroxaban was associated with reduced HRU and costs compared to warfarin among NVAF patients with obesity in a real-world US setting.
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Affiliation(s)
| | | | - Akshay Kharat
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | | | - Young Jung
- Analysis Group, Inc, Montréal, QC, Canada
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210
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Coccina F, Pierdomenico AM, Ianni U, De Rosa M, De Luca A, Pirro D, Pizzicannella J, Trubiani O, Cipollone F, Renda G, Pierdomenico SD. Ambulatory blood pressure and risk of new-onset atrial fibrillation in treated hypertensive patients. J Clin Hypertens (Greenwich) 2021; 23:147-152. [PMID: 33242233 PMCID: PMC8029687 DOI: 10.1111/jch.14112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/25/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022]
Abstract
The aim of this study was to evaluate the influence of clinic and ambulatory blood pressure (BP) on the occurrence of new-onset atrial fibrillation (AF) in treated hypertensive patients. We studied 2135 sequential treated hypertensive patients aged >40 years. During the follow-up (mean 9.7 years, range 0.4-20 years), 116 events (new-onset AF) occurred. In univariate analysis, clinic, daytime, nighttime, and 24-h systolic BP were all significantly associated with increased risk of new-onset AF, that is, hazard ratio (95% confidence interval) per 10 mm Hg increment 1.22 (1.11-1.35), 1.36 (1.21-1.53), 1.42 (1.29-1.57), and 1.42 (1.26-1.60), respectively. After adjustment for various covariates in multivariate analysis, clinic systolic BP was no longer associated with increased risk of new-onset AF, whereas daytime, nighttime, and 24-h systolic BP remained significantly associated with outcome, that is, hazard ratio (95% confidence interval) per 10 mm Hg increment 1.09 (0.97-1.23), 1.23 (1.10-1.39), 1.16 (1.03-1.31), and 1.22 (1.06-1.40), respectively. Daytime, nighttime, and 24-h systolic BP are superior to clinic systolic BP in predicting new-onset AF in treated hypertensive patients. Future studies are needed to evaluate whether a better control of ambulatory BP might be helpful in reducing the occurrence of new-onset AF.
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Affiliation(s)
- Francesca Coccina
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Anna M. Pierdomenico
- Department of Medicine and Aging SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Umberto Ianni
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Matteo De Rosa
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Andrea De Luca
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Davide Pirro
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Jacopo Pizzicannella
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Oriana Trubiani
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Francesco Cipollone
- Department of Medicine and Aging SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Giulia Renda
- Department of Neurosciences, Imaging and Clinical SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
| | - Sante D. Pierdomenico
- Department of Medical, Oral and Biotechnological SciencesUniversity “Gabriele d'Annunzio”ChietiItaly
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211
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Malaspina D, Brasca F, Iacopino S, Arena G, Molon G, Pieragnoli P, Tondo C, Manfrin M, Rovaris G, Verlato R, Dello Russo A, Startari U, Sgarito G, Perego GB. Cryoablation for pulmonary veins isolation in obese patients with atrial fibrillation compared to nonobese patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 44:306-317. [PMID: 33372267 DOI: 10.1111/pace.14149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/09/2020] [Accepted: 12/06/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pulmonary veins isolation (PVI) by cryoballoon (CB) ablation is marginally represented in clinical studies in obese patients. The aim of this analysis was to evaluate the safety and efficacy of CB-PVI in a large cohort of overweight and obese patients from the 1STOP project. METHODS From 2012 to 2018, 2048 patients with atrial fibrillation (AF) (70% male, 59 ± 11 years; 75% paroxysmal AF) underwent index CB-PVI. The patient data were separated into three cohorts for statistical evaluation, including: normal weight (body mass index [BMI] < 25 kg/m2 ), overweight (BMI = 25-30 kg/m2 ), and obese patients (BMI > 30 kg/m2 ). RESULTS Out of 2048 patients, 693 (34%) patients had a BMI < 25 and were deemed as normal. There were 944 (46%) patients categorized as overweight (BMI = 25-30) and 411 (20%) as obese (BMI > 30). Overweight or obese patients were more often in persistent AF, had more frequently hypertension and diabetes, had higher CHA2 DS2 -VASc score, and had a number of failed antiarrhythmic drug (AAD). Periprocedural complication rates were similar among the three cohorts. The 12-month freedom from AF recurrence was 76.4% in the normal BMI group as compared to 79.2% in the overweight and 73.5% in the obese group (p = .35). However, 48% of overweight patients were on AAD treatment during the follow-up. By multivariate analysis, BMI was not a predictor for AF recurrence following the index CB-PVI. CONCLUSION CB-PVI in obese patients is a safe procedure. Increased BMI (either moderate or severe) does not seem to be associated with a worse outcome or to a different rate of AAD discontinuation at 12 months.
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Affiliation(s)
- Daniele Malaspina
- Department of Cardiology, ASST Santi Paolo e Carlo, Presidio Ospedaliero San Carlo Borromeo, Milano, Italy
| | - Francesco Brasca
- Department of Cardiology, Ospedale San Luca, Istituto Auxologico, Milano, Italy
| | - Saverio Iacopino
- Arrhythmology Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Giuseppe Arena
- Ospedale delle Apuane, Cardiology Department, Massa, Italy
| | - Giulio Molon
- Department of Cardiology, IRCCS Sacro Cuore don Calabria, Negrar, Italy
| | | | - Claudio Tondo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS. Milan
| | | | | | - Roberto Verlato
- AULSS 6 Euganea, Ospedale di Cittadella-Camposampiero, Padova, Italy
| | - Antonio Dello Russo
- Biomedical Science and Public Health Department, Cardiology and Arrhythmology Clinic, Polytechnic University, Ancona, Italy
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212
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Volgman AS, Benjamin EJ, Curtis AB, Fang MC, Lindley KJ, Naccarelli GV, Pepine CJ, Quesada O, Vaseghi M, Waldo AL, Wenger NK, Russo AM. Women and atrial fibrillation. J Cardiovasc Electrophysiol 2020; 32:2793-2807. [PMID: 33332669 DOI: 10.1111/jce.14838] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 02/06/2023]
Abstract
Atrial fibrillation (AF) remains a growing problem in the United States and worldwide, imposing a high individual and health system burden, including increased resource consumption due to repeated hospitalizations, stroke, dementia, heart failure, and death. This comprehensive review summarizes the most recent data on sex-related differences in risks associated with AF. Women with AF have increased risk of stroke and death compared to men, and possible reasons for this disparity are explored. Women also continue to have worse symptoms and quality of life, and poorer outcomes with stroke prevention, as well as with rate and rhythm control management strategies. Many current rhythm control treatment strategies for AF, including cardioversion and ablation, are used less frequently in women as compared to men, whereas women are more likely to be treated with rate control strategies or antiarrhythmic drugs. Sex differences should be considered in treating women with AF to improve outcomes and women and men should be offered the same interventions for AF. We need to improve the evidence base to understand if variation in utilization of rate and rhythm control management between men and women represents health inequities or appropriate clinical judgement.
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Affiliation(s)
| | - Emelia J Benjamin
- Boston University School of Medicine and School of Public Health, Boston, Massachusetts, USA
| | - Anne B Curtis
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Margaret C Fang
- Division of Hospital Medicine, University of California, San Francisco, California, USA
| | | | | | - Carl J Pepine
- Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Odayme Quesada
- The Christ Hospital Women's Heart Center, Cincinnati, Ohio, USA
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, California, USA
| | - Albert L Waldo
- Division of Cardiovascular Medicine, Case Western Reserve University Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Nanette K Wenger
- Department of Medicine, Section of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
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213
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Meng X, Xu X. What Is the Ideal Blood Pressure Treatment Target for Primary Prevention and Management of Atrial Fibrillation? Front Cardiovasc Med 2020; 7:586183. [PMID: 33330646 PMCID: PMC7728604 DOI: 10.3389/fcvm.2020.586183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/26/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Xiaoyong Xu
- Department of Cardiovascular Disease, Ningbo Medical Center Lihuili Hospital, Ningbo, China
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214
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Wang W, Norby FL, Rooney MR, Zhang M, Gutierrez A, Garg P, Soliman EZ, Alonso A, Dudley SC, Lutsey PL, Chen LY. Association of Life's Simple 7 with Atrial Fibrillation Burden (From the Atherosclerosis Risk in Communities Study). Am J Cardiol 2020; 137:31-38. [PMID: 32998009 PMCID: PMC7704629 DOI: 10.1016/j.amjcard.2020.09.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/16/2020] [Accepted: 09/23/2020] [Indexed: 12/23/2022]
Abstract
The American Heart Association's Life's Simple 7 (LS7) metric consists of 7 modifiable risk factors. Although a more favorable LS7 risk factor profile is associated with lower AF incidence, this relation is unknown in regard to AF burden. We assessed the prospective association of overall LS7 score and individual LS7 risk factors in midlife with AF burden in late-life in the Atherosclerosis Risk in Communities Study. LS7 components were assessed at Visit 3 (1993 to 1995) and a composite score ranging from 0 to 14 was calculated. A higher score indicates better cardiovascular health. AF burden was measured at Visit 6 (2016 to 2017) with a 2-week Zio XT Patch. AF burden, defined as the percent of time a participant was in AF, was categorized as none, intermittent (>0 to <100%), or continuous (100%). Weighted multinomial logistic regression was used. Of the 2,363 participants, 58% were female and 24% were black. Participants were aged 57 ± 5 years at Visit 3 and 79 ± 5 years at Visit 6. From the Zio XT Patch, 5% had continuous AF, 4% had intermittent AF, and 91% had none. After multivariable adjustment, each 1-point increase in LS7 score had 0.87 (95% CI: 0.79 to 0.95) higher odds of continuous AF than no AF. Individually, poor levels of physical activity, BMI, and fasting blood glucose were associated with greater AF burden. In conclusion, this population-based prospective cohort study reports that unfavorable cardiovascular health profile in midlife is associated with higher AF burden in late-life and future research to evaluate the effectiveness of optimizing physical activity, BMI, and fasting blood glucose in lowering AF burden is warranted.
