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Grubb A, Aleong R, Rosenberg MA, Chang S, Padalia K, Ashur C, Adewumi J, Saqi B, Varela D, Sandhu A, Cerbin L, Barrett C, Tumolo AZ, Varosy P, Zipse MM, Tzou WS, Garg L, Sabzwari SRA. Development and validation of the Atri-Risk Conduction Index risk score to predict risk of atrial fibrillation after typical atrial flutter ablation. Heart Rhythm 2024; 21:1621-1629. [PMID: 38762137 DOI: 10.1016/j.hrthm.2024.04.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Identification of patients at risk for atrial fibrillation (AF) after typical atrial flutter (tAFL) ablation is important to guide monitoring and treatment. OBJECTIVE The purpose of this study was to create and validate a risk score to predict AF after tAFL ablation METHODS: We identified patients who underwent tAFL ablation with no AF history between 2017 and 2022 and randomly allocated to derivation and validation cohorts. We collected clinical variables and measured conduction parameters in sinus rhythm on an electrophysiology recording system (CardioLab, GE Healthcare). Univariate and multivariate logistic regressions (LogR) were used to evaluate association with AF development. RESULTS A total of 242 consecutive patients (81% male; mean age 66 ± 11 years) were divided into derivation (n =142) and validation (n = 100) cohorts. Forty-two percent developed AF over median follow-up of 330 days. In multivariate LogR (derivation cohort), proximal to distal coronary sinus time (pCS-dCS) ≥70 ms (odds ratio [OR] 16.7; 95% confidence interval [CI] 5.6-49), pCS time ≥36 ms (OR 4.5; 95% CI 1.5-13), and CHADS2-VASc score ≥3 (OR 4.3; 95% CI 1.6-11.8) were independently associated with new AF during follow-up. The Atri-Risk Conduction Index (ARCI) score was created with 0 as minimal and 4 as high-risk using pCS-dCS ≥70 ms = 2 points; pCS ≥36 ms = 1 point; and CHADS2-VASc score ≥3 = 1 point. In the validation cohort, 0% of patients with ARCI score = 0 developed AF, whereas 89% of patients with ARCI score = 4 developed AF. CONCLUSION We developed and validated a risk score using atrial conduction parameters and clinical risk factors to predict AF after tAFL ablation. It stratifies low-, moderate-, and high-risk patients and may be helpful in individualizing approaches to AF monitoring and anticoagulation.
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Affiliation(s)
- Alex Grubb
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ryan Aleong
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michael A Rosenberg
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Shu Chang
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kishan Padalia
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Carmel Ashur
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Joseph Adewumi
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Bilal Saqi
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Daniel Varela
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Amneet Sandhu
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Cardiac Electrophysiology Section, Division of Cardiology, Rocky Mountain VA Medical Center, Aurora, Colorado
| | - Lukasz Cerbin
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Christopher Barrett
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Cardiac Electrophysiology Section, Division of Cardiology, Denver Health Medical Center, Denver, Colorado
| | - Alexis Z Tumolo
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Paul Varosy
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Cardiac Electrophysiology Section, Division of Cardiology, Rocky Mountain VA Medical Center, Aurora, Colorado
| | - Matthew M Zipse
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Wendy S Tzou
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Lohit Garg
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Syed Rafay A Sabzwari
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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Fan K, Xiao Y, Xue A, Zhou J. Clinical outcomes, management, healthcare resource utilization, and cost according to the CHA 2DS 2-VASc scores in Asian patients with nonvalvular atrial fibrillation. Int J Cardiol 2024:132496. [PMID: 39214472 DOI: 10.1016/j.ijcard.2024.132496] [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: 05/03/2024] [Revised: 08/12/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND The prognosis among non-valvular atrial fibrillation (NVAF) patients with different CHA2DS2-VASc scores in the contemporary Asian population remains unclear. Additionally, there is a lack of research examining the disparities in management patterns, healthcare resource utilization (HCRU), and cost among these patients. METHODS AND RESULTS This retrospective cohort study assessed patients diagnosed with NVAF between January 2018 and July 2022. Patients were stratified into 3 cohorts by CHA2DS2-VASc scores: low-risk, intermediate-risk, and high-risk. One-year incidence rates and cumulative incidence of clinical outcomes (including ischemic stroke [IS], transient ischemic attack [TIA], arterial embolism [AE], and major bleeding [MB]) were calculated. Management patterns, HCRU, and cost were analyzed descriptively. Among 419,490 NVAF patients (mean age: 75.2 years, 45.1 % female), 16,541 (3.9 %) were classified as low-risk, 38,494 (9.2 %) as intermediate-risk, and 364,455 (86.9 %) as high-risk. The one-year incidence rates for IS, TIA, AE, and MB were 12.4 (95 % CI, 12.3-12.5), 1.1 (95 % CI, 1.0-1.1), 0.5 (95 % CI, 0.5-0.5), and 3.1 per 100 person-years (95 % CI, 3.1-3.2), with an increasing trend from the low-risk to the high-risk group, respectively. During follow-up, 16.4 % and 11.1 % of patients in the low-risk and high-risk cohorts received oral anticoagulants (OACs), respectively. In addition, significant differences in HCRU and cost were observed in these three cohorts. CONCLUSION This study demonstrates that contemporary Asian NVAF patients with higher CHA2DS2-VASc scores experience higher incidence of adverse outcomes and increased hospital resource consumption. Additionally, suboptimal management was present across all CHA2DS2-VASc score groups.
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Affiliation(s)
- Keye Fan
- School of International Pharmaceutical Business, China Pharmaceutical University, Jiangsu, China
| | - Yue Xiao
- School of International Pharmaceutical Business, China Pharmaceutical University, Jiangsu, China
| | - Aoming Xue
- School of International Pharmaceutical Business, China Pharmaceutical University, Jiangsu, China
| | - Jifang Zhou
- School of International Pharmaceutical Business, China Pharmaceutical University, Jiangsu, China.
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Rosman L, Lampert R, Zhuo S, Li Q, Varma N, Burg M, Gaffey AE, Armbruster T, Gehi A. Wearable Devices, Health Care Use, and Psychological Well-Being in Patients With Atrial Fibrillation. J Am Heart Assoc 2024; 13:e033750. [PMID: 39011944 DOI: 10.1161/jaha.123.033750] [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: 11/29/2023] [Accepted: 04/05/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Wearables are increasingly used by patients with atrial fibrillation (AF) for symptom monitoring and health management, but their impact on patient health care use and psychological well-being is not well understood. METHODS AND RESULTS In this retrospective, propensity-matched study of patients with AF, survey and electronic health record data were merged to compare AF-specific health care use (outpatient/inpatient visits, rhythm-related testing, and procedures) and informal health care use (telephone calls and patient portal messages) over a 9-month period between wearable users and nonusers. We also examined the effects of wearable cardiac monitoring features (eg, heart rate alerts, irregular rhythm notification, and ECG) on patient behavior and well-being. Of 172 patients with AF in this analysis (age, 72.6±9.0 years; 42% women), 83 used a wearable. Compared with nonusers, wearable users reported higher rates of symptom monitoring and preoccupation (P=0.03) and more AF treatment concerns (P=0.02). Moreover, 20% of wearable users experienced anxiety and always contacted their doctors in response to irregular rhythm notifications. After matching, AF-specific health care use was significantly greater among wearable users compared with nonusers (P=0.04), including significantly higher rates of ECGs, echocardiograms/transesophageal echocardiogram, and ablation. Wearable users were also significantly more likely to use informal health care resources compared with nonusers (P=0.05). CONCLUSIONS Wearables were associated with higher rates of symptom monitoring and preoccupation, AF treatment concerns, AF-specific health care use, and use of informal health care resources. Prospective, randomized studies are needed to understand the net effects of wearables and their alerts on patients, providers, and the health care system.
