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Adamowicz S, Kilger E, Klarwein R. [Perioperative atrial fibrillation : Diagnosis with underestimated relevance]. DIE ANAESTHESIOLOGIE 2024; 73:133-144. [PMID: 38285210 DOI: 10.1007/s00101-023-01375-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/30/2024]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults, both in general and perioperatively and is associated with significant morbidity and mortality. The age of the patients is a major risk factor. The prevalence of AF in noncardiac surgery (NCS) varies widely from 0.4% to 30% and for cardiac surgery, especially major combined procedures, up to approximately 50%. Ectopic excitation centers and reentry mechanisms at the atrial level are favored as the main process of uncoordinated electrical atrial activity. The loss of atrial contraction can lead to a reduction in cardiac output of up to 20-25%. The increased risk of thromboembolism due to AF extends beyond the perioperative period. Medication-based prevention strategies have not yet gained widespread acceptance. Treatment strategies include frequency and rhythm control as well as the avoidance of thromboembolisms through anticoagulation.
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Affiliation(s)
- Sebastian Adamowicz
- Klinik für Anästhesiologie, LMU Klinikum München, Marchioninistr. 15, 81377, München, Deutschland.
| | - Erich Kilger
- Klinik für Anästhesiologie, LMU Klinikum München, Marchioninistr. 15, 81377, München, Deutschland
| | - Raphael Klarwein
- Klinik für Anästhesiologie, LMU Klinikum München, Marchioninistr. 15, 81377, München, Deutschland
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2
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Ouyang X, Wang J, Chen Q, Peng L, Li S, Tang X. Sodium-glucose cotransporter 2 inhibitor may not prevent atrial fibrillation in patients with heart failure: a systematic review. Cardiovasc Diabetol 2023; 22:124. [PMID: 37226247 DOI: 10.1186/s12933-023-01860-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) and heart failure (HF) frequently coexist because of their similar pathological basis. However, whether sodium-glucose cotransporter 2 inhibitor (SGLT2i), a novel class of anti-HF medication, decreases the risk of AF in HF patients remains unclear. OBJECTIVES The aim of this study was to assess the relationship between SGLT2i and AF in HF patients. METHODS A meta-analysis of randomized controlled trails evaluating the effects of SGLT2i on AF in HF patients was performed. PubMed and ClinicalTrails.gov were searched for eligible studies until 27 November 2022. The risk of bias and quality of evidence were assessed through the Cochrane tool. Pooled risk ratio of AF for SGLT2i versus placebo in eligible studies was calculated. RESULTS A total of 10 eligible RCTs examining 16,579 patients were included in the analysis. AF events occurred in 4.20% (348/8292) patients treated with SGLT2i, and in 4.57% (379/8287) patients treated with placebo. Meta-analysis showed that SGLT2i did not significantly reduce the risk of AF (RR 0.92; 95% CI 0.80-1.06; p = 0.23) in HF patients when compared to placebo. Similar results remained in the subgroup analyses, regardless of the type of SGLT2i, the type of HF, and the duration of follow-up. CONCLUSIONS Current evidences showed that SGLT2i may have no preventive effects on the risk of AF in patients with HF. TRANSLATIONAL PERSPECTIVE Despite HF being one of the most common heart diseases and conferring increased risk for AF, affective prevention of AF in HF patients is still unresolved. The present meta-analysis demonstrated that SGLT2i may have no preventive effects on reducing AF in patients with HF. How to effectively prevent and early detect the occurrence of AF is worth discussing.
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Affiliation(s)
- Xiaolan Ouyang
- Department of Cardiovascular Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiafu Wang
- Department of Cardiovascular Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qian Chen
- Department of Cardiovascular Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Long Peng
- Department of Cardiovascular Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Suhua Li
- Department of Cardiovascular Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Xixiang Tang
- VIP medical service center, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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3
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Labbé V, Ederhy S, Legouis D, Joffre J, Razazi K, Sy O, Voicu S, Mekontso-Dessap A, Cohen A, Fartoukh M. Clinical impact of successful cardioversion for new-onset atrial fibrillation in critically ill septic patients: A preliminary study. Arch Cardiovasc Dis 2023; 116:230-233. [PMID: 36805239 DOI: 10.1016/j.acvd.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 02/11/2023]
Affiliation(s)
- Vincent Labbé
- Service de médecine intensive réanimation, département médico-universitaire APPROCHES, hôpital Tenon, AP-HP, Sorbonne université, 75020 Paris, France; Groupe de recherche clinique CARMAS, université Paris-Est Créteil, 94010 Créteil, France.
