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Gavrilova A, Zolovs M, Šmits D, Ņikitina A, Latkovskis G, Urtāne I. Role of a National Health Service Electronic Prescriptions Database in the Detection of Prescribing and Dispensing Issues and Adherence Evaluation of Direct Oral Anticoagulants. Healthcare (Basel) 2024; 12:975. [PMID: 38786385 PMCID: PMC11121004 DOI: 10.3390/healthcare12100975] [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: 03/28/2024] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Anticoagulation therapy plays a crucial role in the management of atrial fibrillation (AF) by significantly reducing the risk of stroke. Direct oral anticoagulants (DOAC) became preferred over warfarin due to their superior safety and efficacy profile. Assessing adherence to anticoagulation therapy is necessary in clinical practice for optimising patient outcomes and treatment efficacy, thus emphasising its significance. METHODS A retrospective study utilised the Latvian National Health Service reimbursement prescriptions database, covering prescriptions for AF and flutter from January 2012 to December 2022. The proportion of days covered method was selected for adherence assessment, categorising it into three groups: (1) below 80%, (2) between 80% and 90%, and (3) above 90%. RESULTS A total of 1,646,648 prescriptions were analysed. Dabigatran prescriptions started declining after 2020, coinciding with a decrease in warfarin prescriptions since 2018. The total adherence levels to DOAC therapy were 69.4%. Only 44.2% of users achieved an adherence level exceeding 80%. The rate of paper prescriptions decreased from 98.5% in 2017 to 1.3% in 2022. Additionally, the utilisation of international non-proprietary names reached 79.7% in 2022. Specifically, 16.7% of patients selected a single pharmacy, whereas 27.7% visited one or two pharmacies. Meanwhile, other patients obtained medicines from multiple pharmacies. CONCLUSIONS The total adherence level to DOAC therapy is evaluated as low and there was no significant difference in age, gender, or "switcher" status among adherence groups. Physicians' prescribing habits have changed over a decade.
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Affiliation(s)
- Anna Gavrilova
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Rīga Stradiņš University, LV-1007 Riga, Latvia
| | - Maksims Zolovs
- Statistical Unit, Faculty of Medicine, Rīga Stradiņš University, LV-1007 Riga, Latvia
- Institute of Life Sciences and Technology, Daugavpils University, LV-5401 Daugavpils, Latvia
| | - Dins Šmits
- Department of Public Health and Epidemiology, Faculty of Health and Sports Sciences, Rīga Stradiņš University, LV-1007 Riga, Latvia
| | | | - Gustavs Latkovskis
- Institute of Cardiology and Regenerative Medicine, University of Latvia, LV-1586 Riga, Latvia
- Latvian Center of Cardiology, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia
| | - Inga Urtāne
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Rīga Stradiņš University, LV-1007 Riga, Latvia
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Zhang S, Zuo P. Obesity-hyperlipidemia, Hypertension, and Left Atrial Enlargement During Stroke in Young Adults. Neurologist 2023; 28:386-390. [PMID: 37582559 PMCID: PMC10627530 DOI: 10.1097/nrl.0000000000000505] [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] [Indexed: 08/17/2023]
Abstract
BACKGROUND This study investigated the association between left atrial enlargement and stroke severity in young adults. We also studied the differences between the normal and left atrial enlargement groups in clinical data. METHODS A total of 135 young stroke patients admitted to the Department of Neurology of the Taizhou People's Hospital were recruited from January 2018 to December 2021. The patients were divided into normal and enlarged groups by left atrial size. The relationship between the left atrial diameter and the National Institutes of Health Stroke Scale score was analyzed apart from the differences in clinical variables. RESULTS No relationship was observed between the left atrial diameter and the National Institutes of Health Stroke Scale score ( r =-0.045 P =0.603). The univariate analysis of both groups revealed that hypertension ( P =0.004), hyperlipidemia ( P =0.001), body mass index ( P =0.000), obesity ( P =0.015), and not stroke etiologic subtypes were associated with left atrial enlargement. In binary logistic regression analysis models, hyperlipidemia 3.384 (95% CI, 1.536 to 7.452), hypertension 2.661 (95% CI, 1.066 to 6.639), and obesity 2.858 (95% CI, 1.158 to 7.052) were significantly associated with the young stroke of left atrial enlargement. CONCLUSIONS In young adults, obesity-hyperlipidemia and hypertension were significantly associated with left atrial enlargement in stroke.
