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Lurz J, Hengelhaupt L, Unterhuber M, Stenzel L, Hilbert S, Schöber AR, Dinov B, Darma A, Dagres N, Hindricks G, Lurz P, Bollmann A. App-Based Mental Training to Reduce Atrial Fibrillation-Related Symptoms After Pulmonary Vein Isolation: MENTAL AF Trial. J Am Heart Assoc 2024; 13:e033500. [PMID: 38780185 DOI: 10.1161/jaha.123.033500] [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: 01/08/2024] [Accepted: 03/21/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Even after atrial fibrillation (AF) catheter ablation, many patients still experience relevant symptom burden. The objective of the MENTAL AF trial was to determine whether app-based mental training (MT) during the 3 months following pulmonary vein isolation reduces AF-related symptoms. METHODS AND RESULTS Patients scheduled for pulmonary vein isolation were enrolled and randomized 1:1 to either app-based MT or usual care. Of 174 patients, 76 in the MT and 75 in the usual care group were included in the final analysis. The intervention was delivered by a daily 10-minute app-based MT. The primary outcome was the intergroup difference of the mean AF6 sum score, an AF-specific questionnaire, during the 3-month study period. Secondary outcomes included quality-of-life measures such as the AFEQT (Atrial Fibrillation Effect on Quality of Life). Mean age (SD) was 61 (8.7) years and 61 (41%) were women. The mean AF6 sum score over the study period was 8.9 (6.9) points in the MT group and 12.5 (10.1) in the usual care group (P=0.011). This referred to a reduction in the AF6 sum score compared with baseline of 75% in MT and 52% for usual care (P<0.001). The change in the AFEQT Global Score was 22.6 (16.3) and 15.7 (22.1), respectively; P=0.026. CONCLUSIONS MENTAL AF showed that app-based MT as an adjunctive treatment tool following pulmonary vein isolation was feasible. App-based MT was found to be superior to standard care in reducing AF-related symptom burden and improving health-related quality of life. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04067427.
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Affiliation(s)
- Julia Lurz
- Department of Electrophysiology Heart Center Leipzig at University Leipzig Leipzig Germany
- Department of Cardiology University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
| | - Laura Hengelhaupt
- Department of Electrophysiology Heart Center Leipzig at University Leipzig Leipzig Germany
| | - Matthias Unterhuber
- Department of Cardiology Heart Center Leipzig at University Leipzig Leipzig Germany
- Department of Cardiology San Maurizio Hospital Bolzano Italy
| | - Lukas Stenzel
- Institute of Sport Science, Martin Luther University Halle-Wittenberg Halle (Saale) Germany
| | - Sebastian Hilbert
- Department of Electrophysiology Heart Center Leipzig at University Leipzig Leipzig Germany
| | - Anne Rebecca Schöber
- Department of Cardiology University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
- Department of Cardiology Heart Center Leipzig at University Leipzig Leipzig Germany
| | - Borislav Dinov
- Medical Clinic I, Cardiology and Angiology Medical University of Giessen Giessen Germany
| | - Angeliki Darma
- Department of Electrophysiology Heart Center Leipzig at University Leipzig Leipzig Germany
| | | | | | - Philipp Lurz
- Department of Cardiology University Medical Center of the Johannes Gutenberg University Mainz Mainz Germany
| | - Andreas Bollmann
- Department of Electrophysiology Heart Center Leipzig at University Leipzig Leipzig Germany
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Amsterdam D, Kupershmidt A, Avinir A, Matalon R, Ohana O, Feder O, Shtrozberg S, Choshen G, Ablin JN, Elkana O. Long COVID-19 Enigma: Unmasking the Role of Distinctive Personality Profiles as Risk Factors. J Clin Med 2024; 13:2886. [PMID: 38792428 PMCID: PMC11122355 DOI: 10.3390/jcm13102886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/04/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Background: The COVID-19 (Coronavirus disease 2019) pandemic has prompted extensive research into lingering effects, especially in 'Long COVID' patients. Despite exploration, contributing factors remain elusive; Objective: This study explores the potential link between distinctive personality profiles, particularly type D personality, and an increased risk of Long COVID; Methods: A retrospective cross-sectional study at Tel-Aviv Sourasky Medical Center's Post-COVID clinic analyzed data from 373 Long COVID patients through comprehensive questionnaires covering Long COVID syndrome, Fibromyalgia criteria, personality assessments, social support, and subjective evaluations of cognitive decline, health and life quality. In total, 116 out of 373 patients completed the questionnaire, yielding a 31% participation rate; Results: Cluster analysis revealed two groups, with Cluster 1 (N = 58) exhibiting Type D personality traits while Cluster 2 (N = 56) not meeting criteria for Type D personality. In comparison to Cluster 2, Cluster 1 patients reported heightened anxiety, depression, reduced social support, increased pain symptoms, manifestations of fibromyalgia, cognitive decline, and poor sleep quality, contributing to a diminished quality-of-life perception; Conclusions: findings highlight diverse personality profiles among Long COVID patients, emphasizing the need for tailored care. This approach shows potential for improving Long COVID patient care, aligning with the evolving personalized medicine paradigm.
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Affiliation(s)
- Dana Amsterdam
- Department of Internal Medicine H, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel; (A.K.); (O.F.); (S.S.)
| | - Aviv Kupershmidt
- Department of Internal Medicine H, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel; (A.K.); (O.F.); (S.S.)
| | - Asia Avinir
- School of Behavioral Sciences, The Academic College of Tel-Aviv—Yaffo, Tel Aviv 6818211, Israel; (A.A.); (O.E.)
| | - Ron Matalon
- Department of Internal Medicine H, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel; (A.K.); (O.F.); (S.S.)
| | - Ofir Ohana
- Department of Internal Medicine H, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel; (A.K.); (O.F.); (S.S.)
| | - Omri Feder
- Department of Internal Medicine H, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel; (A.K.); (O.F.); (S.S.)
| | - Shai Shtrozberg
- Department of Internal Medicine H, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel; (A.K.); (O.F.); (S.S.)
| | - Guy Choshen
- Department of Internal Medicine B, Meir Medical Center, 59 Tsharnehovski St., Kfar Saba 4428163, Israel;
| | - Jacob Nadav Ablin
- Department of Internal Medicine H, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel; (A.K.); (O.F.); (S.S.)
| | - Odelia Elkana
- School of Behavioral Sciences, The Academic College of Tel-Aviv—Yaffo, Tel Aviv 6818211, Israel; (A.A.); (O.E.)
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Veeneman RR, Vermeulen JM, Bialas M, Bhamidipati AK, Abdellaoui A, Munafò MR, Denys D, Bezzina CR, Verweij KJH, Tadros R, Treur JL. Mental illness and cardiovascular health: observational and polygenic score analyses in a population-based cohort study. Psychol Med 2024; 54:931-939. [PMID: 37706306 DOI: 10.1017/s0033291723002635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND Individuals with serious mental illness have a markedly shorter life expectancy. A major contributor to premature death is cardiovascular disease (CVD). We investigated associations of (genetic liability for) depressive disorder, bipolar disorder and schizophrenia with a range of CVD traits and examined to what degree these were driven by important confounders. METHODS We included participants of the Dutch Lifelines cohort (N = 147 337) with information on self-reported lifetime diagnosis of depressive disorder, bipolar disorder, or schizophrenia and CVD traits. Employing linear mixed-effects models, we examined associations between mental illness diagnoses and CVD, correcting for psychotropic medication, demographic and lifestyle factors. In a subsample (N = 73 965), we repeated these analyses using polygenic scores (PGSs) for the three mental illnesses. RESULTS There was strong evidence that depressive disorder diagnosis is associated with increased arrhythmia and atherosclerosis risk and lower heart rate variability, even after confounder adjustment. Positive associations were also found for the depression PGSs with arrhythmia and atherosclerosis. Bipolar disorder was associated with a higher risk of nearly all CVD traits, though most diminished after adjustment. The bipolar disorder PGSs did not show any associations. While the schizophrenia PGSs was associated with increased arrhythmia risk and lower heart rate variability, schizophrenia diagnosis was not. All mental illness diagnoses were associated with lower blood pressure and a lower risk of hypertension. CONCLUSIONS Our study shows widespread associations of (genetic liability to) mental illness (primarily depressive disorder) with CVD, even after confounder adjustment. Future research should focus on clarifying potential causal pathways between mental illness and CVD.