| | - Stephane Ederhy
- Department of Cardiology, UNICO Cardio-Oncology Program, hôpital Saint-Antoine, AP-HP, 75012 Paris, France; Inserm U 856, 75013 Paris, France
| | - David Legouis
- Division of Intensive Care, Department of Acute Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland; Laboratory of Nephrology, Department of Medicine, University Hospitals of Geneva, 1205 Geneva; and Department of Cell Physiology, Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
| | - Jérémie Joffre
- Service de médecine intensive réanimation, hôpital Saint-Antoine, AP-HP, Sorbonne université, 75012 Paris, France
| | - Keyvan Razazi
- Groupe de recherche clinique CARMAS, université Paris-Est Créteil, 94010 Créteil, France; Service de médecine intensive réanimation, département médico-universitaire médecine, hôpitaux universitaires Henri Mondor-Albert Chenevier, AP-HP, 94000 Créteil, France
| | - Oumar Sy
- Service de médecine intensive réanimation, centre hospitalier melun, groupe hospitalier Sud Ile-de-France, 77000 Melun, France
| | - Sebastian Voicu
- Réanimation médicale et toxicologique, hôpital Lariboisière, AP-HP, université de Paris, Inserm UMRS-1144, 75010 Paris, France
| | - Armand Mekontso-Dessap
- Groupe de recherche clinique CARMAS, université Paris-Est Créteil, 94010 Créteil, France; Service de médecine intensive réanimation, département médico-universitaire médecine, hôpitaux universitaires Henri Mondor-Albert Chenevier, AP-HP, 94000 Créteil, France
| | - Ariel Cohen
- Department of Cardiology, UNICO Cardio-Oncology Program, hôpital Saint-Antoine, AP-HP, 75012 Paris, France; Inserm U 856, 75013 Paris, France; UMR-S ICAN 1166, Sorbonne université, 75013 Paris, France
| | - Muriel Fartoukh
- Service de médecine intensive réanimation, département médico-universitaire APPROCHES, hôpital Tenon, AP-HP, Sorbonne université, 75020 Paris, France; Groupe de recherche clinique CARMAS, université Paris-Est Créteil, 94010 Créteil, France
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Lancini D, Tan WL, Guppy-Coles K, Boots R, Prasad S, Atherton J, Martin P. Critical illness associated new onset atrial fibrillation: subsequent atrial fibrillation diagnoses and other adverse outcomes. Europace 2022; 25:300-307. [PMID: 36256594 PMCID: PMC9935047 DOI: 10.1093/europace/euac174] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/23/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS Amongst patients with critical illness associated new onset AF (CI-NOAF), the risk of subsequent atrial fibrillation (AF) diagnoses and other adverse outcomes is unknown, and the role for long-term anticoagulation is unclear. This study sought to determine the factors associated with subsequent AF diagnoses and other adverse outcomes in this cohort. METHODS AND RESULTS Admissions to a tertiary general intensive care unit (ICU) between December 2015 and September 2018 were screened for AF episodes through hourly analysis of continuous ECG monitoring. Patients with a prior history of AF were excluded. AF burden was defined as the percentage of monitored ICU hours in AF. The primary endpoint was subsequent AF diagnoses, as collated from the statewide electronic medical records. Secondary endpoints included mortality, embolic events, MACE and subsequent anticoagulation. RESULTS Of 7030 admissions with 509 303 h of monitoring data, 309 patients with CI-NOAF were identified, and 235 survived to discharge. Subsequent AF diagnoses were identified in 75 (31.9%) patients after a median of 413 days. Increased AF burden had the strongest independent association with AF recurrence (OR = 15.03, P = 0.002), followed by increased left atrial area (OR = 1.12, P = 0.01). Only 128 (54.5%) patients had their AF diagnosis acknowledged at ICU discharge, and 50 (21.3%) received anticoagulation at hospital discharge. CONCLUSION CI-NOAF is often under-recognized, and subsequent AF diagnoses are common post-discharge. AF burden during ICU admission has a strong independent association with subsequent AF diagnoses. Left atrial size is also independently associated with subsequent AF.