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Affiliation(s)
- Wendy Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
| | - Faye L Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Mary R Rooney
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Michael Zhang
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Alejandra Gutierrez
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Parveen Garg
- Division of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Elsayed Z Soliman
- Department of Epidemiology, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Samuel C Dudley
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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215
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Rustem Gulluoglu F, Souverein PC, van den Ham HA, de Boer A, Komen J. Comparative effectiveness and safety of direct oral anticoagulants versus warfarin in UK patients with atrial fibrillation and type 2 diabetes: A retrospective cohort study. Pharmacoepidemiol Drug Saf 2020; 30:1293-1320. [PMID: 33314401 PMCID: PMC8451809 DOI: 10.1002/pds.5181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 09/09/2020] [Accepted: 12/07/2020] [Indexed: 01/27/2023]
Abstract
PURPOSE To estimate the effectiveness and safety of direct oral anticoagulants (DOACs) compared with warfarin in AF patients with type 2 diabetes (T2DM). METHODS A retrospective cohort study was designed, using the UK Clinical Practice Research Datalink (August 2011-June 2018). Participants were 1-year naïve users of DOACs or warfarin, followed from the date of first prescription of an oral anticoagulant until the end of the study period, death, discontinuation of treatment, switching to another anticoagulant, or an outcome of interest, whichever came first. Cox regression analysis was performed to estimate the hazard ratio (HR) adjusted for potential confounders. RESULTS A total of 8555 patients were identified. No significant differences were found between DOACs and warfarin in the risk of stroke (adjusted HR 1.15; 95% CI 0.82-1.60), ischemic and unspecified stroke (adjusted HR 1.23; 95% CI 0.86-1.76) or haemorrhagic stroke (adjusted HR 0.75; 95% CI 0.30-1.85), and myocardial infarction (adjusted HR 1.39;95% CI 0.99-1.97). DOAC and warfarin users were comparable with respect to risk of major bleed (adjusted HR 0.83; 95% CI 0.68-1.03), intracranial bleeding (HR 0.66; 95% CI 0.34-1.30), gastrointestinal bleeding (HR 0.88; 95% CI 0.60-1.30), and bleeding on other clinically relevant sites (HR 0.89; 95% CI 0.60-1.31). In the subgroup analyses stratified by gender and diabetes severity, the risk for stroke and bleeding remained consistent. CONCLUSION DOACs are effective and safe alternatives to warfarin for the prevention of stroke in AF patients with T2DM.
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Affiliation(s)
- Fatma Rustem Gulluoglu
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hendrika A van den Ham
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Joris Komen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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216
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Kamil-Rosenberg S, Kokkinos P, Grune de Souza e Silva C, Yee WLS, Abella J, Chan K, Myers J. Association between cardiorespiratory fitness, obesity, and incidence of atrial fibrillation. IJC HEART & VASCULATURE 2020; 31:100663. [PMID: 33145394 PMCID: PMC7596185 DOI: 10.1016/j.ijcha.2020.100663] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/29/2020] [Accepted: 10/12/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND The interaction between cardiorespiratory fitness (CRF) and incidence of atrial fibrillation (AF) and the interaction between obesity and incidence of AF have been explored separately. Therefore, we evaluated the association between CRF, body mass index (BMI), and risk of developing AF in a cohort of middle-aged and older US Veterans. METHODS Symptom limited exercise tests (ETT) were conducted among 16,397 Veterans (97% male) from January 9,1987 to December 31,2017. No history of AF was evident at the time of the ETTs. CRF was expressed as quartiles of peak metabolic equivalents (METs) achieved within each age decile. Weight status was classified as normal (BMI < 25 kg/m2), overweight (BMI 25-30 kg/m2), obese (BMI 30-35 kg/m2), or severely obese (BMI > 35 kg/m2). Multivariable Cox proportional hazards regression models were used to compare the association between BMI, CRF categories, and incidence of AF. RESULTS Over a median follow-up of 10.7 years, 2,155 (13.1%) developed AF. Obese and severely obese subjects had 13% and 32% higher risks for incidence of AF, respectively, vs. normal weight subjects. Overweight and obese subjects in the most fit quartile had 50% decline in AF risk compared to the least-fit subjects. Severely obese subjects had marked increases in AF risk (~50-60%) regardless of fitness level. Risk of developing AF increases with higher BMI and lower CRF. CONCLUSION Improving CRF should be advocated when assessing those at risk for developing AF.
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Key Words
- AF, Atrial fibrillation
- Arrhythmias
- BMI
- BMI, Body mass index
- CPRS, Computerized patient record system
- CRF, Cardiorespiratory fitness
- CVD, Cardiovascular disease
- Cardiopulmonary fitness
- DM, Diabetes mellitus
- ETT, Exercise tolerance test
- HR, Hazard ratio
- HTN, Hypertension
- MET, Metabolic equivalent
- PA, Physical activity
- Risk factors
- VA, Veterans affairs
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Affiliation(s)
- Shirit Kamil-Rosenberg
- Cardiology Division, Veterans Affairs Palo Alto Health Care System and Stanford University, Stanford, CA, United States
| | - Peter Kokkinos
- Cardiology Division, Veterans Affairs Medical Center, Washington, DC and Georgetown University School of Medicine, Washington, DC, United States
| | | | - Win Leth Shwe Yee
- Cardiology Division, Veterans Affairs Palo Alto Health Care System and Stanford University, Stanford, CA, United States
| | - Joshua Abella
- Cardiology Division, Veterans Affairs Palo Alto Health Care System and Stanford University, Stanford, CA, United States
| | - Khin Chan
- Cardiology Division, Veterans Affairs Palo Alto Health Care System and Stanford University, Stanford, CA, United States
| | - Jonathan Myers
- Cardiology Division, Veterans Affairs Palo Alto Health Care System and Stanford University, Stanford, CA, United States
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217
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Nagata T, Hata J, Sakata S, Oishi E, Honda T, Furuta Y, Ohara T, Yoshida D, Hirakawa Y, Shibata M, Ide T, Kitazono T, Tsutsui H, Ninomiya T. Serum N-terminal pro-B-type natriuretic peptide as a predictor for future development of atrial fibrillation in a general population: the Hisayama Study. Int J Cardiol 2020; 320:90-96. [PMID: 32592745 DOI: 10.1016/j.ijcard.2020.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/27/2020] [Accepted: 06/12/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Biomarkers for predicting future development of atrial fibrillation (AF) have not been fully established in general populations. The aim of this study was to assess the predictive ability of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) for the development of AF. METHODS AND RESULTS A total of 3126 community-dwelling Japanese subjects aged ≥ 40 years without a history of AF in 2002 were followed up for a median of 10.2 years. Serum NT-proBNP levels at baseline were divided into four categories (≤ 54, 55-124, 125-299, and ≥ 300 pg/mL) according to the current guidelines and prior reports. The hazard ratios for the development of AF were estimated using a Cox proportional hazards model. During the follow-up period, 153 subjects developed new-onset AF. The age- and sex-adjusted cumulative incidence of AF increased significantly with higher serum NT-proBNP levels (p < 0.001 for trend). The association remained significant after adjustment for known risk factors for AF and cardiovascular disease (hazard ratio [95% confidence interval]: ≤ 54 pg/mL: 1.00 [reference]; 55-124 pg/mL: 1.72 [1.00-2.97]; 125-299 pg/mL: 3.95 [2.23-6.98]; ≥ 300 pg/mL: 8.51 [4.48-16.17]; p < 0.001 for trend). Furthermore, incorporation of serum NT-proBNP levels into the model consisting of known risk factors for AF and cardiovascular disease significantly improved the predictive ability for developing AF (Harrell's c-statistics: 0.828 to 0.844, p = 0.01; continuous net reclassification improvement: 0.41, p < 0.001; integrated discrimination improvement: 0.031, p < 0.001). CONCLUSIONS Serum NT-proBNP levels can be a risk biomarker for predicting future development of AF in a general Japanese population.
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Affiliation(s)
- Takuya Nagata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Satoko Sakata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Emi Oishi
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Takanori Honda
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yoshihiko Furuta
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Tomoyuki Ohara
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Daigo Yoshida
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yoichiro Hirakawa
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Mao Shibata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Takanari Kitazono
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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218
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Abstract
PURPOSE OF REVIEW The focus of this review is to discuss obesity, physical activity (and physical inactivity/sedentary behavior), cardiovascular disease (CVD), and their often interrelated health implications. The authors summarize the pathophysiological changes associated with obesity, which lead to the development of CVD, recommendations for interventions such as diet, increased physical activity, and weight loss according to current literature and guidelines, and the critical importance of cardiorespiratory fitness (CRF). RECENT FINDINGS Clinical trials continue to demonstrate improved outcomes among overweight or obese individuals who achieve a healthy weight using various methods. Increasing CRF levels appears to demonstrate the largest health improvements, regardless of underlying comorbidities or achieving weight loss. CRF, which is perhaps the single most important predictor of overall health, seems more important than weight loss alone regarding improved CVD outcomes in the obese population. These findings are reproduced in studies involving patients with various forms of CVD and CVD risk factors. The importance of CRF is well established; future endeavors to establish specific CRF targets for various patient cohorts are needed.
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Affiliation(s)
- Andrew Elagizi
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, 70121-2483, USA
| | - Sergey Kachur
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, 70121-2483, USA
| | - Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, 70121-2483, USA.
| | - Steven N Blair
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Liu G, Long M, Hu X, Hu CH, Du ZM. Meta-Analysis of Atrial Fibrillation and Outcomes in Patients With Heart Failure and Preserved Ejection Fraction. Heart Lung Circ 2020; 30:698-706. [PMID: 33191141 DOI: 10.1016/j.hlc.2020.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/07/2020] [Accepted: 10/01/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is common in heart failure with preserved ejection fraction (HFpEF); However, the prognostic impact of AF on HFpEF patients has not been fully elucidated. METHODS A literature search of the PubMed and EMBASE databases on literature published through April 2019 was undertaken. Combined hazard ratio (HR) estimates and 95% confidence intervals (CIs) were calculated using fixed-effects or random-effects models, depending on the heterogeneity. Subgroup analyses, sensitivity analysis and meta-regression analyses were also performed. RESULTS Fourteen (14) eligible studies with 1,948,923 patients with HFpEF were included in the analysis. Atrial fibrillation was associated with an 11% increased risk of all-cause mortality in patients with HFpEF (HR 1.11, 95% CI 1.09-1.12). Sensitivity analysis confirmed the stability of the results. The stratification of studies by controlled or uncontrolled confounding factors affected the final estimate (confounder-controlled HR 1.21, 95% CI 1.12-1.30; confounder-uncontrolled HR 1.13, 95% CI 0.96-1.31). In addition, AF was an independent predictor of hospitalisation for heart failure (HR 1.32, 95% CI 1.15-1.52), cardiovascular death (HR 1.38, 95% CI 1.01-1.89) and stroke (HR 1.87, 95% CI 1.54-2.27). CONCLUSIONS Atrial fibrillation was associated with worse clinical outcomes in patients with HFpEF. Further investigation is required to see whether AF is the primary offender in these patients or merely a bystander to worse diastolic function.
