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Magtibay K, Massé S, Nanthakumar K, Umapathy K. Effects of spatially dense adrenergic stimulation to rotor behaviour in simulated atrial sheets. Comput Biol Med 2024; 182:109195. [PMID: 39332114 DOI: 10.1016/j.compbiomed.2024.109195] [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: 01/02/2024] [Revised: 08/21/2024] [Accepted: 09/21/2024] [Indexed: 09/29/2024]
Abstract
Sympathetic hyperactivity via spatially dense adrenergic stimulation may create pro-arrhythmic substrates even without structural remodelling. However, the effect of sympathetic hyperactivity on arrhythmic activity, such as rotors, is unknown. Using simulations, we examined the effects of gradually increasing the spatial density of adrenergic stimulation (AS) in atrial sheets on rotors. We compared their characteristics against rotors hosted in atrial sheets with increasing spatial density of minimally conductive (MC) elements to simulate structural remodelling due to injury or disease. We generated rotors using an S1-S2 stimulation protocol. Then, we created phase maps to identify phase singularities and map their trajectory over time. We measured each rotor's duration (s), angular speed (rad/s), and spatiotemporal organization. We demonstrated that atrial sheets with increased AS spatial densities could maintain rotors longer than with MC elements (2.6 ± 0.1 s vs. 1.5 ± 0.2 s, p<0.001). Moreover, rotors have higher angular speed (70 ± 7 rads/s vs. 60 ± 15 rads/s, p<0.05) and better spatiotemporal organization (0.56 ± 0.05 vs. 0.58 ± 0.18, p<0.05) in atrial sheets with less than 25% AS elements compared to MC elements. Our findings may help elucidate electrophysiological potential alterations in atrial substrates due to sympathetic hyperactivity, particularly among individuals with autonomic derangements caused by chronic distress.
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Affiliation(s)
- Karl Magtibay
- Biomedical Signal and Image Processing Laboratory, Department of Electrical, Computer, and Biomedical Engineering, Faculty of Engineering and Architectural Science, Toronto Metropolitan University, 350 Victoria St, Toronto, M5B 2K3, ON, Canada.
| | - Stéphane Massé
- Toby Hull Cardiac Fibrillation Management, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, M5G 2C4, ON, Canada.
| | - Kumaraswamy Nanthakumar
- Toby Hull Cardiac Fibrillation Management, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, M5G 2C4, ON, Canada.
| | - Karthikeyan Umapathy
- Biomedical Signal and Image Processing Laboratory, Department of Electrical, Computer, and Biomedical Engineering, Faculty of Engineering and Architectural Science, Toronto Metropolitan University, 350 Victoria St, Toronto, M5B 2K3, ON, Canada.
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Moor J, Kuhne M, Moschovitis G, Kobza R, Netzer S, Auricchio A, Beer JH, Bonati L, Reichlin T, Conen D, Osswald S, Rodondi N, Clair C, Baumgartner C, Aubert CE. Sex-specific association of cardiovascular drug doses with adverse outcomes in atrial fibrillation. Open Heart 2024; 11:e002720. [PMID: 39134361 PMCID: PMC11331917 DOI: 10.1136/openhrt-2024-002720] [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: 04/19/2024] [Accepted: 07/19/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVES Sex differences occur in atrial fibrillation (AF), including age at first manifestation, pathophysiology, treatment allocation, complication rates and quality of life. However, optimal doses of cardiovascular pharmacotherapy used in women with AF with or without heart failure (HF) are unclear. We investigated sex-specific associations of beta-blocker and renin-angiotensin system (RAS) inhibitor doses with cardiovascular outcomes in patients with AF or AF with concomitant HF. METHODS We used data from the prospective Basel Atrial Fibrillation and Swiss Atrial Fibrillation cohorts on patients with AF. The outcome was major adverse cardiovascular events (MACEs), including death, myocardial infarction, stroke, systemic embolisation and HF-related hospitalisation. Predictors of interest were spline (primary analysis) or quartiles (secondary analysis) of beta-blocker or RAS inhibitor dose in per cent of the maximum dose (reference), in interaction with sex. Cox models were adjusted for demographics, comorbidities and comedication. RESULTS Among 3961 patients (28% women), MACEs occurred in 1113 (28%) patients over a 5-year median follow-up. Distributions of RAS inhibitor and beta-blocker doses were similar in women and men. Cox models revealed no association between beta-blocker dose or RAS inhibitor dose and MACE. In a subgroup of patients with AF and HF, the lowest hazard of MACE was observed in women prescribed 100% of the RAS inhibitor dose. However, there was no association between RAS dose quartiles and MACE. CONCLUSIONS In this study of patients with AF, doses of beta-blockers and RAS inhibitors did not differ by sex and were not associated with MACE overall.