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Affiliation(s)
- Daniel Lancini
- Corresponding author. Tel: +61 437784738, E-mail address:
| | - Wei Lian Tan
- Cardiology Department, Royal Brisbane and Women’s Hospital, Brisbane 4029, Australia
| | - Kristyan Guppy-Coles
- Cardiology Department, Royal Brisbane and Women’s Hospital, Brisbane 4029, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
| | - Robert Boots
- Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane 4029, Australia
- School of Medicine, Griffith University, Brisbane 4111, Australia
| | - Sandhir Prasad
- Cardiology Department, Royal Brisbane and Women’s Hospital, Brisbane 4029, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
- School of Medicine, Griffith University, Brisbane 4111, Australia
| | - John Atherton
- Cardiology Department, Royal Brisbane and Women’s Hospital, Brisbane 4029, Australia
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
| | - Paul Martin
- Cardiology Department, Royal Brisbane and Women’s Hospital, Brisbane 4029, Australia
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Li Z, Pang M, Li Y, Yu Y, Peng T, Hu Z, Niu R, Li J, Wang X. Development and validation of a predictive model for new-onset atrial fibrillation in sepsis based on clinical risk factors. Front Cardiovasc Med 2022; 9:968615. [PMID: 36082114 PMCID: PMC9447992 DOI: 10.3389/fcvm.2022.968615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveNew-onset atrial fibrillation (NOAF) is a common complication and one of the primary causes of increased mortality in critically ill adults. Since early assessment of the risk of developing NOAF is difficult, it is critical to establish predictive tools to identify the risk of NOAF.MethodsWe retrospectively enrolled 1,568 septic patients treated at Wuhan Union Hospital (Wuhan, China) as a training cohort. For external validation of the model, 924 patients with sepsis were recruited as a validation cohort at the First Affiliated Hospital of Xinjiang Medical University (Urumqi, China). Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analyses were used to screen predictors. The area under the ROC curve (AUC), calibration curve, and decision curve were used to assess the value of the predictive model in NOAF.ResultsA total of 2,492 patients with sepsis (1,592 (63.88%) male; mean [SD] age, 59.47 [16.42] years) were enrolled in this study. Age (OR: 1.022, 1.009–1.035), international normalized ratio (OR: 1.837, 1.270–2.656), fibrinogen (OR: 1.535, 1.232–1.914), C-reaction protein (OR: 1.011, 1.008–1.014), sequential organ failure assessment score (OR: 1.306, 1.247–1.368), congestive heart failure (OR: 1.714, 1.126–2.608), and dopamine use (OR: 1.876, 1.227–2.874) were used as risk variables to develop the nomogram model. The AUCs of the nomogram model were 0.861 (95% CI, 0.830–0.892) and 0.845 (95% CI, 0.804–0.886) in the internal and external validation, respectively. The clinical prediction model showed excellent calibration and higher net clinical benefit. Moreover, the predictive performance of the model correlated with the severity of sepsis, with higher predictive performance for patients in septic shock than for other patients.ConclusionThe nomogram model can be used as a reliable and simple predictive tool for the early identification of NOAF in patients with sepsis, which will provide practical information for individualized treatment decisions.
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Affiliation(s)
- Zhuanyun Li
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ming Pang
- Department of Neurophysiology, Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Cangzhou, China
| | - Yongkai Li
- Department of Emergency Medicine, The First Affiliated Hospital, Xinjiang Medical University, Ürümqi, China
| | - Yaling Yu
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tianfeng Peng
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhenghao Hu
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruijie Niu
- Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiming Li
- Department of Emergency Medicine, The First Affiliated Hospital, Xinjiang Medical University, Ürümqi, China
- Jiming Li,
| | - Xiaorong Wang
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xiaorong Wang,
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6
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Johnston BW, Chean CS, Duarte R, Hill R, Blackwood B, McAuley DF, Welters ID. Management of new onset atrial fibrillation in critically unwell adult patients: a systematic review and narrative synthesis. Br J Anaesth 2021; 128:759-771. [PMID: 34916053 DOI: 10.1016/j.bja.2021.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND New onset atrial fibrillation (NOAF) is the most common arrhythmia affecting critically unwell patients. NOAF can lead to worsening haemodynamic compromise, heart failure, thromboembolic events, and increased mortality. The aim of this systematic review and narrative synthesis is to evaluate the non-pharmacological and pharmacological management strategies for NOAF in critically unwell patients. METHODS Of 1782 studies, 30 were eligible for inclusion, including 4 RCTs and 26 observational studies. Efficacy of direct current cardioversion, amiodarone, β-antagonists, calcium channel blockers, digoxin, magnesium, and less commonly used agents such as ibutilide are reported. RESULTS Cardioversion rates of 48% were reported for direct current cardioversion; however, re-initiation of NOAF was as high as 23.4%. Amiodarone was the most commonly reported intervention with cardioversion rates ranging from 18% to 95.8% followed by β-antagonists with cardioversion rates from 40% to 92.3%. Amiodarone was more effective than diltiazem (odds ratio [OR]=1.91, P=0.32) at cardioversion. Short-acting β-antagonists esmolol and landiolol were more effective compared with diltiazem at cardioversion (OR=3.55, P=0.04) and HR control (OR=3.2, P<0.001). CONCLUSION There was significant variation between studies with regard to the definition of successful cardioversion and heart rate control, making comparisons between studies and interventions difficult. Future RCTs comparing individual anti-arrhythmic agents, in particular magnesium, amiodarone, and β-antagonists, and the role of anticoagulation in critically unwell patients are required. There is also an urgent need for a core outcome dataset for studies of new onset atrial fibrillation to allow comparisons between different anti-arrhythmic strategies. CLINICAL TRIAL REGISTRATION PROSPERO CRD42019121739.