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Affiliation(s)
- Gang Liu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Ming Long
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Xun Hu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Cheng-Heng Hu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China.
| | - Zhi-Min Du
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China.
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Hodis JD, Gottesman RF, Windham BG, Knopman DS, Lutsey PL, Walker KA, Alonso A. Association of Hypertension According to New American College of Cardiology/American Heart Association Blood Pressure Guidelines With Incident Dementia in the ARIC Study Cohort. J Am Heart Assoc 2020; 9:e017546. [PMID: 33170065 PMCID: PMC7763722 DOI: 10.1161/jaha.120.017546] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background The impact of the new 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline on dementia risk at the population level has not been evaluated. Methods and Results We studied dementia‐free participants in the ARIC (Atherosclerosis Risk in Communities) Study cohort in 1987 to 1989. Hypertension was defined by 2003 Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and 2017 ACC/AHA guidelines using blood pressure measured at baseline. Dementia was defined using adjudicated consensus diagnoses, informant telephone interviews, and discharge codes from hospitalizations and death certificates. Cox regression estimated hazard ratios (HRs) for dementia and 95% CIs by hypertension categories, adjusting for confounders. Population attributable fraction of dementia was calculated by hypertension categories. Among 13 971 participants followed up for a median of 23 years, 1381 dementia cases were identified. Prevalence of hypertension was 34% and 48%, according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and ACC/AHA criteria, respectively. HRs (95% CIs) compared with normal blood pressure, according to ACC/AHA categories, were 1.35 (1.12–1.61) for elevated blood pressure, 1.28 (1.07–1.52) for hypertension stage 1, and 1.36 (1.18–1.57) for hypertension stage 2. Population attributable fractions (95% CIs) of dementia from blood pressure categories were 3% (1%–5%), 3% (1%–5%), and 9% (4%–14%), respectively. Population attributable fractions (95% CIs) using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure categories were 6% (3%–9%) for prehypertension, 0% (−2% to 2%) for hypertension stage 1, and 9% (5%–13%) for hypertension stage 2. Conclusions Risk of dementia increased across hypertension categories defined by ACC/AHA guidelines. The population impact on dementia incidence using ACC/AHA categories was similar to the impact of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
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Affiliation(s)
- Jeffrey D Hodis
- Department of Epidemiology, Rollins School of Public Health Emory University Atlanta GA
| | - Rebecca F Gottesman
- Department of Neurology Johns Hopkins University School of Medicine Baltimore MD
| | - B Gwen Windham
- Department of Medicine University of Mississippi Medical Center Jackson MS
| | | | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health University of Minnesota Minneapolis MN
| | - Keenan A Walker
- Department of Neurology Johns Hopkins University School of Medicine Baltimore MD
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health Emory University Atlanta GA
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Buckley BJR, Lip GYH, Thijssen DHJ. The counterintuitive role of exercise in the prevention and cause of atrial fibrillation. Am J Physiol Heart Circ Physiol 2020; 319:H1051-H1058. [DOI: 10.1152/ajpheart.00509.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia, characterized by irregular atrial activity. AF is related to increased risk of thromboembolic events, heart failure, and premature mortality. Recent advances in our understanding of its pathophysiology include a potentially central role for inflammation and presence of cardiovascular risk factors. The role of physical activity and exercise in the development and progression of AF, however, are not yet fully understood. Physical activity is protective for modifiable cardiovascular risk factors, including those associated with AF. Indeed, emerging research has demonstrated beneficial effects of exercise on AF-specific outcomes, including AF recurrence postablation. Counterintuitively, the prevalence of AF in veteran endurance athletes seems higher compared with the general population. In this review, we discuss the novel evidence and underlying mechanisms underpinning the role of exercise as medicine in the development and management of AF but also the counterintuitive detrimental role of excessive endurance exercise. Finally, we advocate regular (but not long-term high-intensity endurance) exercise training as a safe and effective strategy to reduce the risk of incident AF and to minimize the associated risk of secondary cardiovascular events.
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Affiliation(s)
- Benjamin J. R. Buckley
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Dick H. J. Thijssen
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, United Kingdom
- Research Institute for Health Science, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
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Castro-Clavijo JA, Quintero S, Valderrama F, Diaztagle JJ, Ortega J. Prevalencia de fibrilación auricular en pacientes hospitalizados por Medicina interna. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2019.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Turagam MK, Whang W, Miller MA, Neuzil P, Aryana A, Romanov A, Cuoco FA, Mansour M, Lakkireddy D, Michaud GF, Dukkipati SR, Cammack S, Reddy VY. Renal Sympathetic Denervation as Upstream Therapy During Atrial Fibrillation Ablation: Pilot HFIB Studies and Meta-Analysis. JACC Clin Electrophysiol 2020; 7:109-123. [PMID: 33478702 DOI: 10.1016/j.jacep.2020.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/16/2020] [Accepted: 08/03/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study sought to determine the impact of adjunctive renal sympathetic denervation to catheter ablation in patients with atrial fibrillation (AF) and history of hypertension. BACKGROUND There are limited data regarding the impact of upstream adjunctive renal sympathetic denervation (RSDN) to pulmonary vein isolation (PVI) in patients with symptomatic atrial fibrillation (AF) and hypertension. METHODS The data for this study were obtained from 2 prospective randomized pilot studies, the HFIB (Adjunctive Renal Denervation to Modify Hypertension and Sympathetic tone as Upstream Therapy in the Treatment of Atrial Fibrillation)-1 (n = 30) and HFIB (Adjunctive Renal Denervation to Modify Hypertension and Sympathetic tone as Upstream Therapy in the Treatment of Atrial Fibrillation)-2 (n = 50) studies, and we performed a meta-analysis including all published studies comparing RSDN+PVI versus PVI alone up to January 25, 2020, in patients with AF and hypertension. RESULTS At 24 months, AF recurrence occurred in 53% and 38% in the PVI and PVI+RSDN groups (p = 0.43) in the HFIB-1 study, respectively, and 27% and 25% in the PVI and PVI+RSDN groups (p = 0.80) in the HFIB-2 study, respectively. When combined in a meta-analysis including 6 studies (n = 725), adjunctive RSDN significantly decreased the risk of AF recurrence (risk ratio [RR]: 0.68; 95% confidence interval [CI]: 0.55 to 0.83; p = 0.0002; I2 = 0%) when compared with PVI. Six renal artery complications occurred in the HFIB-1 study and none occurred in the HFIB-2 study with RSDN. However, in the meta-analysis, there were no significant differences in overall complications between both groups (RR: 1.43; 95% CI: 0.63 to 3.22; p = 0.40; I2 = 7%). When compared with baseline, RDSN significantly reduced the systolic blood pressure (-12.1 mm Hg; 95% CI: -20.9 to -3.3 mm Hg; p < 0.007; I2 = 99%) and diastolic blood pressure (-5.60 mm Hg; 95% CI: -10.05 to -1.10 mm Hg; p = 0.01; I2 = 98%) on follow-up. CONCLUSIONS The pilot HFIB-1 and HFIB-2 studies did not demonstrate a benefit with RSDN as an adjunctive upstream therapy during PVI. However, in the meta-analysis, adjunctive RSDN to PVI appears to be safe, and improves clinical outcomes in AF patients with a history of hypertension.
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Affiliation(s)
- Mohit K Turagam
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - William Whang
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marc A Miller
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | - Alexander Romanov
- E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Frank A Cuoco
- Trident Health System, Charleston, South Carolina, USA
| | - Moussa Mansour
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, Kansas, USA
| | | | | | - Sam Cammack
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vivek Y Reddy
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Jiang J, Gu X, Cheng CD, Li HX, Sun XL, Duan RY, Zhu Y, Sun L, Chen FK, Bao ZY, Zhang Y, Shen JH. The Hospital-Community-Family-Based Telemedicine (HCFT-AF) Program for Integrative Management of Patients With Atrial Fibrillation: Pilot Feasibility Study. JMIR Mhealth Uhealth 2020; 8:e22137. [PMID: 33084588 PMCID: PMC7641782 DOI: 10.2196/22137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 12/30/2022] Open
Abstract
Background The potential effectiveness of integrated management in further improving the prognosis of patients with atrial fibrillation has been demonstrated; however, the best strategy for implementation remains to be discovered. Objective The aim of this study was to ascertain the feasibility of implementing integrated atrial fibrillation care via the Hospital-Community-Family–Based Telemedicine (HCFT-AF) program. Methods In this single-arm, pre-post design pilot study, a multidisciplinary teamwork, supported by efficient infrastructures, provided patients with integrated atrial fibrillation care following the Atrial fibrillation Better Care (ABC) pathway. Eligible patients were continuously recruited and followed up for at least 4 months. The patients’ drug adherence, and atrial fibrillation–relevant lifestyles and behaviors were assessed at baseline and at 4 months. The acceptability, feasibility, and usability of the HCFT-AF technology devices and engagement with the HCFT-AF program were assessed at 4 months. Results A total of 73 patients (mean age, 68.42 years; 52% male) were enrolled in November 2019 with a median follow up of 132 days (IQR 125–138 days). The patients’ drug adherence significantly improved after the 4-month intervention (P<.001). The vast majority (94%, 64/68) of indicated patients received anticoagulant therapy at 4 months, and none of them received antiplatelet therapy unless there was an additional indication. The atrial fibrillation–relevant lifestyles and behaviors ameliorated to varying degrees at the end of the study. In general, the majority of patients provided good feedback on the HCFT-AF intervention. More than three-quarters (76%, 54/71) of patients used the software or website more than once a week and accomplished clinic visits as scheduled. Conclusions The atrial fibrillation–integrated care model described in this study is associated with improved drug adherence, standardized therapy rate, and lifestyles of patients, which highlights the possibility to better deliver integrated atrial fibrillation management. Trial Registration Clinicaltrials.gov NCT04127799; https://clinicaltrials.gov/ct2/show/NCT04127799
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Affiliation(s)
| | - Xiang Gu
- Medical College of Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Chen-Di Cheng
- Second Affiliated Hospital, Xiang-Ya Medical College of Central South University, Changsha, China
| | - Hong-Xiao Li
- Medical College of Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Xiao-Lin Sun
- Medical College of Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | | | - Ye Zhu
- Medical College of Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Lei Sun
- Medical College of Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Fu-Kun Chen
- Medical College of Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Zheng-Yu Bao
- Medical College of Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Yi Zhang
- Medical College of Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Jian-Hua Shen
- Medical College of Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
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Malik V, Mishima R, D Elliott A, H Lau D, Sanders P. The "Road" to Atrial Fibrillation: The Role of the Cardiac Autonomic Nervous System. J Atr Fibrillation 2020; 13:2400. [PMID: 33024501 DOI: 10.4022/jafib.2400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/16/2020] [Accepted: 03/18/2020] [Indexed: 01/04/2023]
Abstract
At the population level, there is a parallel escalation in the healthcare burden of both, atrial fibrillation (AF) as well its risk factors. Compounding this relationship, AF is associated with escalating burden at an individual level, due its self-perpetuating and progressive nature. The mechanisms by which these risk factors interact to produce atrial remodelling and subsequent AF are unclear. This intersection is critical to the development of strategies to combat this disease at both the individual and population-level. It is well known that AF can manifest from disturbances in autonomic activity. At the population level, there is growing data to suggest a role of the autonomic nervous system in the future incidence of AF. Here, we provide an overview of the association of cardiac autonomic dysfunction with the incidence of AF, review the role of the autonomic nervous system (ANS) as an intermediary between risk factors and the development of AF and finally, we discuss the bidirectional relationship between AF and cardiac autonomic nervous system dysfunction; to determine whether this is implicated in the progression of AF.