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Hewage S, Jadamba A, Brain D, Parsonage W, McPhail S, Kularatna S. Global and regional burden of ischemic stroke associated with atrial fibrillation, 2009-2019. Prev Med 2023; 173:107584. [PMID: 37348767 DOI: 10.1016/j.ypmed.2023.107584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/27/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023]
Abstract
The extent of the preventable burden of ischaemic stroke associated with atrial fibrillation (AF) remains uncertain to date. To address this knowledge gap, we utilised the comparative risk assessment methodology to estimate the burden of ischaemic stroke associated with AF at both global and regional levels. The population attributable fraction for ischaemic stroke and AF was obtained from published literature, while data on the prevalence, incidence, deaths, and disability-adjusted life years (DALY) associated with ischaemic stroke were sourced from the Global Burden of Disease study database. Our analysis revealed that in 2019, globally, there were an estimated 0.7 (95% uncertainty interval [UI] of 0.55 to 0.83) million incident cases, 6.9 (5.81 to 8.12) million prevalence cases, 0.3 0.25 to 0.34) million deaths and 5.7 (4.91 to 6.57) million DALY resulting from ischaemic stroke associated with AF. The age-standardised death and DALY rates declined between 2009 and 2019 in all regions to varying degrees. Conversely, the age-standardised incidence and prevalence rates reduced only in high-income countries, Central Europe, Eastern Europe and Central Asia and Latin America and Caribbean regions. It is likely that our findings under-estimated the true burden of ischaemic stroke associated with AF due to limitations such as the use of a fixed population attributable fraction and poor quality of data. Nevertheless, we believe that our estimates provide valuable insights and highlight the urgent need for optimised management of AF through the implementation of efficacious interventions. Such efforts can help reduce the occurrence of preventable ischaemic strokes.
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Affiliation(s)
- Sumudu Hewage
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia.
| | - Amarzaya Jadamba
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia
| | - David Brain
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia
| | - William Parsonage
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia; Cardiology Department, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Steven McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia; Digital Health and Informatics Directorate, Metro South Health, Queensland, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia
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Trohman RG, Huang HD, Sharma PS. Atrial fibrillation: primary prevention, secondary prevention, and prevention of thromboembolic complications: part 1. Front Cardiovasc Med 2023; 10:1060030. [PMID: 37396596 PMCID: PMC10311453 DOI: 10.3389/fcvm.2023.1060030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 03/14/2023] [Indexed: 07/04/2023] Open
Abstract
Atrial fibrillation (AF), is the most common sustained cardiac arrhythmia. It was once thought to be benign as long as the ventricular rate was controlled, however, AF is associated with significant cardiac morbidity and mortality. Increasing life expectancy driven by improved health care and decreased fertility rates has, in most of the world, resulted in the population aged ≥65 years growing more rapidly than the overall population. As the population ages, projections suggest that the burden of AF may increase more than 60% by 2050. Although considerable progress has been made in the treatment and management of AF, primary prevention, secondary prevention, and prevention of thromboembolic complications remain a work in progress. This narrative review was facilitated by a MEDLINE search to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and other clinically relevant studies. The search was limited to English-language reports published between 1950 and 2021. Atrial fibrillation was searched via the terms primary prevention, hyperthyroidism, Wolff-Parkinson-White syndrome, catheter ablation, surgical ablation, hybrid ablation, stroke prevention, anticoagulation, left atrial occlusion and atrial excision. Google and Google scholar as well as bibliographies of identified articles were reviewed for additional references. In these two manuscripts, we discuss the current strategies available to prevent AF, then compare noninvasive and invasive treatment strategies to diminish AF recurrence. In addition, we examine the pharmacological, percutaneous device and surgical approaches to prevent stroke as well as other types of thromboembolic events.