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Affiliation(s)
- R R Veeneman
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - J M Vermeulen
- Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - M Bialas
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - A K Bhamidipati
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - A Abdellaoui
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - M R Munafò
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - D Denys
- Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - C R Bezzina
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - K J H Verweij
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - R Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - J L Treur
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
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Paisey J, Moss J, Andrade J, Kuniss M, Wazni O, Chierchia GB, Mealing S, Ismyrloglou E, Sale A, Souter M, Kaplon R, Bromilow T, Lane E, Lewis D, Todd D. Economic evaluation of first-line cryoballoon ablation versus antiarrhythmic drug therapy for the treatment of paroxysmal atrial fibrillation from an English National Health Service perspective. Open Heart 2024; 11:e002423. [PMID: 38238026 PMCID: PMC10806544 DOI: 10.1136/openhrt-2023-002423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/08/2023] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Three recent randomised controlled trials have demonstrated that pulmonary vein isolation as an initial rhythm control strategy with cryoablation reduces atrial arrhythmia recurrence in patients with symptomatic paroxysmal atrial fibrillation (PAF) compared with antiarrhythmic drug (AAD) therapy. The aim of this study was to evaluate the cost-effectiveness of first-line cryoablation compared with first-line AADs for treating symptomatic PAF in an English National Health Service (NHS) setting. METHODS Individual patient-level data from 703 participants with PAF enrolled into Cryo-FIRST (Catheter Cryoablation Versus Antiarrhythmic Drug as First-Line Therapy of Paroxysmal Atrial Fibrillation), STOP AF First (Cryoballoon Catheter Ablation in an Antiarrhythmic Drug Naive Paroxysmal Atrial Fibrillation) and EARLY-AF (Early Aggressive Invasive Intervention for Atrial Fibrillation) were used to derive the parameters applied in the cost-effectiveness model (CEM). The CEM comprised a hybrid decision tree and Markov structure. The decision tree had a 1-year time horizon and was used to inform the initial health state allocation in the first cycle of the Markov model (40-year time horizon; 3-month cycle length). Health benefits were expressed in quality-adjusted life years (QALYs). Costs and benefits were discounted at 3.5% per year. Model outcomes were generated using probabilistic sensitivity analysis. RESULTS The results estimated that cryoablation would yield more QALYs (+0.17) and higher costs (+£641) per patient over a lifetime than AADs. This produced an incremental cost-effectiveness ratio of £3783 per QALY gained. Independent of initial treatment, individuals were expected to receive ~1.2 ablations over a lifetime. There was a 45% relative reduction in time spent in AF health states for those initially treated with cryoablation. DISCUSSION AF rhythm control with first-line cryoablation is cost effective compared with first-line AADs in an English NHS setting.
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Affiliation(s)
- John Paisey
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Joe Moss
- York Health Economics Consortium, York, UK
| | - Jason Andrade
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | - Emily Lane
- York Health Economics Consortium, York, UK
| | | | - Derick Todd
- Department of Cardiology, Liverpool Heart & Chest Hospital, Liverpool, UK
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Hussein AA, Delaughter MC, Monir G, Natale A, Dukkipati S, Oza S, Daoud E, Di Biase L, Mansour M, Fishel R, Valderrabano M, Ellenbogen K, Osorio J. Paroxysmal atrial fibrillation ablation with a novel temperature-controlled CF-sensing catheter: Q-FFICIENCY clinical and healthcare utilization benefits. J Cardiovasc Electrophysiol 2023; 34:2493-2503. [PMID: 37870157 DOI: 10.1111/jce.16093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/15/2023] [Accepted: 09/22/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION The prospective, nonrandomized, multicenter Q-FFICIENCY study demonstrated the safety and 12-month efficacy of paroxysmal atrial fibrillation (AF) ablation with the novel QDOT MICRO temperature-controlled, contact force-sensing, radiofrequency (RF) catheter. Participants underwent pulmonary vein isolation with very high-power short-duration (vHPSD) mode (90 W, ≤4 s) alone or combined with conventional-power temperature-controlled (CPTC) mode (25-50 W). This study aimed to assess quality-of-life (QOL) and healthcare utilization (HCU) benefits experienced by Q-FFICIENCY study participants. METHODS Besides evaluating procedural efficiency, QOL and HCU were assessed through 12 months postablation via Atrial Fibrillation Effect on Quality-of-Life Tool (AFEQT) score, antiarrhythmic drug (AAD) use, and incidence of cardioversion and cardiovascular hospitalization. RESULTS Of 191 participants enrolled, 166 were ablated with the new catheter. Compared to baseline, statistically significant, clinically meaningful improvements in composite and subcategories of AFEQT scores were observed at 3 months and sustained through 12 months (12-month increase, 29.3-44.2 points). Class I/III AAD use decreased from 97.6% (162/166) at baseline to 19.6% (31/158) during Months 6-12, representing a significant 79.9% reduction. The cardioversion rate significantly declined by 93.9% from 31.3% (12 months preablation) to 1.9% (evaluation period). One-year Kaplan-Meier estimates of freedom from all-cause and cardiovascular hospitalization were 80.9% (95% confidence interval [CI], 74.8%-86.9%) and 88.8% (95% CI, 84.0%-93.7%), respectively. CONCLUSIONS Paroxysmal AF ablation with the novel temperature-controlled RF catheter in vHPSD mode, alone or with CPTC mode, led to clinically meaningful improvement in QOL and significant reduction in AAD use, cardioversion, and cardiovascular hospitalization.
