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Taha A, Ali S, Atti L, Duhan S, Elseidy S, Khir F, Keisham B, Aziz S, Spaseski M, Erdem S, ElJack A, Almas T, Uppal D, Ali S, Alraies MC. Cardiovascular Outcomes and Readmissions of Atrial Fibrillation Among Patent Foramen Ovale Occluder Device Recipients: A Propensity Matched National Readmission Study. Curr Probl Cardiol 2024; 49:102115. [PMID: 37802160 DOI: 10.1016/j.cpcardiol.2023.102115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 09/30/2023] [Indexed: 10/08/2023]
Abstract
Patent foramen ovale (PFO) occluder devices are increasingly utilized in minimally invasive procedures used to treat cryptogenic stroke. Data on the impact of Atrial Fibrillation (AF) among PFO occluder device recipients are limited. The Nationwide Readmissions Database was queried between 2016 and 2019 to identify PFO patients with and without AF. The 2 groups were compared using propensity score matching (PSM) and multivariate regression models. The outcomes included in-hospital mortality, acute kidney injury (AKI), Mechanical circulatory support use (MCS), Cardiogenic shock (CS), acute ischemic stroke, bleeding, and other cardiovascular outcomes. Statistical analysis was performed using STATA v. 17. Out of 6508 Weighted hospitalizations for PFO occluder device procedure over the study period, 877 (13.4%) had AF compared to 5631 (86.6%) who did not. On adjusted analysis, PFO with AF group had higher rates of MCS (PSM, 4.5% vs 2.2 %, P value = 0.011) and SCA (PSM, 7.6% vs 4.6 %, P value = 0.015) compared to PFO with no AF. There was no statistically significant difference in the rate of in-hospital mortality (PSM, 5.4% vs 6.4 %, P value = 0.39), CS (PSM, 8.3% vs 5.9 %, P value = 0.075), AKI (PSM, 32.4% vs 32.3 %, P value = 0.96), bleeding (PSM, 2.08% vs 1.3%, P value = 0.235) or the readmission rates among both cohorts. Additionally, AF was associated with higher hospital length of stay (9.5 ± 13.2 vs 8.2 ± 24.3 days, P-value = 0.012) and total cost ($66,513 ± $80,922 vs $52,013±$125,136, 0.025, P-value = 0.025) compared to PFO without AF. AF among PFO occluder device recipients is associated with increased adverse outcomes, including MCS use and SCA, with no difference in mortality and readmission rates among both cohorts. Long-term follow-up needs further studies.
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Affiliation(s)
- Amro Taha
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL
| | - Shafaqat Ali
- Department of Internal Medicine, Louisiana State University, Shreveport, LA
| | - Lalitsiri Atti
- Department of Internal Medicine, Sparrow Hospital-Michigan State University, MI
| | - Sanchit Duhan
- Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD
| | - Sheref Elseidy
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY
| | - Fadi Khir
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL
| | - Bijeta Keisham
- Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD
| | - Sundal Aziz
- Department of Medicine, Khyber Medical University, Peshawar, Pakistan
| | - Maja Spaseski
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL
| | - Saliha Erdem
- Department of Internal Medicine, Wayne State University, Detroit Medical Center, MI
| | - Ammar ElJack
- Department of Cardiology, Baylor Scott and White Health, Heart Hospital Plano, TX
| | - Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Dipan Uppal
- Department of Cardiology, Cleveland Clinic, FL
| | - Shehzad Ali
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL
| | - M Chadi Alraies
- Department of Cardiology, Detroit Medical Center; Detroit, MI.
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Mann HK, Streiff M, Schultz KC, Halpern DV, Ferry D, Johnson AE, Magnani JW. Rurality and Atrial Fibrillation: Patient Perceptions of Barriers and Facilitators to Care. J Am Heart Assoc 2023; 12:e031152. [PMID: 37889198 PMCID: PMC10727401 DOI: 10.1161/jaha.123.031152] [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: 07/23/2023] [Accepted: 10/03/2023] [Indexed: 10/28/2023]
Abstract
Background Patients experience atrial fibrillation (AF) as a complex disease given its adversity, chronicity, and necessity for long-term treatments. Few studies have examined the experience of rural individuals with AF. We conducted qualitative assessments of patients with AF residing in rural, western Pennsylvania to identify barriers and facilitators to care. Methods and Results We conducted 8 semistructured virtual focus groups with 42 individuals living in rural western Pennsylvania using contextually tailored questions to assess participant perspectives. We inductively analyzed focus group transcripts using paragraph-by-paragraph and focused coding to identify themes with the qualitative description approach. We used Krippendorff α scoring to determine interreviewer reliability. We harnessed investigator triangulation to augment the reliability of our findings. We reached thematic saturation after coding 8 focus groups. Participants were 52.4% women, with a median age of 70.9 years (range, 54.5-82.0 years), and most were White race (92.9%). Participants identified medication costliness, invisibility of AF to others, and lack of emergent transportation as barriers to care. Participants described interpersonal support and use of technology as important for AF self-care, and expressed ambivalence about how relationships with health care providers affected AF care. Conclusions Focus group participants described multiple social and structural barriers to care for AF. Our findings highlight the complexity of the experience of individuals with AF residing in rural western Pennsylvania. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04076020.