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Affiliation(s)
- Lindsey Rosman
- Department of Medicine, Division of Cardiology University of North Carolina at Chapel Hill Chapel Hill NC USA
| | - Rachel Lampert
- Department of Internal Medicine (Section of Cardiovascular Medicine) Yale University School of Medicine New Haven CT USA
| | - Songcheng Zhuo
- Department of Biostatistics University of North Carolina at Chapel Hill Chapel Hill NC USA
| | - Quefeng Li
- Department of Biostatistics University of North Carolina at Chapel Hill Chapel Hill NC USA
| | - Niraj Varma
- Heart and Vascular Institute, Cleveland Clinic Cleveland OH USA
| | - Matthew Burg
- Department of Internal Medicine (Section of Cardiovascular Medicine) Yale University School of Medicine New Haven CT USA
- VA Connecticut Healthcare System West Haven CT USA
| | - Allison E Gaffey
- Department of Internal Medicine (Section of Cardiovascular Medicine) Yale University School of Medicine New Haven CT USA
- VA Connecticut Healthcare System West Haven CT USA
| | - Tiffany Armbruster
- Department of Medicine, Division of Cardiology University of North Carolina at Chapel Hill Chapel Hill NC USA
| | - Anil Gehi
- Department of Medicine, Division of Cardiology University of North Carolina at Chapel Hill Chapel Hill NC USA
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Deshmukh AJ, Somers VK. Obstructive Sleep Apnea and Atrial Fibrillation: From Boolean Logic to Fuzzy Inference! JACC Clin Electrophysiol 2024:S2405-500X(24)00638-8. [PMID: 39152967 DOI: 10.1016/j.jacep.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 06/18/2024] [Indexed: 08/19/2024]
Affiliation(s)
- Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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Mulholland RJ, Ciminata G, Quinn TJ, Pollock KG, Lister S, Geue C. Delay and Pay? Healthcare Costs Associated with Late Oral Anti-coagulant Prescribing in People with Atrial Fibrillation. PHARMACOECONOMICS 2024:10.1007/s40273-024-01419-2. [PMID: 39093500 DOI: 10.1007/s40273-024-01419-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/14/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with increased morbidity and mortality and exerts an increasingly significant burden on global healthcare resources, with its prevalence rising with an ageing population. Despite a substantial thromboembolic risk, particularly in the period immediately following diagnosis, oral anti-coagulation is frequently not initiated or is delayed. The aim of this study was to evaluate healthcare costs in people with AF, comparing those who were commenced on oral anti-coagulation in the immediate period following the index diagnosis date with those in whom initiation was late and those who never started anti-coagulation. METHODS This retrospective cost analysis used linked Scottish health data to identify adults newly diagnosed with AF between January 1st 2012 and April 30th 2019 with a baseline CHA2DS2-VASc score of ≥ 2. This AF population was sub-divided according to timing of the first prescription of oral anti-coagulant (OAC) during a 2-year follow-up period: never started (OAC never initiated), immediate OAC (OAC prescribed within 60 days of incident AF diagnosis), and delayed OAC (OAC prescribed more than 60 days after incident AF diagnosis). A two-part model was developed, adjusted for key covariates, including age, sex, and frailty, to estimate costs for inpatient admissions, outpatient care, prescriptions, and care home admissions, and overall costs. RESULTS Of an overall AF population of 54,385, 26,805 (49.3%) never commenced OAC, 7654 (14.1%) initiated an OAC late, and 19,926 (36.6%) were prescribed anti-coagulation immediately. The mean adjusted cost for the overall AF population was £7807 per person per year (unadjusted: £8491). Delayed OAC initiation was associated with the greatest adjusted estimated mean annual cost (unadjusted: £13,983; adjusted: £9763), compared to those that never started (unadjusted: £10,433; adjusted: £7981) and those that received an immediate OAC prescription (unadjusted: £3976; adjusted: £6621). Increasing frailty, mortality, and female sex were associated with greater healthcare costs. CONCLUSION AF is associated with significant healthcare resource utilisation and costs, particularly in the context of delayed or non-initiation of anti-coagulation. Indeed, there exists substantial opportunity to improve the utilisation and prompt initiation in people newly diagnosed with AF in Scotland. Interventions to mitigate against the growing economic burden of AF should focus on reducing admissions to hospitals and care homes, which are the principal drivers of costs; prescriptions and outpatient appointments account for a relatively small proportion of overall costs for AF.
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Ball J, Mahony E, Nehme E, Voskoboinik A, Hogarty J, Dawson LP, Horrigan M, Kaye DM, Stub D, Nehme Z. The burden of atrial fibrillation on emergency medical services: A population-based cohort study. Int J Cardiol 2024; 414:132397. [PMID: 39084296 DOI: 10.1016/j.ijcard.2024.132397] [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: 05/17/2024] [Revised: 07/10/2024] [Accepted: 07/24/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) is a growing burden on healthcare resources, despite improvements in prevention and management. AF is a common cause of hospitalisation, and Emergency Medical Services (EMS) use. However, there is a paucity of data describing the burden of AF on EMS. We aimed to determine the prevalence, characteristics, and outcomes of patients presenting with AF to EMS using a large population-based sample. METHODS Consecutive attendances for AF in Victoria, Australia (January 2015-June 2019) were included if patients had a diagnosis of "AF" or "arrhythmia" with AF on electrocardiogram. Data were individually linked to emergency, hospital, and mortality records. RESULTS Of 2,613,056 EMS attendances, 16,525 were a first attendance for AF and linked to hospital records. Median (IQR) age was 76 (67,84) years (43% female). Seventy-eight percent had high thromboembolic risk (CHA2DS2-VASc score ≥ 2), and 72% had a heart rate ≥ 100 bpm. Forty-two percent of patients received no treatment by paramedics and 99.4% were transported to hospital. Fifty-three percent were discharged from ED. Median length of hospital stay was 2 days. Of 2542 cases reattended for AF, 19% occurred within 30 days, with increased odds for females and those of low socioeconomic status. Overall, 24% died during the study period, 12% within 30 days. Increasing age, heart failure, stroke, COPD, and low socioeconomic status increased the odds of 30-day mortality. CONCLUSIONS EMS utilisation for AF is common and associated with frequent reattendance. Further studies are required to investigate novel pathways of care to reduce AF burden on healthcare systems.