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Affiliation(s)
| | | | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
| | | | - Saumil Oza
- St. Vincent's Medical Center, Jacksonville, Florida, USA
| | - Emile Daoud
- Ohio State University Medical Center, Columbus, Ohio, USA
| | - Luigi Di Biase
- Montefiore Medical Center at Albert Einstein College of Medicine, Bronx, New York, USA
| | - Moussa Mansour
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Miguel Valderrabano
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Research Institute, Houston, Texas, USA
| | | | - Jose Osorio
- Grandview Medical Center Alabama Cardiovascular Group, Birmingham, Alabama, USA
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Manolis TA, Manolis AA, Apostolopoulos EJ, Melita H, Manolis AS. Depression and atrial fibrillation in a reciprocal liaison: a neuro-cardiac link. Int J Psychiatry Clin Pract 2023; 27:397-415. [PMID: 37615537 DOI: 10.1080/13651501.2023.2248214] [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: 06/14/2022] [Accepted: 08/09/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To explore the reciprocal relationship of depression and atrial fibrillation (AF). METHODS A literature search was conducted in Pub Med, Scopus, and Google Scholar using relevant terms for depression and AF and respective therapies. RESULTS There is evidence that depression is involved in the aetiology and prognosis of AF. AF, independently of its type, incurs a risk of depression in 20-40% of patients. Also, depression significantly increases cumulative incidence of AF (from 1.92% to 4.44% at 10 years); 25% increased risk of new-onset AF is reported in patients with depression, reaching 32% in recurrent depression. Hence, emphasis is put on the importance of assessing depression in the evaluation of AF and vice versa. Persistent vs paroxysmal AF patients may suffer from more severe depression. Furthermore, depression can impact the effectiveness of AF treatments, including pharmacotherapy, anticoagulation, cardioversion and catheter ablation. CONCLUSIONS A reciprocal association of depression and AF, a neurocardiac link, has been suggested. Thus, strategies which can reduce depression may improve AF patients' course and treatment outcomes. Also, AF has a significant impact on risk of depression and quality of life. Hence, effective antiarrhythmic therapies may alleviate patients' depressive symptoms. KEY POINTSAF, independently of its type of paroxysmal, permanent or chronic, appears to have mental besides physical consequences, including depression and anxietyA reciprocal influence or bidirectional association of depression and AF, a neurocardiac link, has been suggestedAF has considerable impact on the risk of depression occurrence with 20-40% of patients with AF found to have high levels of depressionAlso, depression significantly increases 10-year cumulative incidence and risk of AF from 1.92% to 4.44% in people without depression, and the risk of new-onset AF by 25-32%Emphasis should be placed on the importance of assessing depression in the evaluation of AF and vice versaPersistent/chronic AF patients may suffer from more severe depressed mood than paroxysmal AF patients with similar symptom burdenDepression and anxiety can impact the effectiveness of certain AF treatments, including pharmacotherapy, anticoagulation treatment, cardioversion and catheter ablationThus, strategies which can reduce anxiety and depression may improve AF patients' course and treatment outcomesAlso, effective antiarrhythmic therapies to control AF may alleviate patients' depressive mood.
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Rush KL, Seaton CL, O’Connor BP, Andrade JG, Loewen P, Corman K, Burton L, Smith MA, Moroz L. Managing With Atrial Fibrillation: An Exploratory Model-Based Cluster Analysis of Clinical and Personal Patient Characteristics. CJC Open 2023; 5:833-845. [PMID: 38020332 PMCID: PMC10679453 DOI: 10.1016/j.cjco.2023.08.005] [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: 06/26/2023] [Accepted: 08/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background Examining characteristics of patients with atrial fibrillation (AF) has the potential to help in identifying groups of patients who might benefit from different management approaches. Methods Secondary analysis of online survey data was combined with clinic referral data abstraction from 196 patients with AF attending an AF specialty clinic. Cluster analyses were performed to identify distinct, homogeneous clusters of AF patients defined by 11 relevant variables: CHA2DS2-VASc score, age, AF symptoms, overall health, mental health, AF knowledge, perceived stress, household and recreation activity, overall AF quality of life, and AF symptom treatment satisfaction. Follow-up analyses examined differences between the cluster groups in additional clinical variables. Results Evidence emerged for both 2- and 4-cluster solutions. The 2-cluster solution involved a contrast between patients who were doing well on all variables (n = 129; 66%) vs those doing less well (n = 67; 34%). The 4-cluster solution provided a closer-up view of the data, showing that the group doing less well was split into 3 meaningfully different subgroups of patients who were managing in different ways. The final 4 clusters produced were as follows: (i) doing well; (ii) stressed and discontented; (iii) struggling and dissatisfied; and (iv) satisfied and complacent. Conclusions Patients with AF can be accurately classified into distinct, natural groupings that vary in clinically important ways. Among the patients who were not managing well with AF, we found 3 distinct subgroups of patients who may benefit from tailored approaches to AF management and support. The tailoring of treatment approaches to specific personal and/or behavioural patterns, alongside clinical patterns, holds potential to improve patient outcomes (eg, treatment satisfaction).
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Affiliation(s)
- Kathy L. Rush
- School of Nursing, University of British Columbia—Okanagan, Kelowna, British Columbia, Canada
| | - Cherisse L. Seaton
- School of Nursing, University of British Columbia—Okanagan, Kelowna, British Columbia, Canada
| | - Brian P. O’Connor
- Department of Psychology, University of British Columbia—Okanagan, Kelowna, British Columbia, Canada
| | - Jason G. Andrade
- Cardiac Atrial Fibrillation Specialty Clinic, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Loewen
- Faculty of Pharmaceutical Sciences, University of British Columbia—Vancouver, Vancouver, British Columbia, Canada
| | - Kendra Corman
- School of Nursing, University of British Columbia—Okanagan, Kelowna, British Columbia, Canada
| | - Lindsay Burton
- School of Nursing, University of British Columbia—Okanagan, Kelowna, British Columbia, Canada
| | - Mindy A. Smith
- Department of Family Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Lana Moroz
- Cardiac Atrial Fibrillation Specialty Clinic, Vancouver General Hospital, Vancouver, British Columbia, Canada
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Lurz J, Ladwig KH. Benefits of Pulmonary Vein Isolation Beyond Rhythm Control: Implications for Mental Health. JAMA 2023; 330:919-920. [PMID: 37698577 DOI: 10.1001/jama.2023.6484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Affiliation(s)
- Julia Lurz
- Department of Electrophysiology, Heart Center Leipzig at University Leipzig, Leipzig, Germany
| | - Karl-Heinz Ladwig
- Department for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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Li PWC, Yu DSF, Yan BP. Nurse-led multi-component behavioural activation programme to improve health outcomes in patients with atrial fibrillation: a mixed-methods study and feasibility analysis. Eur J Cardiovasc Nurs 2023; 22:655-663. [PMID: 36394495 DOI: 10.1093/eurjcn/zvac104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/19/2022] [Accepted: 11/02/2022] [Indexed: 09/06/2023]
Abstract
AIMS Patients with atrial fibrillation (AF) play passive roles in disease management. This study aimed to examine the feasibility and preliminary effects of an empowerment-based care model, titled 'the nurse-led multi-component behavioural activation (N-MBA) programme', on health-related quality of life, AF knowledge, psychological outcomes, medication adherence, and treatment decision-making in patients with AF. METHODS AND RESULTS This mixed-methods study comprised a pilot randomized controlled trial and a qualitative study. Patients with AF who had a moderate-to-high risk of stroke but were not prescribed oral anticoagulants were recruited. Forty participants were recruited and randomized in a 1:1 ratio to receive either the N-MBA programme or standard care. The 13-week programme comprised care components that prepared patients for shared decision-making, an empowerment-based educational module on AF self-care, and continuous support through telephone calls. The programme was feasible, and the overall attendance rate was 82.5%. The participants gave excellent ratings in the satisfaction survey. The N-MBA group showed greater improvements in health-related quality of life (HRQoL) and AF knowledge than the standard care group at the immediate post intervention and 6-month follow-up time points. No significant between-group changes in medication adherence, anxiety, and depression were detected. Participants in the N-MBA group actively raised concerns about AF and its treatment with their attending doctors. The qualitative data were consistent with the quantitative data, indicating that the programme built a comprehensive knowledge base of AF and self-care behaviours. CONCLUSION The N-MBA programme is feasible and acceptable to patients with AF. It improved patients' AF knowledge, treatment-related decision-making, and HRQoL. REGISTRATION ClinicalTrials.gov NCT03924739.