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Affiliation(s)
- Varun Malik
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Ricardo Mishima
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Adrian D Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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226
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Office, central and ambulatory blood pressure for predicting incident atrial fibrillation in older adults. J Hypertens 2020; 39:46-52. [PMID: 33031165 DOI: 10.1097/hjh.0000000000002613] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Recently, more sophisticated blood pressure (BP) measurements, such as central and ambulatory BP (ABP), have proven to be stronger predictors of future cardiovascular disease than conventional office BP. Their predictive value for atrial fibrillation development is not established. We investigated the prognostic impact for incident atrial fibrillation of office, central and ambulatory BP measurements in a predominantly older population-based cohort. METHODS Of 1004 participants in the Cardiovascular Abnormalities and Brain Lesions (CABL) study, 769 in sinus rhythm with no history of atrial fibrillation or stroke (mean age 70.5 years) underwent ABP and arterial wave reflection analysis for central BP determination. Fine and Gray's proportional subdistribution hazards models were used to assess the association of BP parameters with incident atrial fibrillation. RESULTS During 9.5 years, atrial fibrillation occurred in 83 participants. No office BP variable showed a significant association with incident atrial fibrillation. Central SBP and central pulse pressure were marginally associated with incident atrial fibrillation in multivariate analysis. Among ABP variables, 24-h SBP [adjusted hazard ratio per 10 mmHg, 1.24; 95% confidence interval (CI) 1.07--1.44; P = 0.004], daytime SBP (adjusted hazard ratio per 10 mmHg, 1.21; 95% CI 1.04--1.40; P = 0.011) and night-time SBP (adjusted hazard ratio per 10 mmHg, 1.22; 95% CI 1.07--1.39; P = 0.002) were significantly associated with incident atrial fibillation. CONCLUSION In a predominantly older, stroke-free community-based cohort, ABP was a better independent predictor of incident atrial fibrillation than central BP, whereas office BP was inadequate for this purpose.
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227
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Lin YS, Wu VCC, Wang HT, Chen HC, Chen MC, Chang ST, Chu PH, Chen YL. The implications of catheter ablation for solitary atrial flutter in preventing stroke risk: a nationwide population-based cohort study. Europace 2020; 22:1558-1566. [PMID: 32830229 DOI: 10.1093/europace/euaa164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/11/2020] [Accepted: 05/25/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS The implications of ablation for atrial fibrillation in preventing stroke are controversial, and no studies have investigated whether ablation prevents ischaemic stroke (IS) in atrial flutter (AFL). METHODS AND RESULTS This study analysed data contained in the Taiwan National Health Insurance Research Database for 16 765 patients with a first diagnosis of solitary AFL during 2001-2013. Eligible patients were divided into two groups according to whether or not they had received ablation. Propensity score matching (PSM) was performed to mitigate the effects of potential confounding factors. The primary outcome was occurrence of IS during follow-up. After 1:2 PSM, the analysis included 1037 patients in the ablation group and 2074 patients in the non-ablation group. The incidence of IS was lower in the ablation group compared to the non-ablation group [subdistribution hazard ratio (SHR) 0.61, 95% confidence interval (CI) 0.41-0.90] during the 2-year follow-up period but not thereafter (SHR 1.03, 95% CI 0.72-1.48). When grouping by stroke history, it revealed that ablation affected the incidence of stroke in patients without history of stroke (SHR 0.59, 95% CI 0.38-0.91) but not in patients with history of stroke. When each group was stratified by CHA2DS2-VASc score, ablation lowered the incidence of stroke in patients with CHA2DS2-VASc ≤3 (SHR 0.31, 95% CI 0.16-0.60) but not in patients with CHA2DS2-VASc ≥4 in the initial 2-year follow-up. CONCLUSION The different incidence of IS in patients with/without ablation indicates that ablation reduces the risk of IS in AFL patients.
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Affiliation(s)
- Yu-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Ta Pei Road, Niao Sung District, Kaohsiung City 83301, Taiwan.,College of Medicine, Chang Gung University, Taiwan
| | - Victor Chien-Chia Wu
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Hui-Ting Wang
- Emergency Department, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Huang-Chung Chen
- College of Medicine, Chang Gung University, Taiwan.,Division of Cardiology and Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Mien-Cheng Chen
- College of Medicine, Chang Gung University, Taiwan.,Division of Cardiology and Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Shih-Tai Chang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Ta Pei Road, Niao Sung District, Kaohsiung City 83301, Taiwan
| | - Pao-Hsien Chu
- College of Medicine, Chang Gung University, Taiwan.,Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Yung-Lung Chen
- College of Medicine, Chang Gung University, Taiwan.,Division of Cardiology and Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
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Park YJ, Yang PS, Yu HT, Kim TH, Jang E, Uhm JS, Pak HN, Lee MH, Lip GY, Joung B. What Is the Ideal Blood Pressure Threshold for the Prevention of Atrial Fibrillation in Elderly General Population? J Clin Med 2020; 9:jcm9092988. [PMID: 32947828 PMCID: PMC7563734 DOI: 10.3390/jcm9092988] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022] Open
Abstract
Intensive blood pressure (BP) lowering in patients with hypertension at increased risk of cardiovascular disease has been associated with a lowered risk of incident atrial fibrillation (AF). It is uncertain whether maintaining the optimal BP levels can prevent AF in the general elderly population. We included 115,866 participants without AF in the Korea National Health Insurance Service-Senior (≥60 years) cohort from 2002 to 2013. We compared the influence of BP on the occurrence of new-onset AF between octogenarians (≥80 years) and non-octogenarians (<80 years) subjects. With up to 6.7 ± 1.7 years of follow-up, 4393 incident AF cases occurred. After multivariable adjustment for potentially confounding clinical covariates, the risk of AF in non-octogenarians was significantly higher in subjects with BP levels of <120/<80 and ≥140/90 mm Hg, with hazard ratios of 1.15 (95% confidence interval (CI), 1.03-1.28; p < 0.001) and 1.14 (95% CI, 1.04-1.26; p < 0.001), compared to the optimal BP levels (120-129/<80 mm Hg). In octogenarians, the optimal BP range was 130-139/80-89 mm Hg, higher than in non-octogenarians. A U-shaped relationship for the development of incident AF was evident in non-octogenarians, and BP levels of 120-129/<80 mm Hg were associated the lowest risk of incident AF. Compared to non-octogenarians, the lowest risk of AF was associated with higher BP levels of 130-139/80-89 mm Hg amongst octogenarians.
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Affiliation(s)
- Yoon Jung Park
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.J.P.); (H.T.Y.); (T.-H.K.); (E.J.); (J.-S.U.); (H.-N.P.); (M.-H.L.)
| | - Pil-Sung Yang
- Department of Cardiology, CHA Bundang Medical Centre, CHA University, Seongnam 13496, Korea;
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.J.P.); (H.T.Y.); (T.-H.K.); (E.J.); (J.-S.U.); (H.-N.P.); (M.-H.L.)
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.J.P.); (H.T.Y.); (T.-H.K.); (E.J.); (J.-S.U.); (H.-N.P.); (M.-H.L.)
| | - Eunsun Jang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.J.P.); (H.T.Y.); (T.-H.K.); (E.J.); (J.-S.U.); (H.-N.P.); (M.-H.L.)
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.J.P.); (H.T.Y.); (T.-H.K.); (E.J.); (J.-S.U.); (H.-N.P.); (M.-H.L.)
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.J.P.); (H.T.Y.); (T.-H.K.); (E.J.); (J.-S.U.); (H.-N.P.); (M.-H.L.)
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.J.P.); (H.T.Y.); (T.-H.K.); (E.J.); (J.-S.U.); (H.-N.P.); (M.-H.L.)
| | - Gregory Y.H. Lip
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.J.P.); (H.T.Y.); (T.-H.K.); (E.J.); (J.-S.U.); (H.-N.P.); (M.-H.L.)
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L14 3PE, UK
- Correspondence: (G.Y.H.L.); (B.J.); Tel.: +82-2-2228-846 (B.J.)
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (Y.J.P.); (H.T.Y.); (T.-H.K.); (E.J.); (J.-S.U.); (H.-N.P.); (M.-H.L.)