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Affiliation(s)
- Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3000, Australia; Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3000, Australia; Ambulance Victoria, 31 Joseph St, Blackburn North, Victoria 3130, Australia; Department of Cardiology, Alfred Hospital, 55 Commercial Rd, Melbourne, Victoria 3000, Australia; Monash Alfred Baker Centre for Cardiovascular Research, 55 Commercial Rd, Melbourne, Victoria 3000, Australia.
| | - Emily Mahony
- Ambulance Victoria, 31 Joseph St, Blackburn North, Victoria 3130, Australia
| | - Emily Nehme
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3000, Australia; Ambulance Victoria, 31 Joseph St, Blackburn North, Victoria 3130, Australia
| | - Aleksandr Voskoboinik
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3000, Australia; Department of Cardiology, Alfred Hospital, 55 Commercial Rd, Melbourne, Victoria 3000, Australia
| | - Joseph Hogarty
- Department of Cardiology, Alfred Hospital, 55 Commercial Rd, Melbourne, Victoria 3000, Australia
| | - Luke P Dawson
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3000, Australia; Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3000, Australia; Department of Cardiology, Alfred Hospital, 55 Commercial Rd, Melbourne, Victoria 3000, Australia
| | - Mark Horrigan
- Department of Cardiology, Austin Hospital, 145 Studley Rd, Heidelberg, Victoria 3084, Australia
| | - David M Kaye
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3000, Australia; Department of Cardiology, Alfred Hospital, 55 Commercial Rd, Melbourne, Victoria 3000, Australia; Monash Alfred Baker Centre for Cardiovascular Research, 55 Commercial Rd, Melbourne, Victoria 3000, Australia; School of Translational Medicine, Monash University, 99 Commercial Rd, Melbourne, Victoria 3000, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3000, Australia; Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3000, Australia; Ambulance Victoria, 31 Joseph St, Blackburn North, Victoria 3130, Australia; Department of Cardiology, Alfred Hospital, 55 Commercial Rd, Melbourne, Victoria 3000, Australia; Monash Alfred Baker Centre for Cardiovascular Research, 55 Commercial Rd, Melbourne, Victoria 3000, Australia
| | - Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3000, Australia; Ambulance Victoria, 31 Joseph St, Blackburn North, Victoria 3130, Australia; Department of Paramedicine, Monash University, 47-49 Moorooduc Hwy, Frankston, Victoria 3199, Australia
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Faris Ali Baig M. NSTEMI mortality and hospital outcomes in patients with atrial fibrillation: A propensity score-matched analysis. IJC HEART & VASCULATURE 2024; 52:101402. [PMID: 38601125 PMCID: PMC11004391 DOI: 10.1016/j.ijcha.2024.101402] [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: 02/13/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/12/2024]
Abstract
Background Atrial fibrillation (AF) is associated with increased cardiovascular mortality. Data regarding the relationship between coronary artery disease (CAD) and AF is mixed. It is uncertain if AF directly increases the risk for future coronary events and if such patients are appropriately evaluated for CAD. Methods This cross-sectional study was performed on hospitalized patients with NSTEMI and concurrent AF in 2019 using the National Inpatient Sample. In-hospital mortality, rates of diagnostic cardiac angiography, percutaneous coronary intervention, ventricular tachycardiac (VT), ventricular fibrillation (VF), cardiogenic shock, cardiac arrest, length of stay (LOS), and total hospitalization charges were studied. Results A total of 433,965 patients met inclusion criteria (169,725 females [39.1 %], 307,985 Caucasian [71 %], 51,570 African American [11.8 %], 37,265 Hispanic [8.6 %]; mean [SD] age, 67.9 [6.2] years). 86,200 (19.8 %) patients with NSTEMI had AF, including 32,775 (38 %) female patients before propensity matching. Patients with NSTEMI and AF had increased odds of mortality (adjusted Odds ratio, 1.32; CI, 1.21-1.43; p < 0.001). AF patients were less likely to undergo diagnostic coronary angiography and PCI and had higher odds of VT, VF, cardiogenic shock, cardiac arrest, tracheal intubation, mechanical ventilation, increased LOS, and higher hospital charges than those without AF. Conclusion AF was independently associated with increased mortality and serious cardiac complications in patients admitted with NSTEMI.
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Ahn HJ, Choi EK, Rhee TM, Choi J, Lee KY, Kwon S, Lee SR, Oh S, Lip GYH. Accelerometer-derived physical activity and the risk of death, heart failure, and stroke in patients with atrial fibrillation: a prospective study from UK Biobank. Br J Sports Med 2024; 58:427-434. [PMID: 38418213 DOI: 10.1136/bjsports-2023-106862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE Data on cardiovascular outcomes according to objectively measured physical activity (PA) in patients with atrial fibrillation (AF) are scarce. This study explored the associations between PA derived from wrist-worn accelerometers and the risk of death, incident heart failure (HF), and incident stroke in patients with AF. METHODS From 37 990 patients with AF in UK Biobank, 2324 patients with accelerometer data were included. Weekly moderate-to-vigorous PA (MVPA) duration was computed from accelerometer data. The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular mortality, incident HF, and incident stroke. Restricted cubic splines estimated the dose-response associations between MVPA duration and the outcomes. The adjusted HRs (aHRs) of the outcomes according to adherence to PA standard guidelines (performing MVPA≥150 min/week) were also evaluated. RESULTS The mean age was 66.9±6.2 years and 64.9% were male. During a median follow-up of 6.7 years, there were 181 all-cause deaths, 62 cardiovascular deaths, 225 cases of incident HF, and 91 cases of incident stroke; the overall incidence rate per 1000 patient-years was 11.76, 4.03, 15.16 and 5.99, respectively. There was a linear inverse dose-response relationship between MVPA (≥108 min/week) and all-cause mortality. Performing MVPA for 105-590 min/week was associated with a lower risk of HF than those with no measurable MVPA. The risk of stroke and cardiovascular mortality was not associated with MVPA. Performing guideline-adherent MVPA was related to a 30% lower risk of all-cause mortality (aHR: 0.70 (0.50-0.98), p=0.04) and 33% lower risk of HF (aHR 0.67 (0.49-0.93), p=0.02). CONCLUSION In patients with AF, accelerometer-derived PA data supports lower risks of all-cause mortality and HF according to a greater level of MVPA and adherence to PA guidelines. Regular MVPA should be encouraged in patients with AF as a part of integrated management.