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Affiliation(s)
- Brian W Johnston
- Institute for Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
| | - Chung S Chean
- Northampton General Hospital NHS Trust, Northampton, UK
| | - Rui Duarte
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Danny F McAuley
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Ingeborg D Welters
- Institute for Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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7
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Labbé V, Ederhy S, Lapidus N, Joffre J, Razazi K, Laine L, Sy O, Voicu S, Chemouni F, Aissaoui N, Smonig R, Doyen D, Carrat F, Voiriot G, Mekontso-Dessap A, Cohen A, Fartoukh M. Transesophageal echocardiography for cardiovascular risk estimation in patients with sepsis and new-onset atrial fibrillation: a multicenter prospective pilot study. Ann Intensive Care 2021; 11:146. [PMID: 34661761 PMCID: PMC8523595 DOI: 10.1186/s13613-021-00934-1] [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] [Received: 06/28/2021] [Accepted: 10/02/2021] [Indexed: 12/25/2022] Open
Abstract
Background Echocardiographic parameters have been poorly investigated for estimating cardiovascular risk in patients with sepsis and new-onset atrial fibrillation. We aim to assess the prevalence of transesophageal echocardiographic abnormalities and their relationship with cardiovascular events in mechanically ventilated patients with sepsis and new-onset atrial fibrillation. Methods In this prospective multicenter pilot study, left atrial/left atrial appendage (LA/LAA) dysfunction, severe aortic atheroma, and left ventricular systolic dysfunction were assessed using an initial transesophageal echocardiographic study, which was repeated after 48–72 h to detect LA/LAA thrombus formation. The study outcome was a composite of cardiovascular events at day 28, including arterial thromboembolic events (ischemic stroke, non-cerebrovascular arterial thromboembolism, LA/LAA thrombus), major bleeding, and all-cause death. Results The study population comprised 94 patients (septic shock 63%; 35% women; median age 69 years). LA/LAA dysfunction, severe aortic atheroma, and left ventricular systolic dysfunction were detected in 17 (19%), 22 (24%), and 27 (29%) patients, respectively. At day 28, the incidence of cardiovascular events was 46% (95% confidence interval [CI]: 35 to 56). Arterial thromboembolic events and major bleeding occurred in 7 (7%) patients (5 ischemic strokes, 1 non-cerebrovascular arterial thromboembolism, 2 left atrial appendage thrombi) and 18 (19%) patients, respectively. At day 28, 27 patients (29%) died. Septic shock (hazard ratio [HR]: 2.36; 95% CI 1.06 to 5.29) and left ventricular systolic dysfunction (HR: 2.06; 95% CI 1.05 to 4.05) were independently associated with cardiovascular events. Conclusions Transesophageal echocardiographic abnormalities are common in mechanically ventilated patients with sepsis and new-onset atrial fibrillation, but only left ventricular systolic dysfunction was associated with cardiovascular events at day 28. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00934-1.
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Affiliation(s)
- Vincent Labbé
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Médecine Intensive Réanimation, Département Médico-Universitaire APPROCHES, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France. .,Université Paris Est, Groupe de Recherche Clinique GR05 CARMAS, Institut Mondor de recherche biomédicale, INSERM, Créteil, France.
| | - Stephane Ederhy
- Department of Cardiology, UNICO Cardio-Oncology Program, Hôpital Saint-Antoine, AP-HP, Paris, France.,INSERM U 856, Paris, France
| | - Nathanael Lapidus
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, AP-HP, Paris, France.,Sorbonne Université, Public Health Department, Saint Antoine Hospital, AP-HP, Paris, France
| | - Jérémie Joffre
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Keyvan Razazi
- Université Paris Est, Groupe de Recherche Clinique GR05 CARMAS, Institut Mondor de recherche biomédicale, INSERM, Créteil, France.,Service de Médecine Intensive Réanimation, Département Médico-Universitaire Médecine, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, AP-HP, Créteil, France
| | - Laurent Laine
- Service de Médecine Intensive Réanimation, Centre Hospitalier de Saint-Denis, Saint Denis, France
| | - Oumar Sy
- Service de Médecine Intensive Réanimation, Groupe Hospitalier Sud Ile-de-France, Centre Hospitalier Melun, Melun, France
| | - Sebastian Voicu
- Service de Réanimation Médicale et Toxicologique, Hôpital Lariboisière, AP-HP, INSERM UMRS-1144, Université de Paris, Paris, France
| | - Frank Chemouni
- Service de Médecine Intensive Réanimation, Gustave Roussy, Villejuif, France
| | - Nadia Aissaoui
- Service de Médecine Intensive Réanimation, Hôpital Européen Georges-Pompidou, AP-HP, Université Paris-Descartes, Paris, France
| | - Roland Smonig
- Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
| | - Denis Doyen
- Service de Médecine Intensive Réanimation, Hôpital l'Archet 1, Centre Hospitalier Universitaire de Nice, and UR2CA Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