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Affiliation(s)
- Jeanne Moor
- Department of General Internal Medicine, Inselspital University Hospital Bern, Bern, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Michael Kuhne
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
| | - Giorgio Moschovitis
- Cardiology Regional Hospital of Lugano, Cardiocentro Ticino, Lugano, Switzerland
| | - Richard Kobza
- Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Seraina Netzer
- Department of General Internal Medicine, Inselspital University Hospital Bern, Bern, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Angelo Auricchio
- Cardiology Regional Hospital of Lugano, Cardiocentro Ticino, Lugano, Switzerland
| | - Juerg H Beer
- Department of Medicine, Baden Cantonal Hospital, Baden, Switzerland
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Leo Bonati
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital University Hospital Bern, Bern, Switzerland
| | - David Conen
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Stefan Osswald
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital University Hospital Bern, Bern, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Carole Clair
- Department of Ambulatory Care, University of Lausanne, Lausanne, Switzerland
| | - Christine Baumgartner
- Department of General Internal Medicine, Inselspital University Hospital Bern, Bern, Switzerland
| | - Carole Elodie Aubert
- Department of General Internal Medicine, Inselspital University Hospital Bern, Bern, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
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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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Kogelschatz B, Zenger B, Steinberg BA, Ranjan R, Jared Bunch T. Atrial fibrillation and the risk of early-onset dementia and cognitive decline: An updated review. Trends Cardiovasc Med 2024; 34:236-241. [PMID: 36702389 DOI: 10.1016/j.tcm.2023.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/02/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023]
Abstract
The relationship between atrial fibrillation (AF) and dementia has been well described; however, recent data suggest that AF confers a greater risk for the development of early-onset dementia irrespective of clinical stroke. Numerous mechanisms have been hypothesized to explain cognitive decline in the setting of AF, including silent cerebral ischemia, cerebral hypoperfusion, and cerebral microvascular disease. Despite the emergence of data supporting the increased risk of early-onset dementia in patients with AF, the underlying mechanism remains unclear. Furthermore, the mechanism may be influenced by survival bias, genetic susceptibility, or early dysfunction of brain adaptation. Investigation into why this relationship exists could change how prevention and treatment are evaluated.
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Affiliation(s)
- Benjamin Kogelschatz
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA
| | - Brian Zenger
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA
| | - Benjamin A Steinberg
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA
| | - Ravi Ranjan
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA
| | - T Jared Bunch
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132 USA.
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5
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Kataoka N, Imamura T. Association between depression, quality of life, and ablation for atrial fibrillation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01739-5. [PMID: 38261102 DOI: 10.1007/s10840-024-01739-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Affiliation(s)
- Naoya Kataoka
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan.