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Affiliation(s)
- Polly W C Li
- School of Nursing, LKS Faculty of Medicine, 5/F, HKUMed Academic Building, 3 Sassoon Road, The University of Hong Kong, Pokfulam, Hong Kong
| | - Doris S F Yu
- School of Nursing, LKS Faculty of Medicine, 5/F, HKUMed Academic Building, 3 Sassoon Road, The University of Hong Kong, Pokfulam, Hong Kong
| | - Bryan P Yan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Fadlan MR, Rizal A, Satrijo B, Astiawati T, Rohman MS, Baskoro SS. Validity of MENARI plus (self-pulse assessment and clinical scoring) mobile apps for detecting atrial fibrillation in high-risk population. J Arrhythm 2023; 39:507-514. [PMID: 37560267 PMCID: PMC10407179 DOI: 10.1002/joa3.12863] [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: 09/03/2022] [Revised: 03/07/2023] [Accepted: 04/08/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Even before it is clinically diagnosed, atrial fibrillation (AF) can cause a stroke. This study validates self-pulse assessment and clinical scoring (MENARI Plus) based on android apps. OBJECTIVE The aim of this study was to examine the validity of AF screening using MENARI Plus compared with an ECG recording. METHODS We collected a total of 1385 subjects from high-risk population according to CHA2DS2-VASc score ≥2, attending 8 primary care centers (PCCs) in Malang between July 2021 and December 2021. Every participant underwent self-pulse assessment, and then was evaluated for MENARI Plus Score on android Apps. These cases had been classified as low or high probability for AF (cut-off score 7). After that, electrocardiography examinations were performed and classified with AF and Sinus Rhythm group. RESULTS In this study, the mean age of these patients was 61.5 ± 6.9 years old. We found that 156/1385 (11%) patients had AF. There were 68/156 (43.5%) new cases of AF. The sensitivity for self-pulse palpation was 73.1% (95% CI: 68%-76%) and specificity was 68.3% (95% CI: 65%-72%). MENARI Plus had an area under the receiver operating curve (AUC) of 0.86 (95% CI: 0.82-0.89) with sensitivity per measurement occasion was (84%, 95% CI: 82%-88%) and specificity was (87.9%, 95% CI: 82%-90%). CONCLUSION In this study, we found that MENARI Plus has high sensitivity and specificity for AF. It is therefore useful for ruling out AF. It may also be a useful screen that can be applied opportunistically for previously undetected AFs.
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Affiliation(s)
- Muhamad R. Fadlan
- Department of Cardiology and Vascular Medicine, Faculty of MedicineUniversitas Brawijaya, Dr. Saiful Anwar General HospitalMalangEast JavaIndonesia
| | - Ardian Rizal
- Department of Cardiology and Vascular Medicine, Faculty of MedicineUniversitas Brawijaya, Dr. Saiful Anwar General HospitalMalangEast JavaIndonesia
| | - Budi Satrijo
- Department of Cardiology and Vascular Medicine, Faculty of MedicineUniversitas Brawijaya, Dr. Saiful Anwar General HospitalMalangEast JavaIndonesia
| | - Tri Astiawati
- Department of Cardiology and Vascular Medicine, Faculty of MedicineUniversitas Brawijaya, Dr. Iskak General HospitalTulung AgungEast JavaIndonesia
| | - Mohammad S. Rohman
- Department of Cardiology and Vascular Medicine, Faculty of MedicineUniversitas Brawijaya, Dr. Saiful Anwar General HospitalMalangEast JavaIndonesia
| | - Shalahuddin S. Baskoro
- Department of Cardiology and Vascular Medicine, Faculty of MedicineUniversitas Brawijaya, Dr. Saiful Anwar General HospitalMalangEast JavaIndonesia
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Särnholm J, Skúladóttir H, Rück C, Axelsson E, Bonnert M, Bragesjö M, Venkateshvaran A, Ólafsdóttir E, Pedersen SS, Ljótsson B, Braunschweig F. Cognitive Behavioral Therapy Improves Quality of Life in Patients With Symptomatic Paroxysmal Atrial Fibrillation. J Am Coll Cardiol 2023; 82:46-56. [PMID: 37380303 DOI: 10.1016/j.jacc.2023.04.044] [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: 03/07/2023] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is often associated with troubling symptoms leading to impaired quality of life (QoL) and high health care use. Symptom preoccupation, that is, fear of cardiac-related symptoms and avoidance behavior, potentially contributes to disability in AF but is not targeted by current interventions. OBJECTIVES We sought to evaluate the effect of online cognitive behavior therapy (AF-CBT) on QoL in patients with symptomatic paroxysmal AF. METHODS Patients with symptomatic paroxysmal AF (n = 127) were randomly assigned to receive AF-CBT (n = 65) or standardized AF education (n = 62). Online AF-CBT lasted 10 weeks and was therapist guided. The main components were exposure to cardiac-related symptoms and reduction of AF-related avoidance behavior. Patients were evaluated at baseline, posttreatment, and at the 3-month follow-up. Primary outcome was AF-specific QoL as assessed by the Atrial Fibrillation Effect on Quality of Life summary score (range: 0-100) at the 3-month follow-up. Secondary outcomes included AF-specific health care consumption and AF burden assessed by 5-day continuous electrocardiogram recording. The AF-CBT group was followed for 12 months. RESULTS AF-CBT led to large improvements in AF-specific QoL (Atrial Fibrillation Effect on Quality of Life summary score) by 15.0 points (95% CI: 10.1-19.8; P < 0.001). Furthermore, AF-CBT reduced health care consumption by 56% (95% CI: 22-90; P = 0.025). The AF burden remained unchanged. Results on self-assessed outcomes were sustained 12 months after treatment. CONCLUSIONS In patients with symptomatic paroxysmal AF, online CBT led to large improvements in AF-specific QoL and reduced health care use. If these results are replicated, online CBT may constitute an important addition to AF management. (Internet-Delivered Cognitive Behavior Therapy for Atrial Fibrillation; NCT03378349).
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Affiliation(s)
- Josefin Särnholm
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
| | - Helga Skúladóttir
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Cardiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm, Sweden
| | - Erland Axelsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Liljeholmen Primary Health Care Center, Region Stockholm, Stockholm, Sweden; Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
| | - Marianne Bonnert
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Bragesjö
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Ashwin Venkateshvaran
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Cardiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Eva Ólafsdóttir
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Cardiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Cardiology Unit, Karolinska Institutet, Stockholm, Sweden
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12
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Yamin M, Salim S, Setiati S, Pudianto AP, Zulmiyusrini P, Nasution SA, Wijaya IP, Rusdi L, Karim B, Santoso RFH, Silitonga FAH. Validity and reliability studies of the Indonesian version of Atrial Fibrillation Severity Scale (AFSS). BMC Cardiovasc Disord 2023; 23:216. [PMID: 37118699 PMCID: PMC10148504 DOI: 10.1186/s12872-023-03240-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/12/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND In the atrial fibrillation (AF) population, worsened quality of life (QOL) has been reported even before complications occur. Symptom-based questionnaires can be used to evaluate AF treatment. The Atrial Fibrillation Severity Scale (AFSS) was first developed in Canada in English, which is not the main language in Indonesia. This study aims to test the reliability and validity of the Indonesian version of the Atrial Fibrillation Severity Scale (AFSS). METHODS Translation of the AFSS from English to Indonesian was done using forward and backward translation. The final version was then validated with the Short Form-36 (SF-36) questionnaire, and a test-retest reliability study was done in a 7-14-day interval. RESULTS An Indonesian version of AFSS was achieved and deemed acceptable by a panel of researchers. This version is reliable and valid, with Cronbach's α of 0.819, Intraclass Correlation Coefficient (ICC) ranging from 0.803 to 0.975, and total score correlation ranging from 0.333 to 0.895. Pearson's analysis of AFSS and SF-36 revealed that the total AF burden domain was poorly correlated with role limitations due to emotional problems (r:0.427; p < 0.01) and pain (r:0.495; p < 0.01). The symptom severity domain was poorly correlated with physical functioning (r:-0.335; p < 0.01), role limitations due to emotional problems (r:0.499; p < 0.01), pain (r:0.458; p < 0.01), and total SF-36 score (r:-0.361; p < 0.01). Total AFSS score was moderately correlated with role limitations due to emotional problems (r:0.516; p < 0.01) and pain (r:0.538; p < 0.01). The total AFSS score was poorly correlated with the European Heart Rhythm Association (EHRA) score (r:0.315; p < 0.01). CONCLUSION The Indonesian version of AFSS has good internal and external validity with good reliability.