- Correspondence: (G.Y.H.L.); (B.J.); Tel.: +82-2-2228-846 (B.J.)
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Senoo K, Nakata M, Teramukai S, Yamamoto T, Nishimura H, Matoba S. Age-Specific Association Between Body Mass Index and the Incidence of Atrial Fibrillation in Japanese Men. Circ Rep 2020; 2:466-470. [PMID: 33693271 PMCID: PMC7819657 DOI: 10.1253/circrep.cr-20-0067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background:
Obesity is reportedly associated with the incidence of atrial fibrillation (AF), but the patterns of age-specific associations between body mass index (BMI) and the risk of AF are unknown. Methods and Results:
We analyzed 10,921 Japanese men without AF from a cohort of employees undergoing annual health examinations. During a follow-up period of 5.0±3.8 years, the incidence of AF was 118 (2.18/1,000 person-years). Using a multivariable Cox regression analysis, high BMI was associated with a risk of AF (hazard ratio; 1.07 by 1 unit change of BMI, 95% confidence interval [CI] 1.00–1.13, P=0.05) overall, and the effect of BMI on AF incidence changed with age (P for interaction=0.08); with subjects aged <65 years with BMI <25 as the reference, HR 0.74 (95% CI 0.47–1.17) in subjects aged <65 years with BMI ≥25, HR 2.98 (95% CI 1.36–6.54) in subjects aged ≥65 years with BMI <25, and HR 6.50 (95% CI 2.58–16.38) in subjects aged ≥65 years with BMI ≥25. The 5-year probability of AF incidence in subjects aged <65 years was 0.87% with BMI <25 and 0.64% in those with BMI ≥25, and in subjects aged ≥65 years it was 2.58% with BMI <25 and 5.53% with BMI ≥25. Conclusions:
Our results indicated that the effect of BMI on AF incidence changes with age among Japanese men. Both physicians and cardiologists need to integrate advice on lifestyle measures, particularly for elderly obese men, into their daily medical routine.
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Affiliation(s)
- Keitaro Senoo
- Department of Cardiac Arrhythmia Research and Innovation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto Japan.,Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto Japan
| | - Mitsuko Nakata
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto Japan
| | | | | | - Satoaki Matoba
- Department of Cardiac Arrhythmia Research and Innovation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto Japan.,Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto Japan
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230
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Effects of occlusal disharmony on susceptibility to atrial fibrillation in mice. Sci Rep 2020; 10:13765. [PMID: 32792672 PMCID: PMC7426945 DOI: 10.1038/s41598-020-70791-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 07/20/2020] [Indexed: 12/12/2022] Open
Abstract
Tooth loss or incorrect positioning causes occlusal disharmony. Furthermore, tooth loss and atrial fibrillation (AF) are both risk factors for ischemic stroke and coronary heart disease. Therefore, we hypothesized that occlusal disharmony-induced stress increases susceptibility to AF, and we designed the present study to test this idea in mice. Bite-opening (BO) was done by cementing a suitable appliance onto the mandibular incisor to cause occlusal disharmony by increasing the vertical height of occlusion by 0.7 mm for a period of 2 weeks. AF susceptibility, evaluated in terms of the duration of AF induced by transesophageal burst pacing, was significantly increased concomitantly with atrial remodeling, including fibrosis, myocyte apoptosis and oxidative DNA damage, in BO mice. The BO-induced atrial remodeling was associated with increased calmodulin kinase II-mediated ryanodine receptor 2 phosphorylation on serine 2814, as well as inhibition of Akt phosphorylation. However, co-treatment with propranolol, a non-selective β-blocker, ameliorated these changes in BO mice. These data suggest that improvement of occlusal disharmony by means of orthodontic treatment might be helpful in the treatment or prevention of AF.
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231
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Joseph PG, Healey JS, Raina P, Connolly SJ, Ibrahim Q, Gupta R, Avezum A, Dans AL, Lopez-Jaramillo P, Yeates K, Teo K, Douma R, Bahonar A, Chifamba J, Lanas F, Dagenais GR, Lear SA, Kumar R, Kengne AP, Keskinler M, Mohan V, Mony P, Alhabib KF, Huisman H, Iype T, Zatonska K, Ismail R, Kazmi K, Rosengren A, Rahman O, Yusufali A, Wei L, Orlandini A, Islam S, Rangarajan S, Yusuf S. Global variations in the prevalence, treatment, and impact of atrial fibrillation in a multi-national cohort of 153 152 middle-aged individuals. Cardiovasc Res 2020; 117:1523-1531. [PMID: 32777820 DOI: 10.1093/cvr/cvaa241] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/17/2020] [Accepted: 08/04/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS To compare the prevalence of electrocardiogram (ECG)-documented atrial fibrillation (or flutter) (AF) across eight regions of the world, and to examine antithrombotic use and clinical outcomes. METHODS AND RESULTS Baseline ECGs were collected in 153 152 middle-aged participants (ages 35-70 years) to document AF in two community-based studies, spanning 20 countries. Medication use and clinical outcome data (mean follow-up of 7.4 years) were available in one cohort. Cross-sectional analyses were performed to document the prevalence of AF and medication use, and associations between AF and clinical events were examined prospectively. Mean age of participants was 52.1 years, and 57.7% were female. Age and sex-standardized prevalence of AF varied 12-fold between regions; with the highest in North America, Europe, China, and Southeast Asia (270-360 cases per 100 000 persons); and lowest in the Middle East, Africa, and South Asia (30-60 cases per 100 000 persons) (P < 0.001). Compared with low-income countries (LICs), AF prevalence was 7-fold higher in middle-income countries (MICs) and 11-fold higher in high-income countries (HICs) (P < 0.001). Differences in AF prevalence remained significant after adjusting for traditional AF risk factors. In LICs/MICs, 24% of participants with AF and a CHADS2 score ≥1 received antithrombotic therapy, compared with 85% in HICs. AF was associated with an increased risk of stroke [hazard ratio (HR) 2.29; 95% confidence interval (CI) 1.49-3.52] and death (HR 2.97; 95% CI 2.25-3.93); with similar rates in different countries grouped by income level. CONCLUSIONS Large variations in AF prevalence occur in different regions and countries grouped by income level, but this is only partially explained by traditional AF risk factors. Antithrombotic therapy is infrequently used in poorer countries despite the high risk of stroke associated with AF.
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Affiliation(s)
- Philip G Joseph
- Population Health Research Institute, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada
| | - Jeffrey S Healey
- Population Health Research Institute, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada
| | - Parminder Raina
- Canadian Longitudinal Study of Aging, McMaster University, Hamilton, Ontario, Canada
| | - Stuart J Connolly
- Population Health Research Institute, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada
| | - Quazi Ibrahim
- Population Health Research Institute, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, India
| | - Alvaro Avezum
- Hospital Alemão Oswaldo Cruz and UNISA, São Paulo, Brazil
| | | | | | | | - Koon Teo
- Population Health Research Institute, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada
| | - Reuben Douma
- Population Health Research Institute, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada
| | - Ahmad Bahonar
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jephat Chifamba
- University of Zimbabwe, Department Of Physiology, Harare, Zimbabwe
| | | | | | | | - Rajesh Kumar
- Post Graduate Institute of Medical Education and Research (PGIMER) School of Public Health, Chandigarh, India
| | - Andre P Kengne
- South African Medical Research Council, Pietermaritzburg, South Africa
| | - Mirac Keskinler
- Istanbul Goztepe Training and Research Hospital, Istanbul, Turkey
| | | | - Prem Mony
- St John's Medical College & Research Institute, Bengaluru, India
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hugo Huisman
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | | | - Katarzyna Zatonska
- Department of Social Medicine, Medical University of Wroclaw, Wroclaw, Poland
| | | | | | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Li Wei
- Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | | | - Shofiqul Islam
- Population Health Research Institute, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada
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232
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Bianchi VE. Caloric restriction in heart failure: A systematic review. Clin Nutr ESPEN 2020; 38:50-60. [PMID: 32690177 DOI: 10.1016/j.clnesp.2020.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/17/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Nutrition exerts a determinant role in maintaining cardiac function, regulating insulin and mitochondrial efficiency, that are essential to support energy production for contractility. In patients with heart failure (HF), myocardial tissue efficiency is reduced because of decreased mitochondrial oxidative capacity. In HF conditions, cardiomyocytes shift toward glucose and a reduction in fatty acid utilization. Calorie restriction induces weight loss in obese patients and can be beneficial in some HF patients, although this has generated some controversy. This study aims to evaluate the impact of the CR diet on myocardial efficiency in HF patients. METHODS On Pubmed and Embase, articles related to the keywords: "chronic heart failure" with "diet," "nutrition," "insulin resistance," and "caloric restriction" have been searched, Studies, including exercise or food supplementation, were excluded. RESULTS The retrieved articles showed that weight loss, through the activation of insulin and various kinase pathways, regulates the efficiency of myocardial tissue. In contrast, insulin resistance represents a strong cardiovascular risk factor that reduces myocardial function. CONCLUSION CR diet represents the first therapy in overweight HF patients, both with preserved ejection fraction (HFpEF) and with reduced ejection fraction (HFrHF) because reducing body fat, the myocardial function increased. Insulin activity is the critical hormone that regulates mitochondrial function and cardiac efficiency. However, a severely restricted diet may represent a severe risk factor correlated with all-cause mortality, particularly in underweight HF patients. Long-term studies conducted on large populations are necessary to evaluate the effects of CR on myocardial function in HF patients.