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Affiliation(s)
- Hyo-Jeong Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae-Min Rhee
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - JungMin Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Yeon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Peigh G, Zhou J, Rosemas SC, Roberts AI, Longacre C, Nayak T, Schwab G, Soderlund D, Passman RS. Impact of Atrial Fibrillation Burden on Health Care Costs and Utilization. JACC Clin Electrophysiol 2024; 10:718-730. [PMID: 38430088 DOI: 10.1016/j.jacep.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/17/2023] [Accepted: 12/10/2023] [Indexed: 03/03/2024]
Abstract
BACKGROUND Integrating patient-specific cardiac implantable electronic device (CIED)-detected atrial fibrillation (AF) burden with measures of health care cost and utilization allows for an accurate assessment of the AF-related impact on health care use. OBJECTIVES The goal of this study was to assess the incremental cost of device-recognized AF vs no AF; compare relative costs of paroxysmal atrial fibrillation (pAF), persistent atrial fibrillation (PeAF), and permanent atrial fibrillation (PermAF) AF; and evaluate rates and sources of health care utilization between cohorts. METHODS Using the de-identified Optum Clinformatics U.S. claims database (2015-2020) linked with the Medtronic CareLink database, CIED patients were identified who transmitted data ≥6 months postimplantation. Annualized per-patient costs in follow-up were analyzed from insurance claims and adjusted to 2020 U.S. dollars. Costs and rates of health care utilization were compared between patients with no AF and those with device-recognized pAF, PeAF, and PermAF. Analyses were adjusted for geographical region, insurance type, CHA2DS2-VASc score, and implantation year. RESULTS Of 21,391 patients (mean age 72.9 ± 10.9 years; 56.3% male) analyzed, 7,798 (36.5%) had device-recognized AF. The incremental annualized increased cost in those with AF was $12,789 ± $161,749 per patient, driven by increased rates of health care encounters, adverse clinical events associated with AF, and AF-specific interventions. Among those with AF, PeAF was associated with the highest cost, driven by increased rates of inpatient and outpatient hospitalization encounters, heart failure hospitalizations, and AF-specific interventions. CONCLUSIONS Presence of device-recognized AF was associated with increased health care cost. Among those with AF, patients with PeAF had the highest health care costs. Mechanisms for cost differentials include both disease-specific consequences and physician-directed interventions.
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Affiliation(s)
- Graham Peigh
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jiani Zhou
- Medtronic Inc, Minneapolis, Minnesota, USA
| | | | - Anthony I Roberts
- Medtronic Inc, Minneapolis, Minnesota, USA; Brown University School of Public Health, Providence, Rhode Island, USA
| | | | - Tanvi Nayak
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gabrielle Schwab
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Rod S Passman
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
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Kim MH. Atrial Fibrillation, No Matter How Defined, Is a Cost Burden: Insights to Drive Population Health. JACC Clin Electrophysiol 2024; 10:731-733. [PMID: 38658062 DOI: 10.1016/j.jacep.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Michael H Kim
- Creighton University School of Medicine and CHI Health, Omaha, Nebraska, USA.
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Klavebäck S, Svennberg E, Nymark C, Braunschweig F, Lidin M. Management of modifiable risk factors and comorbidities in atrial fibrillation: suggestions for improvement from a patient perspective. Eur J Cardiovasc Nurs 2024; 23:169-175. [PMID: 37249076 DOI: 10.1093/eurjcn/zvad055] [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: 02/19/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 05/31/2023]
Abstract
AIMS In patients with atrial fibrillation (AF), improved management of modifiable risk factors and concomitant diseases is recommended by guidelines, yet many AF patients have sub-optimal risk factor management. Digital health solutions may offer support in this matter. This study aims to identify how patients with AF perceive they could be supported by a digital tool aimed to optimize management of comorbidities and modifiable risk factors associated with an unhealthy lifestyle. METHODS AND RESULTS This was a qualitative, descriptive study based on four semi-structured focus-group interviews analysed by manifest content analysis. Sixteen AF patients with recent in- or outpatient encounters were included [age 68 (52-78) years; 43% female; BMI 29.5 (20.4-35.8) kg/m2; paroxysmal/persistent AF (50%/50%); AF duration 7 (0-22) years]. Relevant comorbidities were hypertension (88%), heart failure (25%), diabetes mellitus type 2 (19%), and ischaemic heart disease (13%). The patients' suggestions were summarized into three main categories. First, person-centred information is essential, meaning that information should be customized and conveyed in an appropriate manner and include practical tips. Second, patients desire help with managing lifestyle habits in a way that is applicable in everyday life, and patients desire help with creating habits. Third, regular communication is necessary including inspirational reminders and motivational feedback. CONCLUSION Patients with AF request person-centred information, support in managing healthy lifestyle habits, and more regular communication with caregivers. This study provides a first foundation on how to better support AF patients, and using a digital tool in standard care may improve outcomes and reduce cost of care.
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Affiliation(s)
- Sofia Klavebäck
- Department of Medicine, Unit of Cardiology, Karolinska Institute, K2 Medicin, Solna, K2 Kardio Pernow J, 171 77 Stockholm, Sweden
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, Norrbacka S1:02, Karolinska Universitetssjukhuset Solna, 17176 Stockholm, Sweden
| | - Emma Svennberg
- Department of Medicine, Unit of Cardiology, Karolinska Institute, K2 Medicin, Solna, K2 Kardio Pernow J, 171 77 Stockholm, Sweden
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, Norrbacka S1:02, Karolinska Universitetssjukhuset Solna, 17176 Stockholm, Sweden
| | - Carolin Nymark
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, Norrbacka S1:02, Karolinska Universitetssjukhuset Solna, 17176 Stockholm, Sweden
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, H1 Neurobiologi, vårdvetenskap och samhälle, H1 Omvårdnad Omv enhet 3, 171 77 Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Medicine, Unit of Cardiology, Karolinska Institute, K2 Medicin, Solna, K2 Kardio Pernow J, 171 77 Stockholm, Sweden
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, Norrbacka S1:02, Karolinska Universitetssjukhuset Solna, 17176 Stockholm, Sweden
| | - Matthias Lidin
- Department of Medicine, Unit of Cardiology, Karolinska Institute, K2 Medicin, Solna, K2 Kardio Pernow J, 171 77 Stockholm, Sweden
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, Norrbacka S1:02, Karolinska Universitetssjukhuset Solna, 17176 Stockholm, Sweden
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12
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Okoli U, Ogunsola AS, Adeniyi Z, Abdulkadir A, DeMetropolis SM, Olatunji EA, Karaye IM. Regional and Demographic Disparities in Atrial Fibrillation Mortality in the USA. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01917-1. [PMID: 38300428 DOI: 10.1007/s40615-024-01917-1] [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: 08/02/2023] [Revised: 01/02/2024] [Accepted: 01/20/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Despite the burden of atrial fibrillation/flutter (AF/AFL) in the USA, an assessment of contemporary mortality trends is scarce in the literature. This study aimed to assess the temporal trends in AF/AFL deaths among US adults by age, sex, race/ethnicity, and census region from 1999 to 2020. METHODS National mortality data was abstracted from the National Center for Health Statistics to identify decedents whose underlying cause of death was cardiovascular disease and multiple cause of death, AF/AFL. Joinpoint regression assessed mortality trends, and we calculated the average percentage changes (APC) and average annual percentage changes in mortality rates. Results were presented as effect estimates and 95% confidence intervals (95% CI). RESULTS Between 1999 and 2020, 657,126 adults died from AF/AFL in the USA. Contemporary trends have worsened overall except among individuals from the Northeast region for whom the rates have remained stationary since 2015 (APC = 0.1; 95% CI, - 1.0, 1.1). Regional and demographic disparities were observed, with higher rates noted among younger persons below 65 years of age, women (APC = 2.1; 95% CI, 1.7, 2.5), and non-Hispanic Blacks (APC = 4.5; 95% CI, 3.9, 5.2). CONCLUSIONS The temporal trends in AF/AFL mortality in the USA have exhibited a worsening pattern in recent years, with regional and demographic disparities. Further investigations are warranted to explore the determinants of AF/AFL mortality in the US population and identify factors that may explain the observed differences. Understanding these factors will facilitate efforts to promote improved and equitable health outcomes for the population.