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Affiliation(s)
- Muhammad Yamin
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Central Jakarta, Jakarta, Indonesia
| | - Simon Salim
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Central Jakarta, Jakarta, Indonesia.
| | - Siti Setiati
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Angga Pramudita Pudianto
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Central Jakarta, Jakarta, Indonesia
| | - Putri Zulmiyusrini
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Sally Aman Nasution
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Central Jakarta, Jakarta, Indonesia
| | - Ika Prasetya Wijaya
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Central Jakarta, Jakarta, Indonesia
| | - Lusiani Rusdi
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Central Jakarta, Jakarta, Indonesia
| | - Birry Karim
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Central Jakarta, Jakarta, Indonesia
| | - Raden Fidiaji Hiltono Santoso
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Central Jakarta, Jakarta, Indonesia
| | - Friska Anggraini Helena Silitonga
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Central Jakarta, Jakarta, Indonesia
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13
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Samaritaki E, Tsiligianni I, Basta M, Alegkakis A, Vlassiadis K, Lazopoulos G. Demographic and clinical predictors of post-operative atrial fibrillation in cardio-surgical patients. Eur J Cardiovasc Nurs 2023; 22:98-106. [PMID: 35672278 DOI: 10.1093/eurjcn/zvac024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 01/14/2023]
Abstract
AIMS Post-operative atrial fibrillation is defined as an episode of atrial fibrillation that occurs 1-5 days after a surgical procedure in patients without a previous history of atrial fibrillation. Multiple factors such as demographics, cardiac surgical, endogenous, or mental health may relate to post-operative atrial fibrillation.The aim of this study was to identify multivariable high-risk factors for post-operative atrial fibrillation and to propose a risk-assessment tool. METHODS AND RESULTS A cross-sectional observational study was conducted in a University Hospital of Greece. Predictor variables examined demographic and clinical variables, anxiety, depression, health-related quality of life, frailty, perioperative mortality (European System for Cardiac Operative Risk Evaluation II), and 10-year survival/mortality risk (Charlson Comorbidity Index score). The outcome variable was post-operative atrial fibrillation. Multivariable analysis was assessed to identify predictors of post-operative atrial fibrillation.Ninety-one patients were included in our sample. Post-operative atrial fibrillation was diagnosed in 44 (48.4%). Factors associated with post-operative atrial fibrillation are the following: age group of 66-75 years [OR 5.78, 95% confidence interval (CI) 1.37-24.34], Charlson Comorbidity Index score (OR 1.42, 95% CI 1.07-1.89), and hours of mechanical ventilation (OR 1.03, 95% CI 1.00-1.06). The Charlson Comorbidity Index score was identified as an independent predictor of post-operative atrial fibrillation (exp: 1.412, 95% CI: 1.017-1.961). CONCLUSION Patients with post-operative atrial fibrillation had a higher Charlson Comorbidity Index score. The Charlson Comorbidity Index was identified as an independent clinical predictor of post-operative atrial fibrillation. The risk-assessment tool proposed includes age, Charlson Comorbidity Index score, and hours of mechanical ventilation. Future studies are needed to establish such an assessment.
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Affiliation(s)
- Evangelia Samaritaki
- School of Medicine, Department of Surgery, University of Crete, Crete, Greece.,Cardiac Surgery Department, University Hospital of Heraklion, Crete, Greece
| | - Ioanna Tsiligianni
- School of Medicine, Department of Social Medicine, University of Crete, Crete, Greece
| | - Maria Basta
- School of Medicine, Department of Psychiatry, University of Crete, Crete, Greece.,Department of Psychiatry, University Hospital of Heraklion, Crete, Greece
| | - Athanasios Alegkakis
- School of Medicine, Department of Toxicology, University of Crete, Crete, Greece
| | - Konstantinos Vlassiadis
- School of Medicine, Laboratory of Health Planning, University of Crete, Crete, Greece.,Dental Clinic, University Hospital of Heraklion, Crete, Greece
| | - Georgios Lazopoulos
- School of Medicine, Department of Surgery, University of Crete, Crete, Greece.,Cardiac Surgery Department, University Hospital of Heraklion, Crete, Greece
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14
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Chen H, Janszky I, Rostila M, Wei D, Yang F, Li J, László KD. Bereavement in childhood and young adulthood and the risk of atrial fibrillation: a population-based cohort study from Denmark and Sweden. BMC Med 2023; 21:8. [PMID: 36600284 PMCID: PMC9814172 DOI: 10.1186/s12916-022-02707-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Adverse childhood life events are associated with increased risks of hypertension, ischemic heart disease, and stroke later in life. Limited evidence also suggests that stress in adulthood may increase the risk of atrial fibrillation (AF). Whether childhood adversity may lead to the development of AF is unknown. We investigated whether the loss of a parent or sibling in childhood is associated with an increased risk of AF and compared this effect to that of similar losses in young adulthood. METHODS We studied 6,394,975 live-born individuals included in the Danish (1973-2018) and Swedish Medical Birth Registers (1973-2014). We linked data from several national registers to obtain information on the death of parents and siblings and on personal and familial sociodemographic and health-related factors. We analyzed the association between bereavement and AF using Poisson regression. RESULTS Loss of a parent or sibling was associated with an increased AF risk both when the loss occurred in childhood and in adulthood; the adjusted incident rate ratios and 95% confidence intervals were 1.24 (1.14-1.35) and 1.24 (1.16-1.33), respectively. Bereavement in childhood was associated with AF only if losses were due to cardiovascular diseases or other natural causes, while loss in adulthood was associated with AF not only in case of natural deaths, but also unnatural deaths. The associations did not differ substantially according to age at loss and whether the deceased was a parent or a sibling. CONCLUSIONS Bereavement both in childhood and in adulthood was associated with an increased AF risk.
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Affiliation(s)
- Hua Chen
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
| | - Imre Janszky
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.,Department of Public Health and Nursing, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.,Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Dang Wei
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
| | - Fen Yang
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
| | - Jiong Li
- Department of Clinical Medicine - Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Krisztina D László
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden. .,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
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15
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Yossef M, Amer R, Elsokkary H, Shama G. Psychiatric symptoms in patients with non-valvular atrial fibrillation. MIDDLE EAST CURRENT PSYCHIATRY 2022. [DOI: 10.1186/s43045-022-00268-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is one of the leading causes of hospitalization and even death worldwide. Complex bidirectional associations have been suggested between psychiatric disorders and AF disease. This study was conducted to investigate the prevalence of psychiatric symptoms in a cohort of Egyptian population presented with symptomatic non-valvular AF (NVAF) and to identify the high-risk subjects in need for professional psychiatric consultation. A total of 100 eligible symptomatic NVAF patients were recruited in this cross-sectional study. Each patient was subjected to: (1) cardiac evaluation included electrocardiogram, trans-esophageal echocardiography, and the European Heart Rhythm Association (EHRA). (2) Psychiatric evaluation consisted of clinical psychiatric interviewing, Hospital Anxiety and Depression Scales (HADS), Mini–Mental State Examination (MMSE), type-D personality screening, and the short form-36 (SF-36) health survey for the assessment of health-related quality of life (HRQoL).