| | - Fabrice Carrat
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, AP-HP, Paris, France.,Sorbonne Université, Public Health Department, Saint Antoine Hospital, AP-HP, Paris, France
| | - Guillaume Voiriot
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Médecine Intensive Réanimation, Département Médico-Universitaire APPROCHES, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.,Université Paris Est, Groupe de Recherche Clinique GR05 CARMAS, Institut Mondor de recherche biomédicale, INSERM, Créteil, France
| | - Armand Mekontso-Dessap
- Université Paris Est, Groupe de Recherche Clinique GR05 CARMAS, Institut Mondor de recherche biomédicale, INSERM, Créteil, France.,Service de Médecine Intensive Réanimation, Département Médico-Universitaire Médecine, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, AP-HP, Créteil, France
| | - Ariel Cohen
- Department of Cardiology, UNICO Cardio-Oncology Program, Hôpital Saint-Antoine, AP-HP, Paris, France.,INSERM U 856, Paris, France.,UMR-S ICAN 1166, Sorbonne Université, Paris, France
| | - Muriel Fartoukh
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Médecine Intensive Réanimation, Département Médico-Universitaire APPROCHES, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.,Université Paris Est, Groupe de Recherche Clinique GR05 CARMAS, Institut Mondor de recherche biomédicale, INSERM, Créteil, France
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8
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Okazaki T, Yoshida T, Uchino S, Sasabuchi Y. Association of onset time of new-onset atrial fibrillation with in-hospital mortality among critically ill patients: A secondary analysis of a prospective multicenter observational study. IJC HEART & VASCULATURE 2021; 36:100880. [PMID: 34632043 PMCID: PMC8488237 DOI: 10.1016/j.ijcha.2021.100880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/01/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022]
Abstract
Background New-onset atrial fibrillation (AF) in critically ill patients is associated with adverse outcomes. In non-critical settings, the circadian variation in paroxysmal AF is of significant interest; however, circadian variation in critically ill patients with new-onset AF has not been thoroughly studied. This study aimed to examine the association between AF onset time and in-hospital mortality. Methods This was a secondary analysis of a prospective multicenter observational study enrolling adult critically ill patients. According to AF onset time, patients were divided into nighttime (0:00–7:59), daytime (8:00–15:59), and evening (16:00–23:59). We conducted a multiple logistic regression analysis to assess the potential association between AF onset time and in-hospital mortality. We also assessed the distribution of AF onset, crude in-hospital mortality, and adjusted in-hospital mortality according to bihourly intervals. Results Of 423 patients, in-hospital mortality was 26%. During nighttime, 135 patients (32%) developed new-onset AF. AF emerged during daytime for 141 (33%) and during evening for 147 (35%). Daytime AF was significantly associated with an increased risk of in-hospital mortality (adjusted OR: 1.92; 95% CI: 1.07–3.44; p = 0.030). Bihourly interval analysis showed that adjusted in-hospital mortality was unevenly distributed and bimodal with troughs between 6:00 and 7:59 and between 18:00 and 19:59. A similar trend was seen in the distribution of the number of new-onset AF. Conclusions We found that the bihourly adjusted in-hospital mortality was distributed in a bimodal fashion. Further research is needed to determine the causes of the diurnal variation and its impact on patient outcomes.
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Affiliation(s)
- Tomoya Okazaki
- Emergency Medical Center, Kagawa University Hospital, Japan
| | - Takuo Yoshida
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Japan.,Department of Intensive Care Medicine, Tokyo Women's Medical University, Japan
| | - Shigehiko Uchino
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Japan
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9
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Sakuraya M, Yoshida T, Sasabuchi Y, Yoshihiro S, Uchino S. Clinical prediction scores and early anticoagulation therapy for new-onset atrial fibrillation in critical illness: a post-hoc analysis. BMC Cardiovasc Disord 2021; 21:423. [PMID: 34496749 PMCID: PMC8424957 DOI: 10.1186/s12872-021-02235-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 09/01/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose This study sought to describe the epidemiology of anticoagulation therapy for critically ill patients with new-onset atrial fibrillation (NOAF) according to CHA2DS2-VASc and HAS-BLED scores and to assess the efficacy of early anticoagulation therapy. Method Adult patients who developed NOAF during intensive care unit stay were included. We compared the patients who were treated with and without anticoagulation therapy within 48 h from AF onset. The primary outcome was a composite outcome that included mortality and ischemic stroke during the period until hospital discharge.