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Schmidt A, Finan C, Bourfiss M, Velthuis B, Puyol-Antón E, Alasiri A, Ruijsink B, Asselbergs F, Ter Riele A, van Setten J. Cardiac MRI to guide heart failure and atrial fibrillation drug discovery: a Mendelian randomization analysis. RESEARCH SQUARE 2023:rs.3.rs-2449265. [PMID: 36778476 PMCID: PMC9915782 DOI: 10.21203/rs.3.rs-2449265/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background drug development and disease prevention of heart failure (HF) and atrial fibrillation (AF) are impeded by a lack of robust early-stage surrogates. We determined to what extent cardiac magnetic resonance (CMR) measurements act as surrogates for the development of HF or AF in healthy individuals. Methods Genetic data was sourced on the association with 22 atrial and ventricular CMR measurements. Mendelian randomization was used to determine CMR associations with atrial fibrillation (AF), heart failure (HF), non-ischemic cardiomyopathy (CMP), and dilated cardiomyopathy (DCM). Additionally, for the CMR surrogates of AF and HF, we explored their association with non-cardiac traits. Results In total we found that 9 CMR measures were associated with the development of HF, 7 with development of non-ischemic CMR, 6 with DCM, and 12 with AF. biventricular ejection fraction (EF), biventricular or end-systolic volumes (ESV) and left-ventricular (LV) end diastolic volume (EDV) were associated with all 4 cardiac outcomes. Increased LV-MVR (mass to volume ratio) affected HF (odds ratio (OR) 0.83, 95%CI 0.79; 0.88), and DCM (OR 0.26, 95%CI 0.20; 0.34. We were able to identify 9 CMR surrogates for HF and/or AF (including LV-MVR, biventricular EDV, ESV, and right-ventricular EF) which associated with non-cardiac traits such as blood pressure, lung function traits, BMI, cardioembolic stroke, and late-onset Alzheimer's disease. Conclusion CMR measurements may act as surrogate endpoints for the development of HF (including non-ischemic CMP and DCM) or AF. Additionally, we show that changes in cardiac function and structure measured through CMR, may affect diseases of other organs leading to lung disease or late-onset Alzheimer's disease.
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Sharashova E, Gerdts E, Ball J, Espnes H, Jacobsen BK, Kildal S, Mathiesen EB, Njølstad I, Rosengren A, Schirmer H, Wilsgaard T, Løchen ML. Sex-specific time trends in incident atrial fibrillation and the contribution of risk factors: the Tromsø Study 1994-2016. Eur J Prev Cardiol 2023; 30:72-81. [PMID: 36239184 DOI: 10.1093/eurjpc/zwac234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/02/2022] [Accepted: 10/08/2022] [Indexed: 01/14/2023]
Abstract
AIMS To explore sex-specific time trends in atrial fibrillation (AF) incidence and to estimate the impact of changes in risk factor levels using individual participant-level data from the population-based Tromsø Study 1994-2016. METHODS AND RESULTS A total of 14 818 women and 13 225 men aged 25 years or older without AF were enrolled in the Tromsø Study between 1994 and 2008 and followed up for incident AF throughout 2016. Poisson regression was used for statistical analyses. During follow-up, age-adjusted AF incidence rates in women decreased from 1.19 to 0.71 per 1000 person-years. In men, AF incidence increased from 1.18 to 2.82 per 1000 person-years in 2004, and then declined to 1.94 per 1000 person-years in 2016. Changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP), body mass index (BMI), physical activity, smoking and alcohol consumption together accounted for 10.9% [95% confidence interval (CI): -2.4 to 28.6] of the AF incidence decline in women and for 44.7% (95% CI: 19.2; 100.0) of the AF incidence increase in men. Reduction in SBP and DBP had the largest contribution to the decrease in AF incidence in women. Increase in BMI had the largest contribution to the increase in AF incidence in men. CONCLUSION In the population-based Tromsø Study 1994-2016, AF incidence decreased in women and increased following a reverse U-shape in men. Individual changes in SBP and DBP in women and individual changes in BMI in men were the most important risk factors contributing to the AF incidence trends.