Results
Forty-four percent of our enrolled AF patients had anxiety symptoms, 32% had depressive symptoms, 24% had mild cognitive impairment, and 32% had type-D personality. Linear regression analysis demonstrated that the left atrial dimension (LAD) and the age were the main significant predictors of MMSE, while the main predictors of HADS were SF-36 (physical functioning and general health) and the age. Neither psychiatric symptoms, nor type-D personality was a significant predictor for the evaluated cardiac parameters.
Conclusions
Mild cognitive impairment as well as depressive and anxiety symptoms is not uncommon associates with NVAF patients. Assessment of cognitive function and HRQoL is strongly advised for AF patients presented with enlarged LAD particularly among old adults.
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16
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Boulmpou A, Teperikidis E, Papadopoulos CΕ, Patoulias DI, Charalampidis P, Mouselimis D, Tsarouchas A, Boutou A, Giannakoulas G, Vassilikos V. The role of cardiopulmonary exercise testing in risk stratification and prognosis of atrial fibrillation: a scoping review of the literature. Acta Cardiol 2022; 78:274-287. [PMID: 36448316 DOI: 10.1080/00015385.2022.2148894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND Cardiopulmonary exercise testing (CPET) is a significant tool for evaluating exercise capacity in healthy individuals and in various pulmonary and cardiovascular conditions, quantifying symptoms and predicting outcomes. Atrial fibrillation (AF) poses a significant burden on patients and health systems; a research marathon is ongoing for discovering the pathophysiologic substrate, natural history, prognostic tools and optimal treatment strategies for AF. Among the plethora of variables measured during CPET, there is a series of parameters of interest concerning AF. METHODS We conducted a scoping review aiming to identify significant CPET-related parameters linked to AF, as well as indicate the impact of other cardiac disease-related variables. We searched PubMed from its inception to 12 January 2022 for reports underlining the contribution of CPET in the assessment of patients with AF. Only clinical trials, observational studies and systematic reviews were included, while narrative reviews, expert opinions and other forms of manuscripts were excluded. RESULTS In our scoping review, we report a group of heterogeneous, thus noteworthy parameters relevant to the potential contribution of CPET in AF. CPET helps phenotype AF populations, evaluates exercise capacity after cardioversion or catheter ablation, and assesses heart rate response to exercise; peak VO2 and VE/VCO2, commonly measured indices during CPET, also serve as prognostic tools in patients with AF and heart failure. CONCLUSIONS CPET seems to hold a clinically important predictive value for future cardiovascular events both in patients with pre-existing cardiac conditions and in healthy individuals. CPET variables may play a fundamental role in the prediction of future AF-related events.
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Affiliation(s)
- Aristi Boulmpou
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleftherios Teperikidis
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christodoulos Ε. Papadopoulos
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Ioannis Patoulias
- Second Propaedeutic Department of Internal Medicine, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Charalampidis
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- St Luke’s Hospital, Thessaloniki, Greece
| | - Dimitrios Mouselimis
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Tsarouchas
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi Boutou
- Department of Respiratory Medicine, Ippokratio General Hospital, Thessaloniki, Greece
| | - Georgios Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios Vassilikos
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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17
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van der Velden RM, Hermans AN, Pluymaekers NA, Gawalko M, Elliott A, Hendriks JM, Franssen FM, Slats AM, van Empel VP, Van Gelder IC, Thijssen DH, Eijsvogels TM, Leue C, Crijns HJ, Linz D, Simons SO. Dyspnea in patients with atrial fibrillation: Mechanisms, assessment and an interdisciplinary and integrated care approach. IJC HEART & VASCULATURE 2022; 42:101086. [PMID: 35873859 PMCID: PMC9304702 DOI: 10.1016/j.ijcha.2022.101086] [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: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained heart rhythm disorder and is often associated with symptoms that can significantly impact quality of life and daily functioning. Palpitations are the cardinal symptom of AF and many AF therapies are targeted towards relieving this symptom. However, up to two-third of patients also complain of dyspnea as a predominant self-reported symptom. In clinical practice it is often challenging to ascertain whether dyspnea represents an AF-related symptom or a symptom of concomitant cardiovascular and non-cardiovascular comorbidities, since common AF comorbidities such as heart failure and chronic obstructive pulmonary disease share similar symptoms. In addition, therapeutic approaches specifically targeting dyspnea have not been well validated. Thus, assessing and treating dyspnea can be difficult. This review describes the latest knowledge on the burden and pathophysiology of dyspnea in AF patients. We discuss the role of heart rhythm control interventions as well as the management of AF risk factors and comorbidities with the goal to achieve maximal relief of dyspnea. Given the different and often complex mechanistic pathways leading to dyspnea, dyspneic AF patients will likely profit from an integrated multidisciplinary approach to tackle all factors and mechanisms involved. Therefore, we propose an interdisciplinary and integrated care pathway for the work-up of dyspnea in AF patients.
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Affiliation(s)
- Rachel M.J. van der Velden
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Astrid N.L. Hermans
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Nikki A.H.A. Pluymaekers
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Monika Gawalko
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
- Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, Germany
- 1st Department of Cardiology, Doctoral School, Medical University of Warsaw, Warsaw, Poland
| | - Adrian Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Jeroen M. Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Frits M.E. Franssen
- Department of Research and Development, Ciro, Horn, the Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Annelies M. Slats
- Department of Respiratory Medicine, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Vanessa P.M. van Empel
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Isabelle C. Van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Dick H.J. Thijssen
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Thijs M.H. Eijsvogels
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carsten Leue
- Department of Psychiatry and Psychology, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
- School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands
| | - Harry J.G.M. Crijns
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Corresponding author at: Maastricht UMC+, Maastricht Heart+Vascular Center, 6202 AZ Maastricht.
| | - Sami O. Simons
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
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18
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Habbal AB, White CT, Shamim H, Al Shouli R, Mohammed L. Posttraumatic Stress Disorder (PTSD) and Instigation of Cardiovascular Events: Ischemic Heart Disease (IHD) and Atrial Fibrillation (AF). Cureus 2022; 14:e30583. [PMID: 36420248 PMCID: PMC9678112 DOI: 10.7759/cureus.30583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023] Open
Abstract
Posttraumatic stress disorder (PTSD) is a disorder with chronic deterioration that arises after exposure to traumatic events. In these events, a persistent maladaptive reaction was found as a result of severe psychological stress and trauma. It is usually accompanied by mood alteration, disturbing memories, evading behavior, and hyperarousal. Many studies found a connection between PTSD and both ischemic heart disease (IHD) and atrial fibrillation (AF). Impairment of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system can contribute to hypercoagulability, elevated cardiac reactivity, hypertension, dyslipidemia, and chronic inflammation, as all of these processes are implicated in IHD and AF risk. PTSD tends to have a more long-term course and is associated with more autonomic reactivity rather than a direct negative impact. More research is needed to understand the mechanisms underlying the increased AF risk in patients with PTSD and to identify supposed objectives for screening, intervention, and treatment. Highlighting the connection between PTSD and cardiovascular events would lead clinicians to develop screening tests that might help with the prevention and treatment of cardiovascular events for these patients.