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233
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Impact of obesity on atrial fibrillation ablation. Arch Cardiovasc Dis 2020; 113:551-563. [PMID: 32753124 DOI: 10.1016/j.acvd.2020.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/07/2020] [Accepted: 03/11/2020] [Indexed: 11/23/2022]
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234
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Zylla MM, Hochadel M, Andresen D, Brachmann J, Eckardt L, Hoffmann E, Kuck KH, Lewalter T, Schumacher B, Spitzer SG, Willems S, Senges J, Katus HA, Thomas D. Ablation of Atrial Fibrillation in Patients with Hypertension-An Analysis from the German Ablation Registry. J Clin Med 2020; 9:jcm9082402. [PMID: 32727136 PMCID: PMC7463680 DOI: 10.3390/jcm9082402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Hypertension (HTN) constitutes a risk factor for the development of atrial fibrillation (AF), as well as for thromboembolic and bleeding events. We analysed the outcome after catheter ablation of AF in HTN in a cohort from the prospective multicenter German Ablation Registry. Methods: Between 03/2008 and 01/2010, 626 patients undergoing AF-ablation were analysed. Patients diagnosed with HTN (n = 386) were compared with patients without HTN (n = 240) with respect to baseline, procedural and long-term outcome parameters. Results: Patients with HTN were older and more often presented with persistent forms of AF and cardiac comorbidities. Major and moderate in-hospital complications were low. At long-term follow-up, major cardiovascular events were rare in both groups. Rates of AF-recurrence, freedom from antiarrhythmic medication and repeat ablation were not statistically different between groups. Most patients reported improvement of symptoms and satisfaction with the treatment. However, patients with HTN more frequently complained of dyspnea of New York Heart Association (NYHA) class ≥ II and angina. They were more often rehospitalized, particularly when persistent AF had been diagnosed. Conclusion: Catheter ablation of AF is associated with low complication rates and favorable arrhythmia-related results in patients with HTN. Residual clinical symptoms may be due to cardiac comorbidities and require additional attention in this important subgroup of AF-patients.
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Affiliation(s)
- Maura M. Zylla
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (M.M.Z.); (H.A.K.)
- HCR (Heidelberg Center for Heart Rhythm Disorders), Medical University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Medical University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Matthias Hochadel
- Stiftung Institut für Herzinfarktforschung, IHF, Bremserstraße 79, 67063 Ludwigshafen, Germany; (M.H.); (J.S.)
| | - Dietrich Andresen
- Department of Cardiology, Vivantes Hospital, Klinikum am Urban, Dieffenbachstraße 1, 10967 Berlin, Germany;
| | - Johannes Brachmann
- Department of Cardiology, Hospital Coburg, Ketschendorfer Str. 33, 96450 Coburg, Germany;
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany;
| | - Ellen Hoffmann
- Department of Cardiology/Intensive Care Medicine, Heart Center Munich-Bogenhausen, Englschalkinger Str. 77, 81925 Munich, Germany;
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Hospital St. Georg, Lohmühlenstraße 5, 20099 Hamburg, Germany;
| | - Thorsten Lewalter
- Klinik für Kardiologie und Internist, Intensivmedizin, Peter Osypka Herzzentrum, Internistisches Klinikum München Süd, Am Isarkanal 36, 81379 Munich, Germany;
| | - Burghard Schumacher
- Department of Cardiology, Herz- und Gefäßklinik, Salzburger Leite 1, 97616 Bad Neustadt/Saale, Germany;
| | - Stefan G. Spitzer
- Praxisklinik Herz und Gefäße, Forststraße 3, 01099 Dresden, Germany;
- Institute of Medical Technology, Brandenburg University of Technology Cottbus-Senftenberg, Universitätsplatz 1, 01968 Senftenberg, Germany
| | - Stephan Willems
- Department of Cardiology/Electrophysiology, University Heart Center, Martinistraße 52, 20251 Hamburg, Germany;
| | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung, IHF, Bremserstraße 79, 67063 Ludwigshafen, Germany; (M.H.); (J.S.)
| | - Hugo A. Katus
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (M.M.Z.); (H.A.K.)
- HCR (Heidelberg Center for Heart Rhythm Disorders), Medical University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Medical University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Dierk Thomas
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; (M.M.Z.); (H.A.K.)
- HCR (Heidelberg Center for Heart Rhythm Disorders), Medical University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Medical University Hospital Heidelberg, 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +49-6221-568855; Fax: +49-6221-565514
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235
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Frenkel D, Aronow WS. Role for risk factor treatment in the management of atrial fibrillation. Hosp Pract (1995) 2020; 48:180-187. [PMID: 32552155 DOI: 10.1080/21548331.2020.1784663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Atrial fibrillation is the most common arrhythmia in the world with continued rising prevalence, significant morbidity and mortality, and a substantial financial burden. It has been associated with numerous modifiable risk factors and chronic medical conditions. Treatment of these modifiable risk factors has improved rhythm control of atrial fibrillation as well as demonstrated cost-effectiveness. Primary prevention of underlying chronic disease should be incorporated into the treatment paradigm for AF. Comprehensive management with integrated care including the patient, allied health professionals, primary care physicians, and specialists will be needed to reverse the epidemiological trends, improve quality of life, and mortality.
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Affiliation(s)
- Daniel Frenkel
- Department of Cardiology, New York Medical College and Westchester Medical Center , Valhalla, NY, USA
| | - Wilbert S Aronow
- Department of Cardiology, New York Medical College and Westchester Medical Center , Valhalla, NY, USA
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236
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Abstract
Atrial fibrillation is a common heart rhythm disorder that leads to an increased risk for stroke and heart failure. Atrial fibrillation is a complex disease with both environmental and genetic risk factors that contribute to the arrhythmia. Over the last decade, rapid progress has been made in identifying the genetic basis for this common condition. In this review, we provide an overview of the primary types of genetic analyses performed for atrial fibrillation, including linkage studies, genome-wide association studies, and studies of rare coding variation. With these results in mind, we aim to highlighting the existing knowledge gaps and future directions for atrial fibrillation genetics research.
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Affiliation(s)
- Carolina Roselli
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, MA, USA
- Department of Cardiology, University of Groningen, University Medical Center Groningen Groningen, the Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen Groningen, the Netherlands
| | - Patrick T. Ellinor
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA
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237
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Kornej J, Börschel CS, Benjamin EJ, Schnabel RB. Epidemiology of Atrial Fibrillation in the 21st Century: Novel Methods and New Insights. Circ Res 2020; 127:4-20. [PMID: 32716709 DOI: 10.1161/circresaha.120.316340] [Citation(s) in RCA: 656] [Impact Index Per Article: 164.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Accompanying the aging of populations worldwide, and increased survival with chronic diseases, the incidence and prevalence of atrial fibrillation (AF) are rising, justifying the term global epidemic. This multifactorial arrhythmia is intertwined with common concomitant cardiovascular diseases, which share classical cardiovascular risk factors. Targeted prevention programs are largely missing. Prevention needs to start at an early age with primordial interventions at the population level. The public health dimension of AF motivates research in modifiable AF risk factors and improved precision in AF prediction and management. In this review, we summarize current knowledge in an attempt to untangle these multifaceted associations from an epidemiological perspective. We discuss disease trends, preventive opportunities offered by underlying risk factors and concomitant disorders, current developments in diagnosis and risk prediction, and prognostic implications of AF and its complications. Finally, we review current technological (eg, eHealth) and methodological (artificial intelligence) advances and their relevance for future prevention and disease management.
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Affiliation(s)
- Jelena Kornej
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts & Sections of Cardiovascular Medicine and Preventive Medicine, Boston Medical Center (J.K., E.J.B.), Boston University School of Medicine, MA
| | - Christin S Börschel
- Department of General and Interventional Cardiology, University Heart & Vascular Center Hamburg Eppendorf, Hamburg, Germany (C.B., R.B.S.)
- German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck (C.B., R.B.S.)
| | - Emelia J Benjamin
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts & Sections of Cardiovascular Medicine and Preventive Medicine, Boston Medical Center (J.K., E.J.B.), Boston University School of Medicine, MA
- Department of Epidemiology (E.J.B.), Boston University School of Medicine, MA
| | - Renate B Schnabel
- Department of General and Interventional Cardiology, University Heart & Vascular Center Hamburg Eppendorf, Hamburg, Germany (C.B., R.B.S.)
- German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck (C.B., R.B.S.)
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238
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Ariyaratnam JP, Middeldorp M, Thomas G, Noubiap JJ, Lau D, Sanders P. Risk Factor Management Before and After Atrial Fibrillation Ablation. Card Electrophysiol Clin 2020; 12:141-154. [PMID: 32451099 DOI: 10.1016/j.ccep.2020.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Atrial fibrillation (AF) is increasingly recognized as the cardiac electrophysiologic manifestation of a multifactorial systemic disease. Several risk factors for development of AF have been identified; many are modifiable. There is evidence to suggest that aggressive management of modifiable risk factors has potential to significantly reduce the burden of AF, before and after AF ablation. Specific risk factor management (RFM) clinics have been shown effective in conferring these benefits into tangible improvements in large cohorts of patients. This review discusses the evidence behind RFM as a key adjunctive management strategy alongside AF ablation and suggests a model for RFM in clinics.
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Affiliation(s)
- Jonathan P Ariyaratnam
- Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia
| | - Melissa Middeldorp
- Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia
| | - Gijo Thomas
- Centre for Heart Rhythm Disorders, University of Adelaide, South Australian Health and Medical Research Institute (SAHMRI) Adelaide, SA 5000, Australia
| | - Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia
| | - Dennis Lau
- Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia.
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239
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Johansson C, Lind MM, Eriksson M, Wennberg M, Andersson J, Johansson L. Alcohol consumption and risk of incident atrial fibrillation: A population-based cohort study. Eur J Intern Med 2020; 76:50-57. [PMID: 32147331 DOI: 10.1016/j.ejim.2020.02.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/01/2020] [Accepted: 02/18/2020] [Indexed: 02/06/2023]
Abstract
AIMS Atrial fibrillation (AF) is a common tachyarrhythmia. High alcohol consumption is associated with increased AF risk. It remains unclear whether lower levels of alcohol consumption are also associated with AF risk, and whether the association differs between men and women. In this study, we investigated the association between low to moderate levels of alcohol consumption and AF risk in men and women. METHODS We performed a population-based cohort study of 109,230 health examination participants in northern Sweden. Data regarding alcohol intake were obtained using a questionnaire administered at the health examination. Incident AF cases were identified from the Swedish National Patient Registry. RESULTS AF was diagnosed in 5,230 individuals during a total follow-up of 1,484,547 person-years. Among men, AF risk increased over quartiles of weekly alcohol consumption (P for trend 0.001). Men with alcohol consumption in the highest quartile (≥4.83 standard drinks [each drink containing 12 gs of ethanol] per week; SDW) had a HR of 1.21 (95% CI 1.09-1.34) for AF compared to men in the lowest quartile (<0.90 SDW). In men, problem drinking was also associated with an increased AF risk (HR: 1.24; 95% CI: 1.10-1.39). Among women, AF risk was not significantly associated with alcohol consumption (P for trend 0.09 for decreasing risk of AF over quartiles of weekly alcohol consumption) or problem drinking (HR: 1.00; 95% CI 0.70-1.42). CONCLUSION Self-reported alcohol consumption and problem drinking were associated with an increased risk of AF among men, but not in women.