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Affiliation(s)
- Ekaterina Sharashova
- Department of Community Medicine, UiT The Arctic University of Norway, PO Box 6050 Langnes, N-9037 Tromsø, Norway.,University Hospital of North Norway, Postboks 100, 9038 Tromsø, Norway
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jocasta Ball
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Hilde Espnes
- Department of Community Medicine, UiT The Arctic University of Norway, PO Box 6050 Langnes, N-9037 Tromsø, Norway
| | - Bjarne K Jacobsen
- Department of Community Medicine, UiT The Arctic University of Norway, PO Box 6050 Langnes, N-9037 Tromsø, Norway.,Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Simon Kildal
- University Hospital of North Norway, Postboks 100, 9038 Tromsø, Norway.,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, UiT The Arctic University of Norway, PO Box 6050 Langnes, N-9037 Tromsø, Norway
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Schirmer
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Akershus University Hospital, Lørenskog, Oslo, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, PO Box 6050 Langnes, N-9037 Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, PO Box 6050 Langnes, N-9037 Tromsø, Norway
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Liebe V, Kruska M, Dürschmied D, Akin I. [What is confirmed in the treatment of atrial fibrillation?]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2022; 63:1244-1249. [PMID: 36355078 DOI: 10.1007/s00108-022-01418-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
Atrial fibrillation is the most common clinically relevant cardiac arrhythmia. Important goals in the treatment of atrial fibrillation are improvement of the quality of life, relief of symptoms and the prevention of stroke. New in the current European guidelines on atrial fibrillation from 2020 is a structured approach with the introduction of the 4S-AF scheme (4S estimation of the risk of stroke, severity of symptoms, degree of severity of atrial fibrillation load and substrate, AF atrial fibrillation) for better characterization of atrial fibrillation and the ABC pathway in the treatment. The decision on the use of anticoagulation should be made after appropriate risk stratification. Depending on the characterization and symptoms of atrial fibrillation, the planning of further treatment should be made with respect to symptom control. Based on recent studies, rhythm-maintaining treatment by means of drugs or catheter ablation is gaining in importance over a strategy purely aimed at controlling the frequency. Integral components of treatment are also the identification and treatment of comorbidities and cardiovascular risk factors as well as the modification of an unhealthy lifestyle.
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Affiliation(s)
- Volker Liebe
- I. Medizinische Klinik, Kardiologie, Angiologie, Hämostaseologie und Internistische Intensivmedizin, Universitätsklinikum Mannheim GmbH, 68135, Mannheim, Deutschland.
| | - Mathieu Kruska
- I. Medizinische Klinik, Kardiologie, Angiologie, Hämostaseologie und Internistische Intensivmedizin, Universitätsklinikum Mannheim GmbH, 68135, Mannheim, Deutschland
| | - Daniel Dürschmied
- I. Medizinische Klinik, Kardiologie, Angiologie, Hämostaseologie und Internistische Intensivmedizin, Universitätsklinikum Mannheim GmbH, 68135, Mannheim, Deutschland
| | - Ibrahim Akin
- I. Medizinische Klinik, Kardiologie, Angiologie, Hämostaseologie und Internistische Intensivmedizin, Universitätsklinikum Mannheim GmbH, 68135, Mannheim, Deutschland
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8
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Han M, Lee SR, Choi EK, Park SH, Lee H, Chung J, Choi J, Han KD, Oh S, Lip GYH. The impact of socioeconomic deprivation on the risk of atrial fibrillation in patients with diabetes mellitus: A nationwide population-based study. Front Cardiovasc Med 2022; 9:1008340. [DOI: 10.3389/fcvm.2022.1008340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
ObjectiveTo evaluate the relationship between socioeconomic status and the risk of atrial fibrillation (AF) in patients with diabetes mellitus (DM).Research design and methodsFrom the National Health Insurance Service (NHIS) database, we identified 2,429,610 diabetic patients who underwent national health check-ups between 2009 and 2012. Tracing back the subjects for 5 years from the date of health check-up, we determined the subjects’ income and whether they received medical aid (MA) during the past 5 years. Subjects were divided into six groups according to the number of years of receiving (MA groups 0 through 5) and into four groups according to socioeconomic status change during the past 5 years. We estimated the risk of AF for each group using the Cox proportional-hazards model.ResultsDuring a median follow-up of 7.2 ± 1.7 years, 80,257 were newly identified as AF. The MA groups showed a higher risk of AF than the non-MA group with the hazard ratios (HRs) and 95% confidence interval (CI) 1.32 (1.2–1.44), 1.33 (1.22–1.45), 1.23 (1.13–1.34), 1.28 (1.16–1.4), and 1.50 (1.39–1.63) for MA groups 1 through 5, respectively. Dividing subjects according to socioeconomic condition change, those who experienced worsening socioeconomic status (non-MA to MA) showed higher risk compared to the persistent non-MA group (HR 1.54; 95% CI 1.38–1.73).ConclusionLow socioeconomic status was associated with the risk of AF in patients with diabetes. More attention should be directed at alleviating health inequalities, targeting individuals with socioeconomic deprivation to provide timely management for AF.