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Affiliation(s)
- Unoma Okoli
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, 330 Mount Auburn St, Cambridge, MA, 02138, USA.
| | - Ayobami S Ogunsola
- Department of Orthopedic Surgery, Wake Forest University School of Medicine, 475 Vine St, Winston-Salem, NC, 27101, USA
| | - Zahira Adeniyi
- Department of Population Health, Hofstra University, 106 Hofstra Dome, Hempstead, NY, 11549, USA
| | - Aisha Abdulkadir
- Department of Population Health, Hofstra University, 106 Hofstra Dome, Hempstead, NY, 11549, USA
| | - Susan M DeMetropolis
- Department of Speech, & Hearing Sciences, Hofstra University, Davison Hall 0106C, LanguageHempstead, NY, 11549, USA
| | - Eniola A Olatunji
- Department of Health Policy & Management, Texas A&M University, 212 Adriance Lab Rd, College Station, TX, 77843-1266, USA
| | - Ibraheem M Karaye
- Department of Population Health, Hofstra University, 106 Hofstra Dome, Hempstead, NY, 11549, USA
- Department of Anaesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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13
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Linz D, Gawalko M, Betz K, Hendriks JM, Lip GY, Vinter N, Guo Y, Johnsen S. Atrial fibrillation: epidemiology, screening and digital health. THE LANCET REGIONAL HEALTH. EUROPE 2024; 37:100786. [PMID: 38362546 PMCID: PMC10866942 DOI: 10.1016/j.lanepe.2023.100786] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/12/2023] [Accepted: 11/02/2023] [Indexed: 02/17/2024]
Abstract
Atrial fibrillation (AF) is highly prevalent with a lifetime risk of about 1 in 3-5 individuals after the age of 45 years. Between 2010 and 2019, the global prevalence of AF has risen markedly from 33.5 million to 59 million individuals living with AF. Early detection of AF and implementation of appropriate treatment could reduce the frequency of complications associated with AF. International AF management guidelines recommend opportunistic and systematic screening for AF, but additional data are needed. Digital approaches and pathways have been proposed for early detection and for the transition to early AF management. Mobile health (mHealth) devices provide an opportunity for digital screening and should be part of novel models of care delivery based on integrated AF care pathways. For a broad implementation of mHealth-based, integrated care for patients with chronic diseases as AF, further high quality evidence is necessary. In this review, we present an overview of the present data on epidemiology, screening techniques, and the contribution of digital health solutions to the integrated management of AF. We also provide a systemic review on current data of digital and integrated AF management.
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Affiliation(s)
- Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Monika Gawalko
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Konstanze Betz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
- Department of Internal Medicine, Eifelklinik St. Brigida, Simmerath, Germany
| | - Jeroen M. Hendriks
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Nicklas Vinter
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Yutao Guo
- Six Medical Center, Department of Pulmonary Vessel and Thrombotic Disease, Chinese PLA General Hospital, Beijing, China
| | - Søren Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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14
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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1-e156. [PMID: 38033089 PMCID: PMC11095842 DOI: 10.1161/cir.0000000000001193] [Citation(s) in RCA: 286] [Impact Index Per Article: 286.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines liaison
| | | | | | | | | | - Paul L Hess
- ACC/AHA Joint Committee on Performance Measures liaison
| | | | | | | | | | - Kazuhiko Kido
- American College of Clinical Pharmacy representative
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15
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Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 83:109-279. [PMID: 38043043 PMCID: PMC11104284 DOI: 10.1016/j.jacc.2023.08.017] [Citation(s) in RCA: 95] [Impact Index Per Article: 95.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
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16
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Atwater BD, Guo JD, Keshishian A, Delinger R, Russ C, Rosenblatt L, Jiang J, Yuce H, Ferri M. Temporal trends in anticoagulation use and clinical outcomes among medicare beneficiaries with non-valvular atrial fibrillation. J Thromb Thrombolysis 2024; 57:1-10. [PMID: 37530955 PMCID: PMC10830709 DOI: 10.1007/s11239-023-02838-2] [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] [Accepted: 05/24/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE Oral anticoagulants effectively prevent stroke/systemic embolism among patients with non-valvular atrial fibrillation but remain under-prescribed. This study evaluated temporal trends in oral anticoagulant use, the incidence of stroke/systemic embolism and major bleeding, and economic outcomes among elderly patients with non-valvular atrial fibrillation and CHA2DS2-VASc scores ≥ 2. METHODS Retrospective analyses were conducted on Medicare claims data from January 1, 2012 through December 31, 2017. Non-valvular atrial fibrillation patients aged ≥ 65 years with CHA2DS2-VASc scores ≥ 2 were stratified by calendar year (2013-2016) of care to create calendar-year cohorts. Patient characteristics were evaluated across all cohorts during the baseline period (12 months before diagnosis). Treatment patterns and clinical and economic outcomes were evaluated during the follow-up period (from diagnosis through 12 months). RESULTS Baseline patient characteristics remained generally similar between 2013 and 2016. Although lack of oral anticoagulant prescriptions among eligible patients remained relatively high, utilization did increase progressively (53-58%). Among treated patients, there was a progressive decrease in warfarin use (79-52%) and a progressive increase in overall direct oral anticoagulant use (21-48%). There were progressive decreases in the incidence of stroke/systemic embolism 1.9-1.4 events per 100 person years) and major bleeding (4.6-3.3 events per 100 person years) as well as all-cause costs between 2013 and 2016. CONCLUSIONS The proportions of patients with non-valvular atrial fibrillation who were not prescribed an oral anticoagulant decreased but remained high. We observed an increase in direct oral anticoagulant use that coincided with decreased incidence of clinical outcomes as well as decreasing total healthcare costs.