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Affiliation(s)
- Cecilia Johansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, 931 86 Skellefteå, Sweden.
| | - Marcus M Lind
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, 931 86 Skellefteå, Sweden
| | | | - Maria Wennberg
- Department of Public Health and Clinical Medicine, Section of Sustainable Health and Nutritional Research, Umeå University, Sweden
| | - Jonas Andersson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, 931 86 Skellefteå, Sweden
| | - Lars Johansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, 931 86 Skellefteå, Sweden
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240
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Effectiveness and Safety of Oral Anticoagulants among NVAF Patients with Obesity: Insights from the ARISTOPHANES Study. J Clin Med 2020; 9:jcm9061633. [PMID: 32481607 PMCID: PMC7355744 DOI: 10.3390/jcm9061633] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022] Open
Abstract
This ARISTOPHANES analysis examined stroke/systemic embolism (SE) and major bleeding (MB) among a subgroup of nonvalvular atrial fibrillation (NVAF) patients with obesity prescribed warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) in order to inform clinical decision making. A retrospective observational study was conducted among NVAF patients who were obese and initiated apixaban, dabigatran, rivaroxaban, or warfarin from 1 January 2013–30 September 2015, with data pooled from CMS Medicare and four US commercial claims databases. Propensity score matching was completed between NOACs and against warfarin in each database, and the results were pooled. Cox models were used to evaluate the risks of stroke/SE and MB. A total of 88,461 patients with obesity were included in the study. Apixaban and rivaroxaban were associated with a lower risk of stroke/SE vs. warfarin (HR: 0.63, 95% CI: 0.49–0.82 and HR: 0.84, 95% CI: 0.72–0.98). Dabigatran was associated with a similar risk of stroke/SE compared to warfarin. Compared with warfarin, apixaban and dabigatran had a lower risk of MB (HR: 0.54, 95% CI: 0.49–0.61 and HR: 0.75, 95% CI: 0.63–0.91). Rivaroxaban was associated with a similar risk of MB compared to warfarin. In this high-risk population with obesity, NOACs had a varying risk of stroke/SE and MB vs. warfarin.
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Predictors of non-pulmonary vein foci in paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2020; 61:71-78. [PMID: 32468323 DOI: 10.1007/s10840-020-00779-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Progress of balloon devices for pulmonary vein (PV) isolation in atrial fibrillation (AF) has been remarkable. However, these techniques were specialized in pulmonary vein treatment; predicting non-PV foci in advance is important to decide the treatment strategy. In this study, we investigate the predictors for paroxysmal AF. METHODS Subjects were consecutive paroxysmal AF patients who underwent high-dose isoproterenol provocation after PV isolation in the first session. The PV group (n = 102) and non-PV group (n = 222) were defined as the patients with and without non-PV ablation, respectively. Non-PV ablation was performed when frequent repetitive premature atrial contractions or triggered AF occurred spontaneously or by isoproterenol provocation. Predictors of non-PV origin in paroxysmal AF patients were examined using clinical characteristics and preoperative echocardiography. RESULTS In the multivariate logistic regression analysis, female sex, body mass index (BMI < 23.8), absence of hypertension, and higher ratio of mitral early diastolic peak (E-wave) to early diastolic mitral annulus peak (e') velocity (E/e' > 8.44) were significant independent predictors of non-PV foci (hazard ratio 2.04, 1.88, 3.63, and 2.33; 95% confidence interval 1.17-3.55, 1.05-3.39, 1.72-7.67, and 1.34-4.05; p = 0.011, 0.035, < 0.001, and 0.003, respectively). If a patient had these four factors, non-PV was detected with 96.8% specificity. CONCLUSION Female sex, lower BMI, absence of hypertension, and higher E/e' were significant indicators of non-PV foci in patients with paroxysmal AF. Reviewing these factors in advance may be useful for selecting a device to perform pulmonary vein isolation.
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242
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Volgman AS, Bairey Merz CN, Benjamin EJ, Curtis AB, Fang MC, Lindley KJ, Pepine CJ, Vaseghi M, Waldo AL, Wenger NK, Russo AM. Sex and Race/Ethnicity Differences in Atrial Fibrillation. J Am Coll Cardiol 2020; 74:2812-2815. [PMID: 31779796 DOI: 10.1016/j.jacc.2019.09.045] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/06/2019] [Accepted: 09/18/2019] [Indexed: 02/03/2023]
Affiliation(s)
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Emelia J Benjamin
- Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Department of Medicine, Boston University School of Medicine, and Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
| | - Anne B Curtis
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Margaret C Fang
- Division of Hospital Medicine, the University of California-San Francisco, San Francisco, California
| | | | - Carl J Pepine
- Division of Cardiovascular Medicine, University of Florida, College of Medicine, Gainesville, Florida
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, California
| | - Albert L Waldo
- Case Western Reserve University Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Division of Cardiovascular Medicine, Cleveland, Ohio
| | - Nanette K Wenger
- Department of Medicine (Cardiology), Emory University School of Medicine, Atlanta, Georgia
| | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, New Jersey
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243
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Renal sympathetic denervation in addition to pulmonary vein isolation reduces the recurrence rate of atrial fibrillation: an updated meta-analysis of randomized control trials. J Interv Card Electrophysiol 2020; 60:459-467. [DOI: 10.1007/s10840-020-00748-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/14/2020] [Indexed: 11/25/2022]
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244
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Parcha V, Patel N, Kalra R, Kim J, Gutiérrez OM, Arora G, Arora P. Incidence and Implications of Atrial Fibrillation/Flutter in Hypertension: Insights From the SPRINT Trial. Hypertension 2020; 75:1483-1490. [PMID: 32362231 DOI: 10.1161/hypertensionaha.120.14690] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We evaluated the impact of intensive blood pressure control on the incidence of new-onset atrial fibrillation/flutter (AF) and the prognostic implications of preexisting and new-onset AF in SPRINT (Systolic Blood Pressure Intervention Trial) participants. New-onset AF was defined as occurrence of AF in 12-lead electrocardiograms after randomization in participants free of AF at baseline. Poisson regression modeling was used to calculate incident rates of new-onset AF. Multivariable-adjusted Cox proportional hazard models were used to evaluate the risk of adverse cardiovascular events (composite of myocardial infarction, non-myocardial infarction acute coronary syndrome, stroke, heart failure, or cardiovascular death). In 9327 participants, 8.45% had preexisting AF, and 1.65% had new-onset AF. The incidence of new-onset AF was 4.53 per 1000-person years, with similar rates in the standard and intensive treatment arms (4.95 versus 4.11 per 1000-person years; adjusted P=0.14). Participants with preexisting AF (adjusted hazard ratio, 1.83 [95% CI, 1.46-2.31]; P<0.001) and new-onset AF (adjusted hazard ratio, 2.45 [95% CI, 1.58-3.80]; P<0.001) had a greater risk for development of adverse cardiovascular events compared with those with no AF. Participants with preexisting AF who achieved blood pressure <120/80 mm Hg at 3 months continued have a poor prognosis (adjusted hazard ratio, 1.88 [95% CI, 1.32-2.70]; P=0.001) compared with those with no AF. Intensive blood pressure control does not diminish the incidence of new-onset AF in an older, high-risk, nondiabetic population. Both preexisting and new-onset AF have adverse prognostic implications. In participants with preexisting AF, residual cardiovascular risk is evident even with on-treatment blood pressure <120/80 mm Hg. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062.
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Affiliation(s)
- Vibhu Parcha
- From the Division of Cardiovascular Disease (V.P., J.K., G.A., P.A.), University of Alabama at Birmingham, Birmingham
| | - Nirav Patel
- Department of Medicine (N.P.), University of Alabama at Birmingham, Birmingham
| | - Rajat Kalra
- Cardiovascular Division, University of Minnesota, Minneapolis (R.K.)
| | - Joonseok Kim
- From the Division of Cardiovascular Disease (V.P., J.K., G.A., P.A.), University of Alabama at Birmingham, Birmingham
| | - Orlando M Gutiérrez
- Division of Nephrology, Department of Medicine (O.M.G.), University of Alabama at Birmingham, Birmingham
- Department of Epidemiology (O.M.G.), University of Alabama at Birmingham, Birmingham
| | - Garima Arora
- From the Division of Cardiovascular Disease (V.P., J.K., G.A., P.A.), University of Alabama at Birmingham, Birmingham
| | - Pankaj Arora
- From the Division of Cardiovascular Disease (V.P., J.K., G.A., P.A.), University of Alabama at Birmingham, Birmingham
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, AL (P.A.)
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245
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Soliman EZ, Rahman AF, Zhang ZM, Rodriguez CJ, Chang TI, Bates JT, Ghazi L, Blackshear JL, Chonchol M, Fine LJ, Ambrosius WT, Lewis CE. Effect of Intensive Blood Pressure Lowering on the Risk of Atrial Fibrillation. Hypertension 2020; 75:1491-1496. [PMID: 32362229 DOI: 10.1161/hypertensionaha.120.14766] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
It remains uncertain whether intensive control of blood pressure (BP) results in a lower risk of atrial fibrillation (AF) in patients with hypertension. Using data from SPRINT (Systolic Blood Pressure Intervention Trial), which enrolled participants with hypertension at increased risk of cardiovascular disease, we examined whether intensive BP lowering (target systolic BP [SBP] <120 mm Hg), compared with standard BP lowering (target SBP<140 mm Hg), results in a lower risk of AF. This analysis included 8022 participants (4003 randomized to the intensive arm and 4019 to standard BP arm) who were free of AF at the time of enrollment and with available baseline and follow-up electrocardiographic data. AF was ascertained from standard 12-lead electrocardiograms recorded at biannual study examinations and an exit visit. During up to 5.2 years of follow-up and a total of 28 322 person-years, 206 incident AF cases occurred; 88 in the intensive BP-lowering arm and 118 in the standard BP-lowering arm. Intensive BP lowering was associated with a 26% lower risk of developing new AF (hazard ratio, 0.74 [95% CI, 0.56-0.98]; P=0.037). This effect was consistent among prespecified subgroups of SPRINT participants stratified by age, sex, race, SBP tertiles, prior cardiovascular disease, and prior chronic kidney disease when interactions between treatment effect and these subgroups were assessed using Hommel adjusted P values. In conclusion, intensive treatment to a target of SBP <120 mm Hg in patients with hypertension at high risk of cardiovascular disease has the potential to reduce the risk of AF. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062.