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Affiliation(s)
| | - Meg Streiff
- University Center for Social and Urban ResearchUniversity of PittsburghPA
| | - Kevan C. Schultz
- University Center for Social and Urban ResearchUniversity of PittsburghPA
| | - David V. Halpern
- University Center for Social and Urban ResearchUniversity of PittsburghPA
| | - Danielle Ferry
- Center for Research on Health Care, Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA
| | - Amber E. Johnson
- Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA
| | - Jared W. Magnani
- Center for Research on Health Care, Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA
- Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA
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Teppo K, Jaakkola J, Biancari F, Halminen O, Linna M, Haukka J, Putaala J, Mustonen P, Kinnunen J, Luojus A, Itäinen-Strömberg S, Hartikainen J, Aro AL, Airaksinen KEJ, Lehto M. Rural-Urban differences in Use of Rhythm Control Therapies in Patients with Incident Atrial Fibrillation: A Finnish Nationwide Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11191. [PMID: 36141456 PMCID: PMC9517432 DOI: 10.3390/ijerph191811191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/30/2022] [Accepted: 09/03/2022] [Indexed: 06/16/2023]
Abstract
Background: Rural-urban disparities have been reported in the access, utilization, and quality of healthcare. We aimed to assess whether use of antiarrhythmic therapies (AATs) in patients with atrial fibrillation (AF) differs between those with rural and urban residence. Methods: The registry-based FinACAF cohort covers all patients with AF from all levels of care in Finland. Patients were divided into rural and urban categories and into urbanization degree tertiles based on their municipality of residence at the time of AF diagnosis. The primary outcome was the use of any AAT, including cardioversion, catheter ablation, and fulfilled antiarrhythmic drug (AAD) prescription. Results: We identified 177,529 patients (49.9% female, mean age 73.0 (SD13.0) years) with incident AF during 2010-2018. Except for AADs, the differences in AAT use were nonsignificant when patients were stratified according to the rural-urban classification system (urban vs. rural adjusted incidence rate ratios (aIRRs) with 95% CIs for any AAT 1.01 (0.99-1.03), AADs 1.11 (1.07-1.15), cardioversion 1.01 (0.98-1.03), catheter ablation 1.05 (0.98-1.12)). However, slightly higher use of all rhythm control modalities was observed in the highest urbanization degree tertile when compared to the lowest tertile (aIRRs with 95% Cis for any AAT 1.06 (1.03-1.08), AADs 1.18 (1.14-1.23), cardioversion 1.05 (1.02-1.08), catheter ablation 1.10 (1.02-1.19)). Conclusions: This nationwide retrospective cohort study observed that urban residence is associated with higher use of AADs in patients with incident AF. Otherwise, the observed disparities were only marginal, suggesting that in the use of rhythm control therapies, no large rural-urban inequity exists in Finland.
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Affiliation(s)
- Konsta Teppo
- Faculty of Medicine, University of Turku, 20500 Turku, Finland
| | - Jussi Jaakkola
- Faculty of Medicine, University of Turku, 20500 Turku, Finland
- Heart Unit, Satakunta Central Hospital, 28500 Pori, Finland
| | - Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland
| | - Olli Halminen
- Department of Industrial Engineering and Management, Aalto University, 02150 Espoo, Finland
| | - Miika Linna
- Department of Industrial Engineering and Management, Aalto University, 02150 Espoo, Finland
- University of Eastern Finland, 70211 Kuopio, Finland
| | - Jari Haukka
- University of Helsinki, 00014 Helsinki, Finland
| | - Jukka Putaala
- Neurology, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland
| | - Pirjo Mustonen
- Heart Center, Turku University Hospital, 20014 Turku, Finland
| | - Janne Kinnunen
- Neurology, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland
| | - Alex Luojus
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland
- University of Helsinki, 00014 Helsinki, Finland
| | - Saga Itäinen-Strömberg
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland
- University of Helsinki, 00014 Helsinki, Finland
| | - Juha Hartikainen
- University of Eastern Finland, 70211 Kuopio, Finland
- Heart Center, Kuopio University Hospital, 70210 Kuopio, Finland
| | - Aapo L. Aro
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland
- University of Helsinki, 00014 Helsinki, Finland
| | - K. E. Juhani Airaksinen
- Faculty of Medicine, University of Turku, 20500 Turku, Finland
- Heart Center, Turku University Hospital, 20014 Turku, Finland
| | - Mika Lehto
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00014 Helsinki, Finland
- University of Helsinki, 00014 Helsinki, Finland
- Department of Internal Medicine, Lohja Hospital, Lohja, Finland
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INCIDENCE OF NEW ONSET ATRIAL FIBRILLATION AFTER TRANSCATHETER PFO CLOSURE USING 15 YEARS OF ONTARIO ADMINISTRATIVE HEALTH DATA. Heart Rhythm 2022; 19:1414-1420. [DOI: 10.1016/j.hrthm.2022.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 03/17/2022] [Accepted: 04/05/2022] [Indexed: 12/19/2022]