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Hegelund ER, Kjerpeseth LJ, Mortensen LH, Igland J, Berge T, Anjum M, Tell GS, Ariansen I. Prevalence and Incidence Rates of Atrial Fibrillation in Denmark 2004–2018. Clin Epidemiol 2022; 14:1193-1204. [PMCID: PMC9618383 DOI: 10.2147/clep.s374468] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/21/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To estimate the prevalence and incidence of atrial fibrillation (AF) in Denmark during 2004–2018 and to investigate whether methodological choices influence these estimates. Patients and Methods A register-based cohort study was conducted of all individuals aged ≥18 years in Denmark 2004–2018. The cumulative prevalence of AF at the end of the study period was calculated as the number of AF cases alive with at least one inpatient or two outpatient diagnoses during 1994–2018 divided by the number of Danish residents in 2018. Incidence rates were calculated as the number of annual AF cases with no previous diagnosis in the past 10 years (ie, a 10-year washout period) divided by the person-time contributed by the population free of AF on 1 January in the same calendar year. Furthermore, the influence of varying case definitions was investigated. Results The cumulative prevalence of AF was 3.0% in 2018. The incidence rate increased from 391 to 481 per 100,000 person-years (PYs) from 2004 to 2015 (1.7% average annual increase) after which it declined to 367 per 100,000 PYs in 2018 (8.5% average annual decrease). This pattern was observed in both sexes irrespective of age. Methodological choices, particularly the case definition’s strictness and the length of the washout period, had a substantial influence on the reported estimates. Conclusion The cumulative prevalence of AF is currently around 3.0% in the Danish population, but the incidence has declined since 2015. As these estimates are influenced by methodological choices, future studies should strive for precise reporting of study methodology. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/ov6Ab_Q65eU
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Affiliation(s)
- Emilie R Hegelund
- Methodology and Analysis, Statistics Denmark, Copenhagen, Denmark,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lars J Kjerpeseth
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Laust H Mortensen
- Methodology and Analysis, Statistics Denmark, Copenhagen, Denmark,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Trygve Berge
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Mariam Anjum
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway,Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Inger Ariansen
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway,Inger Ariansen, Department of Chronic Diseases, Norwegian Institute of Public Health, PO Box 222 Skøyen, Oslo, N-0213, Norway, Tel +47 21 07 70 00, Fax +47 22 35 36 05, Email
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Zhou Y, Lin D, Wu S, Xiao J, Yu M, Xiao Z, Wu M, Chen Z, Tian C, Chen R, Chen Y, Tan X. Dysnatremia is associated with increased risk of all-cause mortality within 365 days post-discharge in patients with atrial fibrillation without heart failure: A prospective cohort study. Front Cardiovasc Med 2022; 9:963103. [PMID: 36312256 PMCID: PMC9597697 DOI: 10.3389/fcvm.2022.963103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/14/2022] [Indexed: 02/05/2023] Open
Abstract
AIM The aim of this study is to evaluate the association between serum sodium concentrations at hospital admission and all-cause mortality within 365 days post-discharge in patients with atrial fibrillation (AF) without heart failure (HF). METHODS The prospective cohort study enrolled 1,446 patients with AF without HF between November 2018 and October 2020. A follow-up was performed 30, 90, 180, and 365 days after enrollment through outpatient visits or telephone interviews. All-cause mortality was estimated in three groups according to serum sodium concentrations: hyponatremia (< 135 mmol/L), normonatremia (135-145 mmol/L), and hypernatremia (> 145 mmol/L). We estimated the risk of all-cause mortalities using univariable and multivariable Cox proportional hazards models with normonatremia as the reference. RESULTS The all-cause mortalities of hyponatremia, normonatremia, and hypernatremia were 20.6, 9.4, and 33.3% within 365 days post-discharge, respectively. In the univariable analysis, hyponatremia (HR: 2.19, CI 1.5-3.2) and hypernatremia (HR: 4.03, CI 2.32-7.02) increased the risk of all-cause mortality. The HRs for hyponatremia and hypernatremia were 1.55 (CI 1.05-2.28) and 2.55 (CI 1.45-4.46) after adjustment for age, diabetes mellitus, loop diuretics, antisterone, antiplatelet drugs, and anticoagulants in the patients with AF without HF. The association between serum sodium concentrations and the HRs of all-cause mortality was U-shaped. CONCLUSION Dysnatremia at hospital admission was an independent factor for all-cause mortality in patients with AF without HF within 365 days post-discharge.