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Affiliation(s)
- Ahmad B Habbal
- Cardiology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Chantelle T White
- Psychology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Humaira Shamim
- Dermatology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Roba Al Shouli
- Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Lubna Mohammed
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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19
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Pogosova NV, Badtieva VA, Ovchinnikova AI, Sokolova OY, Vorobyeva NM. Efficacy of secondary prevention and rehabilitation programs with distant support in patients with atrial fibrillation after intervention procedures: impact on psychological status. KARDIOLOGIIA 2022; 62:27-36. [DOI: 10.18087/cardio.2022.9.n1951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/24/2021] [Indexed: 11/06/2022]
Abstract
Aim To evaluate the effectivity of secondary prevention/rehabilitation programs with remote support for the psychological condition of patients with paroxysmal atrial fibrillation (AF) following interventional procedures (radiofrequency catheter ablation and cryoablation).Material and methods This prospective, controlled, randomized clinical study was performed in three parallel groups. Each group consisted of 45 patients with AF after interventional procedures. In groups 1 and 2, secondary prevention/rehabilitation programs with remote support were performed, including a single individual in-hospital counseling (on risk factors of AF and their control and on major aspects of the disease, treatment and prevention of complications) and three months of remote support (by phone in group 1 and by e-mail in group 2). Patients of group 3 (control group) received standard recommendations at discharge from the hospital. The psychological status was evaluated using the Hospital Anxiety and Depression Scale, the PHQ-9 questionnaire, the Spielberg-Hanin scale for reactive and personal anxiety, and the visual analogue scale for stress assessment. The follow-up duration was 12 months.Results At the end of the follow-up period, the proportion of patients with anxiety symptoms considerably decreased in both intervention groups (р<0.001 for each group) and was significantly less than in the control group (р<0.001 for both comparisons). Also, in intervention group 1, the proportion of patients with clinically pronounced anxiety symptoms was significantly decreased. For 12 months of follow-up, the severity of depressive symptoms significantly decreased in all three groups. However, in both intervention groups, this decrease was significantly greater than in the control group (р<0.001 for group 1 and р=0.020 for group 2). In both intervention groups at 12 months, the stress level was significantly reduced whereas in the control group, it remained practically unchanged. The greatest (50% on average) decrease in the stress level was observed in intervention group 2.Conclusion Secondary prevention and rehabilitation programs with remote support during a 12-month follow-up resulted in improvement of the psychological status in patients with AF after interventional procedures.
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Affiliation(s)
| | - V. A. Badtieva
- Moscow Center for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine, Moscow
| | - A. I. Ovchinnikova
- Therapeutic and Diagnostic Center #9 of the Ministry of Defense of Russia, Moscow
| | | | - N. M. Vorobyeva
- Russian Gerontology Research and Clinical Center, Pirogov Russian National Research Medical University, Moscow
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20
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Wu H, Li C, Li B, Zheng T, Feng K, Wu Y. Psychological factors and risk of atrial fibrillation: A meta-analysis and systematic review. Int J Cardiol 2022; 362:85-92. [PMID: 35618103 DOI: 10.1016/j.ijcard.2022.05.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Multiple studies have shown that mental disorders are common risk factors for cardiovascular diseases (CVD). However, the relationship between psychological factors and atrial fibrillation (AF) incidence remains unclear. Therefore, we performed a systematic review and meta-analysis to assess the risk of AF due to psychological factors. METHODS PubMed, Embase, Web of Science, and Cochrane Library were searched from inception to January 2022. Relevant and eligible cohort studies were included. Random or fixed effect model was used to estimate the pooled hazard ratios (HRs) and 95% confidence intervals (CIs). For non-randomized studies, the risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS Thirteen publications, including 5,329,908 participants, met our inclusion criteria. The incidence of AF was increased by 10% (HR = 1.10, 95% CI 1.02 to 1.19, I2 = 33.6%, P = 0.013, n = 235,599 in 6 studies) for patients with anxiety, by 15% (HR = 1.15, 95% CI 1.04 to 1.26, I2 = 40.2%, P = 0.04, n = 21,791 in 3 studies) for patients with anger, by 25% (HR = 1.25, 95% CI 1.12 to 1.39, I2 = 57.4%, P < 0.001, n = 5,160,247 in 6 studies) for patients with depression, and by 18% (HR = 1.18, 95% CI 1.05 to 1.32, I2 = 19.2%, P = 0.004, n = 51,664 in 4 studies) for people under work stress. CONCLUSIONS Adverse psychological factors such as anxiety, anger, depression, and work stress may increase the risk of AF. Interventions to prevent mental disorders may reduce the growing global burden of AF and its associated healthcare costs. Given the current study's limitations, our findings need to be further confirmed by a larger prospective study.
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Affiliation(s)
- Hao Wu
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Chenxing Li
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Bolin Li
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Tao Zheng
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Kaiyue Feng
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Yue Wu
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
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21
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Zuin M, Rigatelli G. Psychological factors as triggers of atrial fibrillation: Seeking for mind-heart connections. Int J Cardiol 2022; 364:60-61. [PMID: 35690153 DOI: 10.1016/j.ijcard.2022.06.010] [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: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
| | - Gianluca Rigatelli
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
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22
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Ho BL, Hsieh SW, Chou PS, Yang YH. Effects of Dabigatran on Dementia Pathogenesis and Neuropsychological Function: A Review. J Alzheimers Dis 2022; 86:1589-1601. [PMID: 35213379 DOI: 10.3233/jad-215513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients with atrial fibrillation (AF) carry higher risks of cognitive consequences and psychological burden. An optimal anticoagulant therapy would be expected to better preserve neuropsychological function in addition to effective prevention of stroke and systemic thromboembolism. OBJECTIVE The aim of this review is to explore the effects of the non-vitamin K antagonist oral anticoagulant (NOAC) dabigatran, a direct thrombin inhibitor, on cognitive and psychological function as well as dementia pathogenesis. METHODS We performed a comprehensive search of PubMed/Medline for all types of relevant articles using a combination of dabigatran and associated keywords updated to August 31, 2021. All titles and abstracts were screened for eligibility, and potentially relevant papers were collected for inclusion. RESULTS The pooled results demonstrated neutral to positive impacts of dabigatran on cognitive and psychological outcomes, including laboratory results in animal models of Alzheimer's disease, and reduced incidences of anxiety/depression and dementia for AF patients. Dabigatran also exhibited better therapeutic profiles than warfarin in preclinical and observational research. CONCLUSION Given limited strength of evidence from heterogeneous studies, our review proposed modest beneficial effects of dabigatran on neuropsychological function. Further clinical trials are warranted to affirm the pleiotropic protective effects of NOACs on dementia treatment.