Results In total, 308 patients were included in this analysis. Anticoagulants were administered to 95 and 33 patients within 48 h and after 48 h from NOAF onset, respectively. After grouping the patients into four according to their CHA2DS2-VASc and HAS-BLED bleeding scores, we found that the proportion of anticoagulation therapy administered was similar among all groups. After adjustment using a multivariable Cox regression model, we noted that early anticoagulation therapy did not decrease the composite outcome (adjusted hazard ratio [HR] 0.77; 95% confidence interval [CI] 0.47‒1.23). However, in patients without rhythm control drugs, early anticoagulation was significantly associated with better outcomes (adjusted HR 0.46; 95% CI; 0.22‒0.87, P = 0.041). Conclusions We found that clinical prediction scores were supposedly not used in the decision to implement anticoagulation therapy and that early anticoagulation therapy did not improve clinical outcomes in critically ill patients with NOAF. Trial registration UMIN-CTR UMIN000026401. Registered 5 March 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02235-8.
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Affiliation(s)
- Masaaki Sakuraya
- Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, Jigozen 1-3-3, Hatsukaichi, Hiroshima, 738-8503, Japan.
| | - Takuo Yoshida
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan.,Department of Intensive Care Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Yusuke Sasabuchi
- Data Science Center, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Shodai Yoshihiro
- Pharmaceutical Department, JA Hiroshima General Hospital, Hatsukaichi, Hiroshima, Japan
| | - Shigehiko Uchino
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Centre, Saitama, Japan
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10
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Shima N, Miyamoto K, Kato S, Yoshida T, Uchino S. Primary success of electrical cardioversion for new-onset atrial fibrillation and its association with clinical course in non-cardiac critically ill patients: sub-analysis of a multicenter observational study. J Intensive Care 2021; 9:46. [PMID: 34238390 PMCID: PMC8268199 DOI: 10.1186/s40560-021-00562-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Electrical cardioversion (ECV) is widely used to restore sinus rhythm in critically ill adult patients with atrial fibrillation, although its prognostic value is uncertain. This study aims to elucidate the clinical meaning of successful ECV. Methods This is a sub-analysis of the AFTER-ICU study, a multicenter prospective study with a cohort of 423 adult non-cardiac patients with new-onset atrial fibrillation (AF). Patients that underwent ECV within 7 days after initial onset of AF were included in the sub-analysis. We compared intensive care unit (ICU) and overall hospital mortality, survival time within 30 days, cardiac rhythm at ICU discharge, and the length of ICU and overall hospital stay between patients whose sinus rhythm was restored immediately after the first ECV session (primary success group) and those in whom it was not restored (unsuccessful group). To find the factors related to the primary success of ECV, we also compared patient characteristics, the delivered energy, and pretreatment. Results Sixty-five patients received ECV and were included in this study. Although 35 patients (54%) had primary success, recurrence of AF occurred in 24 of these patients (69%). At ICU discharge, three patients still had AF in the unsuccessful group, but no patients in the primary success group still had AF. ICU mortality was 34% in the primary success group and 17% in the unsuccessful group (P = 0.10). Survival time within 30 days did not differ between the groups. Delivered energy and pretreatment were not associated with primary success of ECV. Conclusions The primary success rate of ECV for new-onset AF in adult non-cardiac ICU population was low, and even if it succeeded, the subsequent recurrence rate was high. Primary success of ECV did not affect the rate of mortality. Pretreatment and delivered energy were not associated with the primary success of ECV. Trial registration UMIN clinical trial registry, the Japanese clinical trial registry (registration number: UMIN000026401, March 31, 2017). Supplementary Information The online version contains supplementary material available at 10.1186/s40560-021-00562-8.
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Affiliation(s)
- Nozomu Shima
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, Japan.
| | - Kyohei Miyamoto
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, Japan
| | - Seiya Kato
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, Japan
| | - Takuo Yoshida
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan.,Present address: Department of Intensive Care Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Shigehiko Uchino
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan
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11
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Wetterslev M, Jacobsen PK, Hassager C, Jøns C, Risum N, Pehrson S, Bastiansen A, Andreasen AS, Tjelle Kristiansen K, Bestle MH, Mohr T, Møller‐Sørensen H, Perner A. Cardiac arrhythmias in critically ill patients with coronavirus disease 2019: A retrospective population-based cohort study. Acta Anaesthesiol Scand 2021; 65:770-777. [PMID: 33638870 PMCID: PMC8014528 DOI: 10.1111/aas.13806] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/14/2021] [Accepted: 02/14/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) may be associated with cardiac arrhythmias in hospitalized patients, but data from the ICU setting are limited. We aimed to describe the epidemiology of cardiac arrhythmias in ICU patients with COVID-19. METHODS We conducted a multicenter, retrospective cohort study including all ICU patients with an airway sample positive for severe acute respiratory syndrome corona-virus 2 from March 1st to June 1st in the Capital Region of Denmark (1.8 million inhabitants). We registered cardiac arrhythmias in ICU, potential risk factors, interventions used in ICU and outcomes. RESULTS From the seven ICUs we included 155 patients with COVID-19. The incidence of cardiac arrhythmias in the ICU was 57/155 (37%, 95% confidence interval 30-45), and 39/57 (68%) of these patients had this as new-onset arrhythmia. Previous history of tachyarrhythmias and higher disease severity at ICU admission were associated with cardiac arrhythmias in the adjusted analysis. Fifty-four of the 57 (95%) patients had supraventricular origin of the arrhythmia, 39/57 (68%) received at least one intervention against arrhythmia (eg amiodarone, IV fluid or magnesium) and 38/57 (67%) had recurrent episodes of arrhythmia in ICU. Patients with arrhythmias in ICU had higher 60-day mortality (63%) as compared to those without arrhythmias (39%). CONCLUSION New-onset supraventricular arrhythmias were frequent in ICU patients with COVID-19 and were related to previous history of tachyarrhythmias and severity of the acute disease. The mortality was high in these patients despite the frequent use of interventions against arrhythmias.