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Mulder BA, Khalilian Ekrami N, Van De Lande ME, Nguyen BO, Weberndorfer V, Crijns HJ, Geelhoed B, Blaauw Y, Hemels ME, Tieleman RG, Scheerder CO, De Melis M, Schotten U, Linz D, Van Gelder IC, Rienstra M. Women have less progression of paroxysmal atrial fibrillation: data from the RACE V study. Open Heart 2023; 10:e002534. [PMID: 38135341 DOI: 10.1136/openhrt-2023-002534] [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: 10/31/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Sex differences in atrial fibrillation (AF) are observed in terms of comorbidities, symptoms, therapies received, AF progression and cardiovascular complications. METHODS We assessed the differences in prevalence and the determinants of AF progression, as well as the clinical characteristics and quality of life (QoL), between women and men with paroxysmal AF included in the RACE V (Reappraisal of Atrial Fibrillation: Interaction between hyperCoagulability, Electrical remodeling, and Vascular Destabilisation in the Progression of AF) study. At baseline, extensive phenotyping was done. To assess AF progression, implantable loop recorder (ILR) monitoring was used throughout follow-up. AF progression was defined as (1) progression to persistent or permanent AF or (2) progression of paroxysmal AF (>3% burden increase). RESULTS 417 patients were included, 179 (43%) of whom were women. Women were older (median 67 years vs 63 years, p<0.001), less often had coronary artery disease (n=11 (6%) vs n=36 (16%), p=0.003), had more obesity (n=57 (32%) vs n=50 (21%), p=0.013), had less epicardial and pericardial fat (median 144 (interquartile range [IQR] 94-191) mL vs 199 (IQR 146-248) mL, p<0.001; and median 89 (ICQ 61-121) mL vs 105 (IQR 83-133) mL, p<0.001, respectively) and had more impaired left atrial function. The median follow-up was 2.2 (1.6-2.8) years. 51 of 417 patients (5.5% per year) showed AF progression (15/179 (8.4%) women and 36/238 (15.1%) men, p=0.032). Multivariable analysis showed tissue factor pathway inhibitor, N-terminal prohormone brain natriuretic peptide (NT-proBNP) and PR interval being associated with AF progression in women and factor XIIa:C1 esterase, NT-proBNP and proprotein convertase subtilisin/kexin type 9 in men. QoL was not different between sexes. CONCLUSION Despite older age, the incidence of AF progression was lower in women. Parameters associated with AF progression varied in part between sexes, suggesting different underlying pathophysiological mechanisms.
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Affiliation(s)
- Bart A Mulder
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Neda Khalilian Ekrami
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Martijn E Van De Lande
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Bao-Oanh Nguyen
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Harry J Crijns
- Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Bastiaan Geelhoed
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Yuri Blaauw
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Ew Hemels
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Cardiology, Radboud Universiteit Nijmegen, Nijmegen, The Netherlands
| | | | | | - Mirko De Melis
- Medtronic Bakken Research Center BV, Maastricht, The Netherlands
| | - Ulrich Schotten
- Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
- Physiology, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Dominik Linz
- Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Isabelle C Van Gelder
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
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Du M, Cheng T, Ye Y, Wei Y. Prevalence and Risk Factors of Postprocedure Depression in Patients with Atrial Fibrillation after Radiofrequency Ablation. Cardiol Res Pract 2023; 2023:4635336. [PMID: 38020945 PMCID: PMC10645489 DOI: 10.1155/2023/4635336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/02/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background Recent studies have shown a bidirectional relationship between atrial fibrillation (AF) and psychological depression. However, little is known about the prevalence of postprocedure depression (PPD) in patients with AF at the time of radiofrequency (RF) ablation. Objective To describe the prevalence and identify risk factors for PPD. Methods This was a prospective cohort study, including 428 AF patients who were willing to undergo the first catheter ablation in our hospital from 1st April to 30th December 2019. The primary outcome was PPD, which was determined by Hospital Anxiety and Depression Scale-Depression. Results The prevalence of PPD was 16.8% (72/428) in our cohort, without difference between men (16.0%, 41/256) and women (18.0%, 31/172) (P = 0.586) but with a great difference among different age groups (P = 0.016). On the univariable binary logistic regression analysis, age, a history of coronary heart disease, Observer's Assessment of Alertness/Sedation (OAA/S) score when ablating at the specific position, and OAA/S score when pulling out the catheter sheath were associated with PPD. Subsequent multivariable logistic regression analysis indicated only age (OR 0.96, 95% CI: 0.94-0.99, P < 0.01) and OAA/S score when ablating at the specific position (OR 0.58, 95% CI: 0.39-0.88, P = 0.01) were independently associated with PPD. Conclusion PPD is common in patients with AF after RF ablation. Younger age and lower OAA/S score when ablating at the specific position are its most significant risk factors. Intensive management of sedation may be of great importance for reducing PPD. This trial is registered with the Chinese Clinical Trial Registry (ChiCTR2200057810).