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Affiliation(s)
- Brett D Atwater
- Inova Heart and Vascular Institute, 4Th Floor Medical Directors Suite, 3300 Gallows Road, Falls Church, VA, 22042, USA.
| | | | | | | | | | | | - Jenny Jiang
- Bristol-Myers Squibb Company, Lawrenceville, NJ, USA
| | - Huseyin Yuce
- New York City College of Technology, City University of New York, New York, NY, USA
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17
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Escribano P, Ródenas J, García M, Hornero F, Gracia-Baena JM, Alcaraz R, Rieta JJ. Novel Entropy-Based Metrics for Long-Term Atrial Fibrillation Recurrence Prediction Following Surgical Ablation: Insights from Preoperative Electrocardiographic Analysis. ENTROPY (BASEL, SWITZERLAND) 2023; 26:28. [PMID: 38248154 PMCID: PMC11154238 DOI: 10.3390/e26010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024]
Abstract
Atrial fibrillation (AF) is a prevalent cardiac arrhythmia often treated concomitantly with other cardiac interventions through the Cox-Maze procedure. This highly invasive intervention is still linked to a long-term recurrence rate of approximately 35% in permanent AF patients. The aim of this study is to preoperatively predict long-term AF recurrence post-surgery through the analysis of atrial activity (AA) organization from non-invasive electrocardiographic (ECG) recordings. A dataset comprising ECGs from 53 patients with permanent AF who had undergone Cox-Maze concomitant surgery was analyzed. The AA was extracted from the lead V1 of these recordings and then characterized using novel predictors, such as the mean and standard deviation of the relative wavelet energy (RWEm and RWEs) across different scales, and an entropy-based metric that computes the stationary wavelet entropy variability (SWEnV). The individual predictors exhibited limited predictive capabilities to anticipate the outcome of the procedure, with the SWEnV yielding a classification accuracy (Acc) of 68.07%. However, the assessment of the RWEs for the seventh scale (RWEs7), which encompassed frequencies associated with the AA, stood out as the most promising individual predictor, with sensitivity (Se) and specificity (Sp) values of 80.83% and 67.09%, respectively, and an Acc of almost 75%. Diverse multivariate decision tree-based models were constructed for prediction, giving priority to simplicity in the interpretation of the forecasting methodology. In fact, the combination of the SWEnV and RWEs7 consistently outperformed the individual predictors and excelled in predicting post-surgery outcomes one year after the Cox-Maze procedure, with Se, Sp, and Acc values of approximately 80%, thus surpassing the results of previous studies based on anatomical predictors associated with atrial function or clinical data. These findings emphasize the crucial role of preoperative patient-specific ECG signal analysis in tailoring post-surgical care, enhancing clinical decision making, and improving long-term clinical outcomes.
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Affiliation(s)
- Pilar Escribano
- Research Group in Electronic, Biomedical and Telecommunication Engineering, University of Castilla-La Mancha, 02071 Albacete, Spain; (P.E.); (J.R.); (M.G.); (R.A.)
| | - Juan Ródenas
- Research Group in Electronic, Biomedical and Telecommunication Engineering, University of Castilla-La Mancha, 02071 Albacete, Spain; (P.E.); (J.R.); (M.G.); (R.A.)
| | - Manuel García
- Research Group in Electronic, Biomedical and Telecommunication Engineering, University of Castilla-La Mancha, 02071 Albacete, Spain; (P.E.); (J.R.); (M.G.); (R.A.)
| | - Fernando Hornero
- Cardiovascular Surgery Department, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (F.H.); (J.M.G.-B.)
| | - Juan M. Gracia-Baena
- Cardiovascular Surgery Department, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (F.H.); (J.M.G.-B.)
| | - Raúl Alcaraz
- Research Group in Electronic, Biomedical and Telecommunication Engineering, University of Castilla-La Mancha, 02071 Albacete, Spain; (P.E.); (J.R.); (M.G.); (R.A.)
| | - José J. Rieta
- BioMIT.org, Electronic Engineering Department, Universitat Politecnica de Valencia, 46022 Valencia, Spain
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18
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Berman A, Iglesias M, Khanna R, Beaulieu T. The association between COVID-19 infection and incident atrial fibrillation: results from a retrospective cohort study using a large US commercial insurance database. Open Heart 2023; 10:e002399. [PMID: 37989491 PMCID: PMC10661058 DOI: 10.1136/openhrt-2023-002399] [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: 06/21/2023] [Accepted: 10/31/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND We sought to examine a 1-year incidence of atrial fibrillation (AF) among patients with SARS-CoV-2 virus (COVID-19) in comparison to those with non-COVID-19 acute upper respiratory infection (AURI). METHODS Patients with a diagnosis of COVID-19 (in any setting) between April 2020 and June 2021 were identified in Optum Clinformatics. Two comparator cohorts were constructed: an 'AURI pandemic' cohort (AURI diagnosis between April 2020 and June 2021) and an 'AURI prepandemic' cohort (AURI diagnosis between January 2018 and December 2018). One-year incidence of AF was compared among: COVID-19 versus AURI pandemic cohort; COVID-19 versus AURI prepandemic cohort; and AURI pandemic versus AURI prepandemic cohort. For each comparison, we applied a matching weights technique to balance covariates. Logistic regression was used to compare the odds of incident AF among the matched cohorts. RESULTS When comparing the matched COVID-19 (n=102 227) cohort with the AURI pandemic (n=102 101) cohort, higher incidence of AF was observed among the COVID-19 cohort (2.2% vs 1.2%; p<0.001; OR 1.83; 95% CI 1.72 to 1.95). Similar findings were observed for the COVID-19 (n=169 687) versus AURI prepandemic (n=169 486) comparison (2.7% vs 1.6%; p<0.001; OR 1.70; 95% CI 1.63 to 1.78). When comparing the AURI pandemic (n=1 26 392) versus AURI prepandemic (n=1 26 394) cohort, no significant differences in incident AF were observed (1.1% vs 1.2%; p=0.133; OR 0.95, 95% CI 0.90 to 1.01). CONCLUSION Patients diagnosed with COVID-19 were found to be at a higher risk of incident AF as compared with those with AURI. Timely diagnosis and appropriate treatment of AF may potentially mitigate the burden of AF conferred by COVID-19.