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Affiliation(s)
- Elsayed Z Soliman
- From the Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences and Department of Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.)
| | - Akm F Rahman
- Department of Biostatistics (A.F.R.), University of Alabama at Birmingham, Birmingham, AL
| | - Zhu-Ming Zhang
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Division of Public Health Sciences (Z-M.Z.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Carlos J Rodriguez
- Department of Medicine/Cardiology, Albert Einstein College of Medicine, Bronx, NY (C.J.R.)
| | - Tara I Chang
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA (T.I.C.)
| | - Jeffrey T Bates
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (J.T.B.)
| | - Lama Ghazi
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (L.G.)
| | - Joseph L Blackshear
- Department of Cardiovascular Diseases, Mayo Clinic Florida, Jacksonville, FL (J.L.B.)
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO (M.C.)
| | - Lawrence J Fine
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (L.J.F.)
| | - Walter T Ambrosius
- Department of Biostatistics and Data Science, Division of Public Health Sciences (W.T.A.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Cora E Lewis
- Department of Epidemiology, and Department of Medicine (C.E.L.), University of Alabama at Birmingham, Birmingham, AL
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Soliman EZ, Howard G, Judd S, Bhave PD, Howard VJ, Herrington DM. Factors Modifying the Risk of Atrial Fibrillation Associated With Atrial Premature Complexes in Patients With Hypertension. Am J Cardiol 2020; 125:1324-1331. [PMID: 32139160 DOI: 10.1016/j.amjcard.2020.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/30/2020] [Accepted: 02/04/2020] [Indexed: 11/26/2022]
Abstract
Patients with hypertension who develop atrial premature complexes (APCs) are at a particularly high risk for atrial fibrillation (AF). We sought to identify medications and modifiable risk factors that could reduce the risk of AF imposed by presence of APCs in such a high risk group. This analysis included 4,331 participants with treated hypertension from the Reasons for Geographic and Racial Differences in Stroke study who were free of AF and cardiovascular disease at the time of enrollment (2003-2007). APCs were detected in 8.2% (n = 356) of the participants at baseline. During a median follow-up of 9.4 years, 9.9% (n = 429) of the participants developed AF. Participants with APCs, compared with those without, were more than twice as likely to develop AF (Odds ratio [95% confidence interval]: 2.36[1.75, 3.19]). This association was significantly weaker in statin users than nonusers (Odds ratio [95% confidence interval]:1.42[0.81,2.48] vs 3.01[2.11,4.32], respectively; interaction p-value = 0.02), and in angiotensin-II receptor blocker users than nonusers (Odds ratio [95% confidence interval]:1.31[0.66,2.61] vs 2.78[1.99,3.89], respectively; interaction p-value = 0.05). Borderline weaker associations between APCs and AF were also observed in alpha-blocker users than nonusers, nondiabetics than diabetics, and in those with systolic blood pressure level 130 to 139 mm Hg compared with those with other systolic blood pressure levels. No significant effect modifications were observed by use of other medications or by presence of other cardiovascular risk factors. In conclusion, the significant AF risk associated with APCs in patients with hypertension could potentially be reduced by treatment with angiotensin-II receptor blockers and statins along with lowering blood pressure and management of diabetes.
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247
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Lip GYH, Keshishian AV, Kang AL, Li X, Dhamane AD, Luo X, Balachander N, Rosenblatt L, Mardekian J, Nadkarni A, Pan X, Di Fusco M, Garcia Reeves AB, Yuce H, Deitelzweig SB. Effectiveness and Safety of Oral Anticoagulants in Patients With Nonvalvular Atrial Fibrillation and Diabetes Mellitus. Mayo Clin Proc 2020; 95:929-943. [PMID: 32370854 DOI: 10.1016/j.mayocp.2019.05.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/17/2019] [Accepted: 05/24/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To address gaps in the data comparing non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin among patients with nonvalvular atrial fibrillation (NVAF) and diabetes. PATIENTS AND METHODS A retrospective study was conducted on patients with NVAF and diabetes newly initiating apixaban, dabigatran, rivaroxaban, or warfarin from January 1, 2013, through September 30, 2015, with Medicare data from the US Centers for Medicare & Medicaid Services and 4 other US commercial claims databases. One-to-one propensity score matching was completed between NOACs and warfarin and between NOACs in each database, and the results were pooled. Cox proportional hazards models were used to evaluate the risk of stroke/systemic embolism (SE) and major bleeding (MB). RESULTS A total of 154,324 patients were included in the 6 matched cohorts, with a mean follow-up time of 6 to 8 months. Compared with warfarin, apixaban (hazard ratio [HR], 0.67; 95% CI, 0.57-0.77) and rivaroxaban (HR, 0.79; 95% CI, 0.71-0.89) were associated with a lower risk of stroke/SE; dabigatran (HR, 0.84; 95% CI, 0.67-1.07) was associated with a similar risk of stroke/SE. Apixaban (HR, 0.60; 95% CI, 0.56-0.65) and dabigatran (HR, 0.78; 95% CI, 0.69-0.88) were associated with a lower risk of MB; rivaroxaban (HR, 1.02; 95% CI, 0.94-1.10) was associated with a similar risk of MB compared with warfarin. Compared with dabigatran and rivaroxaban, apixaban was associated with a lower risk of MB. Compared with rivaroxaban, dabigatran was associated with a lower risk of MB. CONCLUSION This study-the largest observational study to date of patients with NVAF and diabetes taking anticoagulants-found that NOACs were associated with variable rates of stroke/SE and MB compared with warfarin. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03087487.
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Affiliation(s)
- Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, at the Liverpool Heart & Chest Hospital, University of Liverpool, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Allison V Keshishian
- Health Economics and Outcomes Research, SIMR, LLC, Ann Arbor, MI; Department of Mathematics, New York City College of Technology, City University of New York, New York
| | - Amiee L Kang
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Company, Lawrenceville, NJ
| | - Xiaoyan Li
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Company, Lawrenceville, NJ
| | - Amol D Dhamane
- Health Economics & Outcomes Research, Bristol-Myers Squibb Company, Lawrenceville, NJ
| | - Xuemei Luo
- Global Research and Development, Pfizer Inc., Groton, CT
| | - Neeraja Balachander
- Worldwide Cardiovascular Department, Bristol-Myers Squibb Company, Lawrenceville, NJ
| | - Lisa Rosenblatt
- Worldwide Cardiovascular Department, Bristol-Myers Squibb Company, Lawrenceville, NJ
| | | | - Anagha Nadkarni
- Health Economics & Outcomes Research, Bristol-Myers Squibb Company, Lawrenceville, NJ
| | - Xianying Pan
- Center for Observational Research & Data Sciences, Bristol-Myers Squibb Company, Lawrenceville, NJ
| | | | - Alessandra B Garcia Reeves
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill; Department of Hospital Medicine, Ochsner Clinic Foundation, New Orleans, LA
| | - Huseyin Yuce
- Department of Mathematics, New York City College of Technology, City University of New York, New York
| | - Steven B Deitelzweig
- Department of Hospital Medicine, Ochsner Clinic Foundation, New Orleans, LA; Queensland School of Medicine, University of Queensland School of Medicine, New Orleans, LA
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248
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Fenger-Grøn M, Vinter N, Frost L. Body mass and atrial fibrillation risk: Status of the epidemiology concerning the influence of fat versus lean body mass. Trends Cardiovasc Med 2020; 30:205-211. [DOI: 10.1016/j.tcm.2019.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/20/2019] [Accepted: 05/27/2019] [Indexed: 12/29/2022]
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249
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Chung MK, Eckhardt LL, Chen LY, Ahmed HM, Gopinathannair R, Joglar JA, Noseworthy PA, Pack QR, Sanders P, Trulock KM. Lifestyle and Risk Factor Modification for Reduction of Atrial Fibrillation: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e750-e772. [DOI: 10.1161/cir.0000000000000748] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, is associated with substantial morbidity, mortality, and healthcare use. Great strides have been made in stroke prevention and rhythm control strategies, yet reducing the incidence of AF has been slowed by the increasing incidence and prevalence of AF risk factors, including obesity, physical inactivity, sleep apnea, diabetes mellitus, hypertension, and other modifiable lifestyle-related factors. Fortunately, many of these AF drivers are potentially reversible, and emerging evidence supports that addressing these modifiable risks may be effective for primary and secondary AF prevention. A structured, protocol-driven multidisciplinary approach to integrate lifestyle and risk factor management as an integral part of AF management may help in the prevention and treatment of AF. However, this aspect of AF management is currently underrecognized, underused, and understudied. The purpose of this American Heart Association scientific statement is to review the association of modifiable risk factors with AF and the effects of risk factor intervention. Implementation strategies, care pathways, and educational links for achieving impactful weight reduction, increased physical activity, and risk factor modification are included. Implications for clinical practice, gaps in knowledge, and future directions for the research community are highlighted.
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250
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Polovina M, Krljanac G, Ašanin M, Seferović PM. Crouching tiger, hidden dragon: insulin resistance and the risk of atrial fibrillation. Eur J Prev Cardiol 2020; 27:1931-1933. [PMID: 32237896 DOI: 10.1177/2047487320912626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Marija Polovina
- Department of Cardiology, Clinical Centre of Serbia, Serbia.,Faculty of Medicine, University of Belgrade, Serbia
| | - Gordana Krljanac
- Department of Cardiology, Clinical Centre of Serbia, Serbia.,Faculty of Medicine, University of Belgrade, Serbia
| | - Milika Ašanin
- Department of Cardiology, Clinical Centre of Serbia, Serbia.,Faculty of Medicine, University of Belgrade, Serbia
| | - Petar M Seferović
- Faculty of Medicine, University of Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Serbia
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