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Affiliation(s)
- Mingli Du
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tieniu Cheng
- Department of Cardiology, Tongling People's Hospital, Tongling, Anhui, China
| | - Yutong Ye
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Wei
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Gaffey AE, Rosman L, Lampert R, Yaggi HK, Haskell SG, Brandt CA, Enriquez AD, Mazzella AJ, Skanderson M, Burg MM. Insomnia and Early Incident Atrial Fibrillation: A 16-Year Cohort Study of Younger Men and Women Veterans. J Am Heart Assoc 2023; 12:e030331. [PMID: 37791503 PMCID: PMC10757545 DOI: 10.1161/jaha.123.030331] [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: 03/27/2023] [Accepted: 07/24/2023] [Indexed: 10/05/2023]
Abstract
Background There is growing consideration of sleep disturbances and disorders in early cardiovascular risk, including atrial fibrillation (AF). Obstructive sleep apnea confers risk for AF but is highly comorbid with insomnia, another common sleep disorder. We sought to first determine the association of insomnia and early incident AF risk, and second, to determine if AF onset is earlier among those with insomnia. Methods and Results This retrospective analysis used electronic health records from a cohort study of US veterans who were discharged from military service since October 1, 2001 (ie, post-9/11) and received Veterans Health Administration care, 2001 to 2017. Time-varying, multivariate Cox proportional hazard models were used to examine the independent contribution of insomnia diagnosis to AF incidence while serially adjusting for demographics, lifestyle factors, clinical comorbidities including obstructive sleep apnea and psychiatric disorders, and health care utilization. Overall, 1 063 723 post-9/11 veterans (Mean age=28.2 years, 14% women) were followed for 10 years on average. There were 4168 cases of AF (0.42/1000 person-years). Insomnia was associated with a 32% greater adjusted risk of AF (95% CI, 1.21-1.43), and veterans with insomnia showed AF onset up to 2 years earlier. Insomnia-AF associations were similar after accounting for health care utilization (adjusted hazard ratio [aHR], 1.27 [95% CI, 1.17-1.39]), excluding veterans with obstructive sleep apnea (aHR, 1.38 [95% CI, 1.24-1.53]), and among those with a sleep study (aHR, 1.26 [95% CI, 1.07-1.50]). Conclusions In younger adults, insomnia was independently associated with incident AF. Additional studies should determine if this association differs by sex and if behavioral or pharmacological treatment for insomnia attenuates AF risk.
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Affiliation(s)
- Allison E. Gaffey
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Internal Medicine (Cardiovascular Medicine)Yale School of MedicineNew HavenCTUSA
| | - Lindsey Rosman
- Division of Cardiology, Department of MedicineUniversity of North Carolina, Chapel HillChapel HillNCUSA
| | - Rachel Lampert
- Department of Internal Medicine (Cardiovascular Medicine)Yale School of MedicineNew HavenCTUSA
| | - Henry K. Yaggi
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Internal Medicine (Pulmonary, Critical Care & Sleep Medicine)Yale School of MedicineCTNew HavenUSA
| | - Sally G. Haskell
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Internal Medicine (General Medicine)Yale School of MedicineNew HavenCTUSA
| | - Cynthia A. Brandt
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Emergency MedicineYale School of MedicineNew HavenCTUSA
- Yale Center for Medical InformaticsYale School of MedicineNew HavenCTUSA
| | - Alan D. Enriquez
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Internal Medicine (Cardiovascular Medicine)Yale School of MedicineNew HavenCTUSA
| | - Anthony J. Mazzella
- Division of Cardiology, Department of MedicineUniversity of North Carolina, Chapel HillChapel HillNCUSA
| | | | - Matthew M. Burg
- VA Connecticut Healthcare SystemWest HavenCTUSA
- Department of Internal Medicine (Cardiovascular Medicine)Yale School of MedicineNew HavenCTUSA
- Department of AnesthesiologyYale School of MedicineNew HavenCTUSA
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9
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Rush KL, Seaton CL, Burton L, Loewen P, O’Connor BP, Moroz L, Corman K, Smith MA, Andrade JG. Quality of life among patients with atrial fibrillation: A theoretically-guided cross-sectional study. PLoS One 2023; 18:e0291575. [PMID: 37797044 PMCID: PMC10553272 DOI: 10.1371/journal.pone.0291575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/31/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Patients with atrial fibrillation (AF) have significantly lower health-related quality of life (HRQoL) compared to the general population and patients with other heart diseases. The research emphasis on the influence of AF symptoms on HRQoL overshadows the role of individual characteristics. To address this gap, this study's purpose was to test an incremental predictive model for AF-related HRQoL following an adapted HRQoL conceptual model that incorporates both symptoms and individual characteristics. METHODS Patients attending an AF specialty clinic were invited to complete an online survey. Hierarchical regression analyses were conducted to examine whether individual characteristics (overall mental health, perceived stress, sex, age, AF knowledge, household and recreational physical activity) incremented prediction of HRQoL and AF treatment satisfaction beyond AF symptom recency and overall health. RESULTS Of 196 participants (mean age 65.3 years), 63% were male and 90% were Caucasian. Most reported 'excellent' or 'good' overall and mental health, had high overall AF knowledge scores, had low perceived stress scores, and had high household and recreation physical activity. The mean overall AF Effect On Quality-Of-Life Questionnaire (AFEQT) and AF treatment satisfaction scores were 70.62 and 73.84, respectively. Recency of AF symptoms and overall health accounted for 29.6% of the variance in overall HRQoL and 20.2% of the variance in AF treatment satisfaction. Individual characteristics explained an additional 13.6% of the variance in overall HRQoL and 7.6% of the variance in AF treatment satisfaction. Perceived stress and household physical activity were the largest contributors to overall HRQoL, whereas age and AF knowledge made significant contributions to AF treatment satisfaction. CONCLUSIONS Along with AF symptoms and overall health, individual characteristics are important predictors of HRQoL and AF treatment satisfaction in AF patients. In particular, perceived stress and household physical activity could further be targeted as potential areas to improve HRQoL.