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Affiliation(s)
- Adam Berman
- Baptist Heart, Mississippi Baptist Health Systems, Jackson, Mississippi, USA
| | - Maximiliano Iglesias
- Franchise Health Economics and Market Access, Johnson & Johnson, Irvine, California, USA
| | - Rahul Khanna
- MedTech Epidemiology & Data Sciences, Johnson & Johnson, New Brunswick, New Jersey, USA
| | - Tara Beaulieu
- MedTech Epidemiology & Data Sciences, Johnson & Johnson, New Brunswick, New Jersey, USA
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19
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Dhande M, Barakat A, Canterbury A, Thoma F, Mulukutla S, Sezer A, Aronis KN, Bhonsale A, Kancharla K, Voigt AH, Wang NC, Shalaby A, Mark Estes NA, Saba S, Jain SK. Cardiovascular Hospitalizations and Resource Use Following Atrial Fibrillation Ablation. J Am Heart Assoc 2023; 12:e028609. [PMID: 37681551 PMCID: PMC10547277 DOI: 10.1161/jaha.122.028609] [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: 10/28/2022] [Accepted: 06/06/2023] [Indexed: 09/09/2023]
Abstract
Background Over the next few years, atrial fibrillation (AF)-related morbidity and costs will increase significantly. Thus, it is prudent to examine the impact of AF treatment on health care resource use. This study examined the impact of AF ablation on hospitalization, length of stay, and resource use for patients undergoing AF ablation in a multihospital system. Methods and Results In an observational analysis, outcomes of total, cardiovascular, and AF hospitalizations, emergency department visits, and length of stay were compared for 3417 patients between 12 months before and 24 months following AF ablation. Use of electrical cardioversions and antiarrhythmic use were also compared 1 year before to 2 years after AF ablation. There were fewer total (0.7±1.3 versus 0.3±0.7; P<0.001), cardiovascular (0.7±1.2 versus 0.2±0.6; P<0.001), and AF (0.6±1.1 versus 0.1±0.3; P<0.001) hospitalizations and emergency department visits (0.8±2.1 versus 0.4±0.9; P<0.001) per patient-year for the 2 years following AF ablation compared with 1 year before. Average length of stay per patient-year (1.4±7.9 versus 3.6±5.3 days; P<0.0001), the percentage of patients on antiarrhythmic therapy (21.2% versus 58.5%; P<0.0001), and those undergoing electrical cardioversions (16.1% versus 28.1%; P<0.0001) were lower 2 years following AF ablation versus 1 year before. Conclusions We noted a decrease in total, cardiovascular, and AF hospitalizations and health care resource use during the 2-year period after index AF ablation, compared with the 1 year before. AF ablation may portend a decline in patient morbidity and health care costs.
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Affiliation(s)
- Mehak Dhande
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Amr Barakat
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Ann Canterbury
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Floyd Thoma
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
- Clinical AnalyticsUniversity of Pittsburgh Medical CenterPittsburghPA
| | - Suresh Mulukutla
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
- Clinical AnalyticsUniversity of Pittsburgh Medical CenterPittsburghPA
| | - Ahmet Sezer
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Konstantinos N. Aronis
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Aditya Bhonsale
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Krishna Kancharla
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Andrew H. Voigt
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Norman C. Wang
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Alaa Shalaby
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - N. A. Mark Estes
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Samir Saba
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
| | - Sandeep K. Jain
- Center for Atrial FibrillationUniversity of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Heart and Vascular InstitutePittsburghPA
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Verma A, Haines DE, Boersma LV, Sood N, Natale A, Marchlinski FE, Calkins H, Sanders P, Packer DL, Kuck KH, Hindricks G, Tada H, Hoyt RH, Irwin JM, Andrade J, Cerkvenik J, Selma J, DeLurgio DB. Influence of monitoring and atrial arrhythmia burden on quality of life and health care utilization in patients undergoing pulsed field ablation: A secondary analysis of the PULSED AF trial. Heart Rhythm 2023; 20:1238-1245. [PMID: 37211146 DOI: 10.1016/j.hrthm.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Freedom from atrial arrhythmia (AA) recurrence ≥30 seconds after pulsed field ablation (PFA) in patients with atrial fibrillation (AF) was reported in PULSED AF (Pulsed Field Ablation to Irreversibly Electroporate Tissue and Treat AF; ClinialTrials.gov Identifier: NCT04198701). AA burden may be a more clinically meaningful endpoint. OBJECTIVE The purpose of this study was to determine the influence of monitoring strategies on AA detection and AA burden association with quality of life (QoL) and health care utilization (HCU) after PFA. METHODS Patients underwent 24-hour Holter monitoring at 6 and 12 months and weekly, and symptomatic transtelephonic monitoring (TTM). AA burden post-blanking was calculated as the greater of (1) percentage of AA on total Holter time; or (2) percentage of weeks with ≥1 TTM with AA out of all weeks with ≥1 TTM. RESULTS Freedom from all AAs varied by >20% when differing monitoring strategies were used. PFA resulted in zero burden in 69.4% of paroxysmal atrial fibrillation (PAF) and 62.2% of persistent atrial fibrillation (PsAF) patients. Median burden was low (<9%). Most PAF and PsAF patients had ≤1 week of AA detection on TTM (82.6% and 75.4%) and <30 minutes of AA per day of Holter monitoring (96.5% and 89.6%), respectively. Only PAF patients with <10% AA burden averaged a clinically meaningful (>19 point) QoL improvement. PsAF patients experienced clinically meaningful QoL improvements irrespective of burden. Repeat ablations and cardioversions significantly increased with higher AA burden (P <.01). CONCLUSION The ≥30-second AA endpoint is dependent on the monitoring protocol used. PFA resulted in low AA burden for most patients, which was associated with clinically relevant improvement in QoL and reduced AA-related HCU.
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Affiliation(s)
- Atul Verma
- McGill University Health Centre, Montreal, Quebec, Canada.
| | | | - Lucas V Boersma
- St. Antonius Hospital, Nieuwegein and Amsterdam UMC, The Netherlands
| | - Nitesh Sood
- Southcoast Health Center, Fall River, Massachusetts
| | | | | | | | | | | | | | | | | | | | | | - Jason Andrade
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | | | - David B DeLurgio
- Emory Heart & Vascular Center at Saint Joseph's, Atlanta, Georgia
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21
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Wazni O, Moss J, Kuniss M, Andrade J, Chierchia GB, Mealing S, Mburu W, Sale A, Kaplon R, Ismyrloglou E, Bromilow T, Lane E, Lewis D, Reynolds MR. An economic evaluation of first-line cryoballoon ablation vs antiarrhythmic drug therapy for the treatment of paroxysmal atrial fibrillation from a U.S. Medicare perspective. Heart Rhythm O2 2023; 4:528-537. [PMID: 37744940 PMCID: PMC10513914 DOI: 10.1016/j.hroo.2023.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Background Three recent randomized controlled trials have demonstrated that, as an initial rhythm control strategy, first-line cryoballoon ablation (cryoablation) reduces atrial arrhythmia recurrence compared with antiarrhythmic drugs (AADs) in patients with symptomatic paroxysmal atrial fibrillation (PAF). Objective The study sought to evaluate the cost-effectiveness of first-line cryoablation compared with first-line AADs for treating symptomatic PAF from a U.S. Medicare payer perspective. Methods Individual patient-level data from 703 participants with PAF enrolled into the Cryo-FIRST (NCT01803438), STOP AF First (NCT03118518), and EARLY-AF (NCT02825979) trials were used to derive parameters for the cost-effectiveness model. The cost-effectiveness model used 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. The Markov model used a 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% per year. Results Cryoablation was estimated to yield higher QALYs (+0.17) and higher costs (+$4274) per patient over a 40-year time horizon than AADs. Ultimately, this produced an average incremental cost-effectiveness ratio of $24,637 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 atrial fibrillation health states for those initially treated with cryoablation compared with AADs. Conclusion Initial rhythm control with first-line cryoballoon ablation is highly cost-effective compared with first-line AADs from a U.S. Medicare payer perspective.