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Affiliation(s)
- Mik Wetterslev
- Department of Intensive Care Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Peter Karl Jacobsen
- Department of Cardiology Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Christian Hassager
- Department of Cardiology Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Christian Jøns
- Department of Cardiology Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Niels Risum
- Department of Cardiology Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Steen Pehrson
- Department of Cardiology Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Anders Bastiansen
- Department of Anaesthesia and Intensive Care Bispebjerg Hospital and Frederiksberg HospitalUniversity of Copenhagen Copenhagen Denmark
| | - Anne Sofie Andreasen
- Department of Anaesthesia and Intensive Care Herlev HospitalUniversity of Copenhagen Copenhagen Denmark
| | - Klaus Tjelle Kristiansen
- Department of Anaesthesia and Intensive Care Hvidovre HospitalUniversity of Copenhagen Copenhagen Denmark
| | - Morten H. Bestle
- Department of Anaesthesia and Intensive Care Nordsjællands HospitalUniversity of Copenhagen Copenhagen Denmark
| | - Thomas Mohr
- Department of Anaesthesia and Intensive Care Gentofte HospitalUniversity of Copenhagen Copenhagen Denmark
| | - Hasse Møller‐Sørensen
- Department of Cardiothoracic Anaesthesiology Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Anders Perner
- Department of Intensive Care Rigshospitalet University of Copenhagen Copenhagen Denmark
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12
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Yoshida T, Uchino S, Sasabuchi Y, Kyo M, Igarashi T, Inoue H. Rhythm-control therapy for new-onset atrial fibrillation in critically ill patients: A post hoc analysis from the prospective multicenter observational AFTER-ICU study. IJC HEART & VASCULATURE 2021; 33:100742. [PMID: 33732869 PMCID: PMC7937754 DOI: 10.1016/j.ijcha.2021.100742] [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] [Received: 01/27/2021] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sustained new-onset atrial fibrillation (AF) in the intensive care unit has been reported to be associated with poor outcomes. However, in critical illness, whether rhythm-control therapy can achieve sinus rhythm (SR) restoration is unknown. This study aimed to assess the impact of rhythm-control therapy on SR restoration for new-onset AF in critically ill patients. METHODS This post-hoc analysis of a prospective multicenter observational study involving 32 Japan intensive care units compared patients with and without rhythm-control therapy for new-onset atrial fibrillation (AF) and conducted a multivariable analysis using Cox proportional hazards regression analysis including rhythm-control therapy as a time-varying covariate for SR restoration. RESULTS Of 423 new-onset AF patients, 178 patients (42%) underwent rhythm-control therapy. Among those patients, 131 (31%) underwent rhythm-control therapy within 6 h after AF onset. Magnesium sulphate was the most frequently used rhythm-control drug. The Cox proportional hazards model for SR restoration showed that rhythm-control therapy had a significant positive association with SR restoration (adjusted hazard ratio: 1.46; 95% confidence interval: 1.16-1.85). However, the rhythm-control group had numerically higher hospital mortality than the non-rhythm-control group (31% vs. 23%, p = 0.09). CONCLUSIONS Rhythm-control therapy for new-onset AF in critically ill patients was associated with SR restoration. However, patients with rhythm-control therapy had poorer prognosis, possibly due to selection bias. These findings may provide important insight for the design and feasibility of interventional studies assessing rhythm-control therapy in new-onset AF.