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Shinoda Y, Sato A, Adach T, Nishi I, Nogami A, Aonuma K, Ieda M. Early clinical experience of radiofrequency catheter ablation using an audiovisual telesupport system. Heart Rhythm 2021; 17:870-875. [PMID: 32354452 DOI: 10.1016/j.hrthm.2020.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND An audiovisual telesupport system that enables real-time audiovisual communications between 2 long-distance hospitals is one method of telemedicine. The usefulness and safety of radiofrequency catheter ablation (RFCA) using an audiovisual telesupport system has not been well established. OBJECTIVE The purpose of this study was to evaluate the effectiveness and safety of RFCA using an audiovisual telesupport system. METHODS An audiovisual telesupport system using a strictly secured virtual network was established between Kamisu Saiseikai Hospital (operator with 10 years' experience and 800 procedures) and the University of Tsukuba (advisor with >20 years' experience and 8000 procedures). We evaluated 19 initial consecutive patients who underwent RFCA using this system for tachyarrhythmia: 10 with atrial fibrillation (AF), 5 with paroxysmal supraventricular tachycardia (PSVT), 3 with premature ventricular contraction (PVC), and 1 with atrial flutter. Electrophysiological and procedural characteristics were retrospectively assessed. RESULTS Acute success was achieved in all 19 patients without any major complications, with the advisor's audiovisual assistance. Mean procedure time and fluoroscopic time were 161 ± 44 minutes and 24 ± 14 minutes for AF, 110 ± 17 minutes and 28 ± 8 minutes for PVC, and 132 ± 19 minutes and 32 ± 2 minutes for PSVT, respectively. There was no recurrence of clinical arrhythmia in 17 of the 19 patients (89%) during 13 ± 9 month follow-up. CONCLUSION An audiovisual telesupport system for RFCA is a useful and safe method that enabled the electrophysiologist with limited human resources to make an optimal decision regarding procedural strategy and endpoint with the remote advisor's audiovisual assistance.
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Affiliation(s)
- Yasutoshi Shinoda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan; Department of Internal Medicine, Kamisu Saiseikai Hospital, Kamisu, Japan
| | - Akira Sato
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Toru Adach
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Isao Nishi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan; Department of Internal Medicine, Kamisu Saiseikai Hospital, Kamisu, Japan
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Lunde ED, Nielsen PB, Riahi S, Larsen TB, Lip GYH, Fonager K, Larsen ML, Joensen AM. Associations between socioeconomic status, atrial fibrillation, and outcomes: a systematic review. Expert Rev Cardiovasc Ther 2018; 16:857-873. [PMID: 30293472 DOI: 10.1080/14779072.2018.1533118] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/01/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is a growing epidemic and evidence of a relationship to socioeconomic status (SES) is inconsistent. We aimed to summarize the literature about SES and AF and defined two objectives: (1) To examine the association between SES and the risk of AF; (2) To examine the association between SES and AF-related outcomes in an AF-population. METHODS We performed a separate search for each objective in Ovid-MEDLINE and Ovid-Embase. For objective 1, the population included was healthy participants and outcome of interest was AF. For objective 2, the population included were patients with AF and outcome of interest was mortality, treatment, ablation for AF, knowledge about AF, and morbidity. RESULTS For objective 1, 12 studies were included. No consistent pattern for an association between SES and the risk of AF was discovered. For objective 2, 39 studies comprising 42 outcomes were included. The majority of studies showed an association between low SES and increased mortality and morbidity. CONCLUSION Low SES was associated with poorer outcomes when AF was present. These findings may imply that health-care professionals and policy interventions should focus on the promotion of AF-education and management among patients with AF and low SES.
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Affiliation(s)
| | - Peter Brønnum Nielsen
- a Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
- b Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health , Aalborg University , Aalborg , Denmark
| | - Sam Riahi
- a Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
- c Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
- d Atrial Fibrillation Study Group , Aalborg University Hospital , Aalborg , Denmark
| | - Torben Bjerregaard Larsen
- a Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
- b Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health , Aalborg University , Aalborg , Denmark
- d Atrial Fibrillation Study Group , Aalborg University Hospital , Aalborg , Denmark
| | - Gregory Y H Lip
- b Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health , Aalborg University , Aalborg , Denmark
- e Institute of Cardiovascular Sciences , University of Birmingham , UK
| | - Kirsten Fonager
- c Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
- f Department of Social Medicine , Aalborg University Hospital , Aalborg , Denmark
| | - Mogens Lytken Larsen
- a Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
- c Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
- g Danish Centre of Inequality in Health, Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
| | - Albert Marni Joensen
- a Department of Cardiology , Aalborg University Hospital , Aalborg , Denmark
- c Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
- d Atrial Fibrillation Study Group , Aalborg University Hospital , Aalborg , Denmark
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