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Affiliation(s)
- Oussama Wazni
- Department of Cardiac Electrophysiology and Pacing, Cleveland Clinic, Cleveland, Ohio
| | - Joe Moss
- York Health Economics Consortium, York, United Kingdom
| | - Malte Kuniss
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Jason Andrade
- Division of Cardiology and Cardiac Electrophysiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gian Battista Chierchia
- Department of Cardiology at Heart Rhythm Management Center, Universitair Ziekenhuis Brussel and Vrije Universiteit Brussel, Brussels, Belgium
| | | | | | | | | | | | - Tom Bromilow
- York Health Economics Consortium, York, United Kingdom
| | - Emily Lane
- York Health Economics Consortium, York, United Kingdom
| | - Damian Lewis
- York Health Economics Consortium, York, United Kingdom
| | - Matthew R. Reynolds
- Baim Institute for Clinical Research, Boston, Massachusetts
- Lahey Hospital and Medical Center, Burlington, Massachusetts
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22
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Ferrick KJ. Atrial Fibrillation Ablation: Safety in Numbers. J Am Coll Cardiol 2023; 81:2100-2102. [PMID: 37225363 DOI: 10.1016/j.jacc.2023.04.002] [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: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Kevin J Ferrick
- Arrhythmia Service, Montefiore Einstein Heart and Vascular Center, Albert Einstein College of Medicine, Bronx, New York, USA.
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23
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Patil S, Rojulpote C, Gonuguntla K, Bhattaru A, Atri A, Madubata C, Khraisha O, Mainigi S. Socioeconomic Status and Burden of Atrial Fibrillation Hospitalizations among Black US Adults: A Fifteen Year Analysis. Curr Probl Cardiol 2023; 48:101737. [PMID: 37040851 DOI: 10.1016/j.cpcardiol.2023.101737] [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: 04/01/2023] [Accepted: 04/06/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Socioeconomic status (SES) may help delineate inequities in atrial fibrillation (AF) among Blacks versus non-blacks. METHODS We queried the National Inpatient Sample database from January 2004 to December 2018 to determine trends in AF hospitalizations and in-hospital mortality stratified by Black race and SES. RESULTS Total admissions for AF in the US has increased by 12% from 1077 to 1202 per 1 million US adults. Among patients hospitalized with AF, the proportion of Black adults is increasing. In those of low SES, both Black and non-black patients have had increases in AF hospitalizations. In those of high SES, Black patients have had a modest increase while non-black patients have had a progressive decrease in rate of hospitalizations. Overall, in-hospital mortality rates improved in Blacks and non-blacks, regardless of SES. CONCLUSION Joint associations of SES and race can further qualify disparities in AF care.
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Affiliation(s)
- Shivaraj Patil
- Division of Cardiology, Department of Medicine, Einstein Medical Center, PA, USA.
| | - Chaitanya Rojulpote
- Division of Internal Medicine, Department of Medicine, The Wright Center for Graduate Medical Education, PA, USA
| | - Karthik Gonuguntla
- Division of Cardiology, Department of Medicine, West Virginia University, WV, USA
| | - Abhijit Bhattaru
- Department of Cardiovascular Imaging, Hospital of the University of Pennsylvania, PA, USA
| | - Avica Atri
- Division of Internal Medicine, Department of Medicine, Einstein Medical Center, PA, USA
| | - Chiduzie Madubata
- Division of Cardiology, Department of Medicine, Einstein Medical Center, PA, USA
| | - Ola Khraisha
- Division of Cardiology, Department of Medicine, Einstein Medical Center, PA, USA
| | - Sumeet Mainigi
- Division of Cardiology, Department of Medicine, Einstein Medical Center, PA, USA
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24
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Kim KM, Kim SY, Schulman KL, Kim MH. Incremental healthcare cost burden in patients with atrial flutter only. Front Cardiovasc Med 2023; 10:1094316. [PMID: 36937931 PMCID: PMC10014458 DOI: 10.3389/fcvm.2023.1094316] [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: 11/09/2022] [Accepted: 01/30/2023] [Indexed: 03/05/2023] Open
Abstract
Background Limited information is available on the costs related to atrial flutter only. This study provides a comprehensive estimate of the cost in patients with atrial flutter only versus matched patients without any atrial arrhythmia. Methods Patients over 20 years of age with a minimum of one inpatient or two outpatient diagnosis codes for atrial flutter in 2005 and a minimum of 12 months of continuous enrollment pre- and post-index were identified using the MarketScan Commercial and Medicare databases. Atrial flutter patients were propensity matched to patients without atrial arrhythmias. Total costs for each patient for 12 months post-index were calculated. National cost was estimated using the projected prevalence of atrial flutter for 2010. Results A total of 1,042 patients with atrial flutter only were successfully matched with comparison patients. For atrial flutter patients compared to matched controls without atrial arrhythmias, total mean annual cost per patient was 81% higher ($23,008 vs. $12,717) and mean annual inpatient expenditure was 214% higher ($8,518 vs. $2,713). When applied to national atrial flutter prevalence data, total incremental cost burden was estimated to be $687.9 million per year more than patients without atrial arrhythmias, primarily due to cardiovascular specific expenditure ($377 million, 55% of total) with 58% ($218.5 million) of the increased inpatient expenditure due to cardiovascular specific admissions and $159 million (23%) for atrial flutter specific care. Sex-related differences were also present in atrial flutter only patients. Conclusion Although atrial flutter-only patients are less prevalent than atrial fibrillation patients, the national incremental cost burden in atrial flutter is substantial on a per-patient level.
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Affiliation(s)
- Kathryn M. Kim
- Chicago Medical School, Rosalind Franklin University, North Chicago, IL, United States
| | - Steven Y. Kim
- School of Medicine, Des Moines University, Des Moines, IA, United States
| | | | - Michael H. Kim
- CHI Health, School of Medicine, Creighton University, Omaha, NE, United States
- *Correspondence: Michael H. Kim,
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25
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Aksu T, Skeete JR, Huang HH. Ganglionic Plexus Ablation: A Step-by-step Guide for Electrophysiologists and Review of Modalities for Neuromodulation for the Management of Atrial Fibrillation. Arrhythm Electrophysiol Rev 2023; 12:e02. [PMID: 36845167 PMCID: PMC9945432 DOI: 10.15420/aer.2022.37] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/29/2022] [Indexed: 02/01/2023] Open
Abstract
As the most common sustained arrhythmia, AF is a complex clinical entity which remains a difficult condition to durably treat in the majority of patients. Over the past few decades, the management of AF has focused mainly on pulmonary vein triggers for its initiation and perpetuation. It is well known that the autonomic nervous system (ANS) has a significant role in the milieu predisposing to the triggers, perpetuators and substrate for AF. Neuromodulation of ANS - ganglionated plexus ablation, vein of Marshall ethanol infusion, transcutaneous tragal stimulation, renal nerve denervation, stellate ganglion block and baroreceptor stimulation - constitute an emerging therapeutic approach for AF. The purpose of this review is to summarise and critically appraise the currently available evidence for neuromodulation modalities in AF.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | | | - Henry H Huang
- Department of Cardiology, Rush Medical College, Chicago, IL, US
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