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Affiliation(s)
- Takuo Yoshida
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan
| | - Shigehiko Uchino
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan
| | | | - Michihito Kyo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takashi Igarashi
- Department of Trauma and Critical Care Medicine, School of Medicine, Kyorin University, Tokyo, Japan
| | - Haruka Inoue
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - on behalf of the AFTER-ICU Study Group
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan
- Data Science Center, Jichi Medical University, Tochigi, Japan
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Trauma and Critical Care Medicine, School of Medicine, Kyorin University, Tokyo, Japan
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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13
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Aoki Y, Kawasaki Y, Ide K, Shimizu Y, Sato S, Yokoyama J. Landiolol hydrochloride for prevention of atrial fibrillation during esophagectomy: a randomized controlled trial. JA Clin Rep 2020; 6:34. [PMID: 32394218 PMCID: PMC7214548 DOI: 10.1186/s40981-020-00338-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/24/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction Landiolol hydrochloride reduces the incidence of perioperative atrial fibrillation (AF) in cardiac surgery; however, little evidence is available regarding its effects in other types of surgery, including esophagectomy. We assessed the hypothesis that landiolol reduces perioperative AF and other complications associated with esophagectomy. Methods This single-center, randomized, double-blind, parallel-group study enrolled patients scheduled for esophagectomy. Patients were divided into those given landiolol at 3 μg/kg/min or placebo for 24 h. The primary outcome was the proportion of patients who developed AF within 96 h starting at 9:00 am on the day of surgery. The secondary outcomes were the proportion of patients whose AF appeared within 24 h, other complications based on the Clavien–Dindo classification, and the intensive care unit and hospital stays. Results Despite early study termination, 80 patients were screened, and 56 were enrolled (28/group) from September 2016 to June 2018. AF occurred within 96 h of surgery in six (21.4%) patients in the landiolol group and five (17.9%) patients in the placebo group (odds ratio, 1.26; 95% confidence interval, 0.33–4.7) and within 24 h of surgery in three (10.7%) patients in the landiolol group and two (7.1%) patients in the placebo group. There were no significant differences in the incidence of complications or in the number of intensive care unit or hospital stays between the groups. Conclusion Although our small sample size prevents definitive conclusions, landiolol might not reduce the occurrence of AF or other complications. Trial registration UMIN, UMIN000024040. Registered 13 September 2016, http://www.umin.ac.jp/ctr/index/htm
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Affiliation(s)
- Yoshitaka Aoki
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu-shi, Shizuoka, 431-3192, Japan. .,Department of Anesthesiology, Shizuoka General Hospital, Shizuoka, Japan.
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Centre, Chiba University Hospital, Chiba, Japan.,Faculty of Nursing, Japanese Red Cross College of Nursing, Tokyo, Japan
| | - Kazuki Ide
- Uehiro Research Division for iPS Cell Ethics, Center for iPS Cell Research and Application, Kyoto University, Kyoto, Japan
| | - Yuichiro Shimizu
- Department of Anesthesiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Shinsuke Sato
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Junichiro Yokoyama
- Department of Anesthesiology, Shizuoka General Hospital, Shizuoka, Japan
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14
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Tralhão A, Póvoa P. Cardiovascular Events After Community-Acquired Pneumonia: A Global Perspective with Systematic Review and Meta-Analysis of Observational Studies. J Clin Med 2020; 9:E414. [PMID: 32028660 PMCID: PMC7073946 DOI: 10.3390/jcm9020414] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 12/12/2022] Open
Abstract
Acute cardiovascular disease after community-acquired pneumonia is a well-accepted complication for which definitive treatment strategies are lacking. These complications share some common features but have distinct diagnostic and treatment approaches. We therefore undertook an updated systematic review and meta-analysis of observational studies reporting the incidence of overall complications, acute coronary syndromes, new or worsening heart failure, new or worsening arrhythmias and acute stroke, as well as short-term mortality outcomes. To set a framework for future research, we further included a holistic review of the interplay between the two conditions. From 1984 to 2019, thirty-nine studies were accrued, involving 92,188 patients, divided by setting (inpatients versus outpatients) and clinical severity (low risk versus high risk). Overall cardiac complications occurred in 13.9% (95% confidence interval (CI) 9.6-18.9), acute coronary syndromes in 4.5% (95% CI 2.9-6.5), heart failure in 9.2% (95% CI 6.7-12.2), arrhythmias in 7.2% (95% CI 5.6-9.0) and stroke in 0.71% (95% CI 0.1-3.9) of pooled inpatients. During this period, meta-regression analysis suggests that the incidence of overall and individual cardiac complications is decreasing. After adjusting for confounders, cardiovascular events taking place after community-acquired pneumonia independently increase the risk for short-term mortality (range of odds-ratio: 1.39-5.49). These findings highlight the need for effective, large trial based, preventive and therapeutic interventions in this important patient population.
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Affiliation(s)
- António Tralhão
- Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005 Lisbon, Portugal;
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Avenida Professor Doutor Reinaldo dos Santos, 2790-134 Carnaxide, Portugal
| | - Pedro Póvoa
- Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005 Lisbon, Portugal;
- NOVA Medical School, CHRH, New University of Lisbon, 1069-056 Lisbon, Portugal
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, DK-5000 Odense C, Denmark
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