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Affiliation(s)
- Kathy L. Rush
- School of Nursing, University of British Columbia, Okanagan, Kelowna, BC, Canada
| | - Cherisse L. Seaton
- School of Nursing, University of British Columbia, Okanagan, Kelowna, BC, Canada
| | - Lindsay Burton
- School of Nursing, University of British Columbia, Okanagan, Kelowna, BC, Canada
| | - Peter Loewen
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Vancouver, BC, Canada
| | - Brian P. O’Connor
- Department of Psychology, University of British Columbia, Okanagan, Kelowna, Canada
| | - Lana Moroz
- Cardiac Atrial Fibrillation Specialty Clinic, Vancouver General Hospital, Vancouver, BC, Canada
| | - Kendra Corman
- School of Nursing, University of British Columbia, Okanagan, Kelowna, BC, Canada
| | - Mindy A. Smith
- Department of Family Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - Jason G. Andrade
- Cardiac Atrial Fibrillation Specialty Clinic, Vancouver General Hospital, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
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10
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Roy R, Mayer MM, Dzekem BS, Laiteerapong N. Screening for Emotional Distress in Patients with Cardiovascular Disease. Curr Cardiol Rep 2023; 25:1165-1174. [PMID: 37610597 DOI: 10.1007/s11886-023-01936-0] [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] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE OF REVIEW In this article, we discuss the relationship between emotional distress and common cardiovascular disease condition, including coronary artery disease, atrial fibrillation, congestive heart failure, mechanical circulatory support, and heart transplant. We review screening measures that have been studied and used in clinical practice for each condition, as well as priorities for future research. RECENT FINDINGS Studies consistently demonstrate failing to identify and treat emotional distress in patients with cardiovascular disease is associated with adverse outcomes. However, routine emotional distress screening is not formally recommended for all cardiovascular disease conditions and is limited to depression screening in select patient populations. Future research should focus on evaluating the validity and reliability of standardized screening measures across the scope of emotional distress in patients with or at risk for cardiovascular disease. Other areas of future research include implementation of evidence-based pharmaceutical treatments and integrated behavioral health approaches and interventions.
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Affiliation(s)
- Rukmini Roy
- Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 3051, Chicago, IL 60637, USA
| | - Michael M Mayer
- Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 3051, Chicago, IL 60637, USA
| | - Bonaventure S Dzekem
- Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 3051, Chicago, IL 60637, USA
| | - Neda Laiteerapong
- Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 3051, Chicago, IL 60637, USA.
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S Maryland Avenue, MC 3051, Chicago, IL 60637, USA.