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Affiliation(s)
- Bo-Lin Ho
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of and Master's Program in Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sun-Wung Hsieh
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of and Master's Program in Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Municipal Siao-Gang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ping-Song Chou
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of and Master's Program in Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of and Master's Program in Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
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23
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Sadlonova M, Senges J, Nagel J, Celano C, Klasen-Max C, Borggrefe M, Akin I, Thomas D, Schwarzbach CJ, Kleeman T, Schneider S, Hochadel M, Süselbeck T, Schwacke H, Alonso A, Haass M, Ladwig KH, Herrmann-Lingen C. Symptom Severity and Health-Related Quality of Life in Patients with Atrial Fibrillation: Findings from the Observational ARENA Study. J Clin Med 2022; 11:jcm11041140. [PMID: 35207412 PMCID: PMC8877113 DOI: 10.3390/jcm11041140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/14/2022] [Accepted: 02/19/2022] [Indexed: 01/10/2023] Open
Abstract
Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with impaired health-related quality of life (HRQoL), high symptom severity, and poor cardiovascular outcomes. Both clinical and psychological factors may contribute to symptom severity and HRQoL in AF. Methods: Using data from the observational Atrial Fibrillation Rhine-Neckar Region (ARENA) trial, we identified medical and psychosocial factors associated with AF-related symptom severity using European Heart Rhythm Association symptom classification and HRQoL using 5-level EuroQoL- 5D. Results: In 1218 AF patients (mean age 71.1 ± 10.5 years, 34.5% female), female sex (OR 3.7, p < 0.001), preexisting coronary artery disease (CAD) (OR 1.7, p = 0.020), a history of cardioversion (OR 1.4, p = 0.041), cardiac anxiety (OR 1.2; p < 0.001), stress from noise (OR 1.4, p = 0.005), work-related stress (OR 1.3, p = 0.026), and sleep disturbance (OR 1.2, p = 0.016) were associated with higher AF-related symptom severity. CAD (β = −0.23, p = 0.001), diabetes mellitus (β = −0.25, p < 0.001), generalized anxiety (β = −0.30, p < 0.001), cardiac anxiety (β = −0.16, p < 0.001), financial stress (β = −0.11, p < 0.001), and sleep disturbance (β = 0.11, p < 0.001) were associated with impaired HRQoL. Conclusions: Psychological characteristics, preexisting CAD, and diabetes may play an important role in the identification of individuals at highest risk for impaired HRQoL and high symptom severity in patients with AF.
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Affiliation(s)
- Monika Sadlonova
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, 37075 Gottingen, Germany; (J.N.); (C.K.-M.); (C.H.-L.)
- Department of Cardiovascular and Thoracic Surgery, University of Göttingen Medical Center, 37075 Gottingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Gottingen, 37075 Gottingen, Germany
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA;
- Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA
- Correspondence: ; Tel.: +1-(617)-643-0119
| | - Jochen Senges
- Institute of Myocardial Infarction Research, Hospital of Ludwigshafen, 67063 Ludwigshafen, Germany; (J.S.); (S.S.); (M.H.)
| | - Jonas Nagel
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, 37075 Gottingen, Germany; (J.N.); (C.K.-M.); (C.H.-L.)
| | - Christopher Celano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA;
- Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA
| | - Caroline Klasen-Max
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, 37075 Gottingen, Germany; (J.N.); (C.K.-M.); (C.H.-L.)
| | - Martin Borggrefe
- Department of Cardiology, Pneumology, Angiology, and Emergency Medicine, University of Mannheim Medical Center, 68167 Mannheim, Germany; (M.B.); (I.A.)
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany;
| | - Ibrahim Akin
- Department of Cardiology, Pneumology, Angiology, and Emergency Medicine, University of Mannheim Medical Center, 68167 Mannheim, Germany; (M.B.); (I.A.)
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany;
| | - Dierk Thomas
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany;
- Department of Internal Medicine III—Cardiology, Angiology and Pneumology, Medical University, Hospital Heidelberg, 69120 Heidelberg, Germany
| | | | | | - Steffen Schneider
- Institute of Myocardial Infarction Research, Hospital of Ludwigshafen, 67063 Ludwigshafen, Germany; (J.S.); (S.S.); (M.H.)
| | - Matthias Hochadel
- Institute of Myocardial Infarction Research, Hospital of Ludwigshafen, 67063 Ludwigshafen, Germany; (J.S.); (S.S.); (M.H.)
| | | | - Harald Schwacke
- Diakonissen-Stiftungs-Hospital Speyer, 67346 Speyer, Germany;
| | - Angelika Alonso
- Department of Neurology, Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany;
| | - Markus Haass
- Department of Cardiology, Theresien Hospital and St. Hedwig Clinic GmbH, 68165 Mannheim, Germany;
| | - Karl-Heinz Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, Technical University Munich, 81675 Munich, Germany;
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 81675 Munich, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, 37075 Gottingen, Germany; (J.N.); (C.K.-M.); (C.H.-L.)
- German Center for Cardiovascular Research (DZHK), Partner Site Gottingen, 37075 Gottingen, Germany
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24
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Ladwig KH, Lukaschek K. Herz-Kreislauf-Erkrankungen. Public Health 2022. [DOI: 10.1016/b978-3-437-22262-7.00023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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25
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Anthony S, Harrell R, Martin C, Hawkins T, Khan S, Naniwadekar A, Sears SF. Fear of Recurrence of Atrial Fibrillation: Translating a Cancer Fear Model to the Atrial Fibrillation Patient Experience. Front Psychiatry 2022; 13:915327. [PMID: 35859607 PMCID: PMC9289241 DOI: 10.3389/fpsyt.2022.915327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Atrial fibrillation occurs when rapid and disorganized electrical signals cause the atria in the heart to beat irregularly and is associated with an increased risk for stroke. Despite medical advancements, first and second line atrial fibrillation treatments exhibit significant recurrence rates. Because of this, atrial fibrillation patients often experience disease-specific fears that are not routinely assessed and targeted in clinical management. Fear of recurrence models in cancer research and other cardiac-specific fears have paved the way for a patient-centric approach to disease intervention. PURPOSE Clinical assessment focused solely on the taxonomy of anxiety disorders may miss key components unique to the atrial fibrillation patient experience. An anxiety disorder diagnosis in the presence of an arrhythmia could be misleading and ultimately fail to address patient needs. Modeled from the cancer literature, providers may benefit from a broader disease specific conceptualization for AF patients that differs from a general DSM-5 diagnosis. AIMS The objectives of this paper are: (1) to review the medical aspects of atrial fibrillation, (2) to examine the comparability of fear of recurrence concept from cancer literature to the atrial fibrillation patient, and (3) to suggest considerations of these novel concepts in patient care. FUTURE DIRECTIONS Increased understanding of fear of recurrence among atrial fibrillation patients aims to define and assess fear of recurrence components, determine treatment targets, and ultimately improve patient outcomes.
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Affiliation(s)
- Scarlett Anthony
- Department of Psychology, East Carolina University, Greenville, NC, United States
| | - Rebecca Harrell
- Department of Psychology, East Carolina University, Greenville, NC, United States
| | - Caroline Martin
- Department of Psychology, East Carolina University, Greenville, NC, United States
| | - Taylor Hawkins
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, United States
| | - Saleen Khan
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, United States
| | - Aditi Naniwadekar
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, United States
| | - Samuel F Sears
- Department of Psychology, East Carolina University, Greenville, NC, United States.,Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, United States
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26
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Is left atrial strain the pathophysiological link between transplanted stem cells and atrial fibrillation? Int J Cardiol 2021; 339:60-61. [PMID: 34214503 DOI: 10.1016/j.ijcard.2021.06.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 01/04/2023]
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27
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Goette A. Does Extensive Left Atrial Ablation in Atrial Fibrillation Patients Increase the Risk of Embolic Stroke? JACC Clin Electrophysiol 2021; 7:319-320. [PMID: 33736752 DOI: 10.1016/j.jacep.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Andreas Goette
- Department of Cardiology and Intensive Care Medicine, St. Vincenz Hospital, Paderborn, Germany; Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Magdeburg, Germany.
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