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Ahn HJ, Lee SR, Choi EK, Bae NY, Ahn HJ, Kwon S, Lee SW, Han KD, Oh S, Lip GYH. Increased risk of incident atrial fibrillation in young adults with mental disorders: A nationwide population-based study. Heart Rhythm 2023; 20:365-373. [PMID: 36563829 DOI: 10.1016/j.hrthm.2022.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/09/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Mental disorders and cardiovascular diseases are closely related. However, a paucity of information on the risk of incident atrial fibrillation (AF) in patients with mental disorders exists. OBJECTIVE We aimed to assess the association between mental disorders and the risk of AF, particularly in young adults. METHODS Using the Korean National Health Insurance Database between 2009 and 2012, we identified adults aged 20-39 years without a history of AF and who have been diagnosed with mental disorders. Mental disorders were defined as having one of the following diagnoses: depression, insomnia, anxiety disorder, bipolar disorder, or schizophrenia. The primary outcome was new-onset AF during follow-up. RESULTS A total of 6,576,582 subjects (mean age 30.9 ± 5.0 years; 3,919,339 [59.6%] men) were included. Among the total population, 10% had mental disorders. During the follow-up period, 8932 incident AF events occurred. Patients with mental disorders showed a higher AF incidence than did those without (25.4 per 100,000 person-years vs 17.7 per 100,000 person-years). After multivariable adjustment, mental disorders were associated with a significantly higher risk of AF (adjusted hazard ratio 1.526; 95% confidence interval 1.436-1.621). Patients with bipolar disorder or schizophrenia had a 2-fold higher risk of AF and those with depression, insomnia, and anxiety disorder had a 1.5- to 1.7-fold higher risk of AF than did those without mental disorders. CONCLUSION Young adults diagnosed with mental disorders have a higher risk of incident AF. Awareness for AF in high-risk populations should thus be considered.
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Affiliation(s)
- Hyun Jin Ahn
- 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
| | - 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.
| | - Nan Young Bae
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo-Jeong Ahn
- 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
| | - Seung-Woo Lee
- Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-Do Han
- Statistics and Actuarial Science, Soongsil University, 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
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Chest and Heart Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Bae NY, Lee SR, Choi EK, Ahn HJ, Ahn HJ, Kwon S, Han KD, Lee KN, Oh S, Lip GYH. Impact of mental disorders on the risk of atrial fibrillation in patients with diabetes mellitus: a nationwide population-based study. Cardiovasc Diabetol 2022; 21:251. [PMID: 36397079 PMCID: PMC9673441 DOI: 10.1186/s12933-022-01682-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/20/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND It is unclear whether mental disorders are an independent risk factor for atrial fibrillation (AF) in patients with diabetes. We aimed to investigate whether patients with diabetes who have mental disorders have an increased risk for AF. METHODS Using the Korea National Health Insurance Service database, we enrolled 2,512,690 patients diagnosed with diabetes without AF between 2009 and 2012. We assessed five mental disorders: depression, insomnia, anxiety, bipolar disorder, and schizophrenia. Newly diagnosed AF was identified during the follow-up period, and multivariate Cox regression analysis was performed. RESULTS Among the 2,512,690 patients (mean age 57.2 ± 12.3 years; 60.1% men), 828,929 (33.0%) had mental disorders. Among the five mental disorders, anxiety (68.1%) was the most common, followed by insomnia (40.0%). During a median follow-up duration of 7.1 years, new-onset AF was diagnosed in 79,525 patients (4.66 per 1,000 person-years). Patients with diabetes who had mental disorders showed a higher risk for AF (adjusted hazard ratio [HR] 1.19; 95% confidence interval [CI] 1.17-1.21; p-value < 0.001). Depression, insomnia, and anxiety were significantly associated with higher risk for AF (adjusted HR [95% CI]: 1.15 [1.12-1.17], 1.15 [1.13-1.18], and 1.19 [1.67-1.21], respectively; all p-values < 0.001), whereas bipolar disorder and schizophrenia were not. CONCLUSIONS Mental disorders, especially depression, insomnia, and anxiety, were associated with an increased risk for AF in patients with diabetes. Greater awareness with a prompt diagnosis of AF should be considered for patients with both DM and mental disorders.
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Affiliation(s)
- Nan Young Bae
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - So-Ryoung Lee
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Eue-Keun Choi
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea ,grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Jin Ahn
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Hyo-Jeong Ahn
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Soonil Kwon
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Kyung-Do Han
- grid.263765.30000 0004 0533 3568Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Kyu-Na Lee
- grid.263765.30000 0004 0533 3568Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Seil Oh
- grid.412484.f0000 0001 0302 820XDepartment of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea ,grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gregory Y. H. Lip
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea ,grid.10025.360000 0004 1936 8470Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Chest & Heart Hospital, Liverpool, UK ,grid.5117.20000 0001 0742 471XDepartment of Clinical Medicine, Aalborg University, Aalborg, Denmark
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