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Affiliation(s)
- Yan Zhou
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Dong Lin
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Shiwan Wu
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Jiaxin Xiao
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Min Yu
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zhongbo Xiao
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Muli Wu
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zhisheng Chen
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Cuihong Tian
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Rongbing Chen
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yequn Chen
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Clinical Research Center, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Xuerui Tan
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Clinical Research Center, First Affiliated Hospital of Shantou University Medical College, Shantou, China
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Karamitanha F, Ahmadi F, fallahabadi H. Difference between various countries in mortality and incidence rate of the atrial fibrillation based on human development index in worldwide: data from global burden of disease 2010-2019. Curr Probl Cardiol 2022; 48:101438. [DOI: 10.1016/j.cpcardiol.2022.101438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/15/2022]
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12
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Dilk P, Wachter R, Hindricks G. Catheter ablation for atrial fibrillation: impact on mortality, morbidity, quality of life, and implications for the future. Herz 2022; 47:118-122. [PMID: 35258637 PMCID: PMC8902845 DOI: 10.1007/s00059-022-05101-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/05/2022]
Abstract
Despite the advances in technologies and techniques in the field of catheter ablation for cardiac arrhythmias, it is estimated that the prevalence of atrial fibrillation (AF) will further increase in the nearest future. The latest trials have proven the beneficial effect on mortality after pulmonary vein isolation in patients with impaired left ventricular function, while no such effect has been seen in patients without left ventricular dysfunction. This raises the question of whether catheter ablation for AF is still suited for the latter patient cohort or whether the endpoint of mortality is not adequate enough. Not only does pulmonary vein isolation reduce the burden of atrial fibrillation, but it also somehow alters the patients’ perception of it in the case of recurrence. Independent of the presence of ventricular dysfunction, patients experience a relief of AF-related symptoms, which is accompanied by an increase in quality of life based on the available patient-reported outcome measures, despite AF recurrence. Trials that are currently recruiting patients seek to unveil the accountable circumstances for these remaining uncertainties and help expand our understanding of a procedure that has been routinely performed for two decades.
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Affiliation(s)
- Patrick Dilk
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany. .,Department of Electrophysiology, Heart Centre Leipzig, Leipzig, Germany.
| | - Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Centre Leipzig, Leipzig, Germany
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Pharmacological Management of Atrial Fibrillation: A Century of Expert Opinions in Cecil Textbook of Medicine. Am J Ther 2022; 29:e18-e25. [PMID: 34994347 DOI: 10.1097/mjt.0000000000001464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Advances in drug therapy for atrial fibrillation (AF) have had a significant impact on the quality of life of a substantial majority of affected persons, which has contributed to a remarkable decrease in the frequency and severity of thromboembolic complications, hospitalizations, and mortality. STUDY QUESTION What are the milestones of the changes in the expert approach to the pharmacological management of AF in the past century? STUDY DESIGN To determine the changes in the experts' approach to the management of AF, as presented in a widely used textbook in the United States. DATA SOURCES The chapters presenting the management of AF in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020. RESULTS AF was consistently described in Cecil Textbook of Medicine as the most common sustained arrhythmia in adults. The authors emphasized its thromboembolic complications and potential for hemodynamic deterioration. Rate control with digitalis and rhythm control with quinidine were the standard in 1927. The pharmacological advances have focused on atrioventricular nodal blocking for rate control, conversion to and maintenance of sinus rhythm, and preventive anticoagulation. The first new class of drugs for rate control was beta-adrenergic receptor blockers, starting with propranolol which was introduced in 1979, followed by the calcium channel blocker verapamil in 1988. Rhythm control with amiodarone, a potassium channel blocker, has been recommended since 2004, and the sodium channel blockers propafenone and flecainide became part of standard therapy in 2008. Anticoagulation with warfarin was recommended starting in 2000, followed by the introduction of direct thrombin inhibitor in 2012 and factor Xa inhibitors in 2016. CONCLUSIONS The pharmacological management of AF was unchanged for more than 50 years (1927-1979), a period during which the devastating effects of thromboembolic complications were not addressed. The major therapeutic advance is represented by preventive anticoagulation with the newer, safer, and more user-friendly direct thrombin and factor Xa inhibitors.
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Abstract
Menopause transition marks an important phase in life when cardiovascular risk in women gradually takes an adverse turn. Although menopausal hormone therapy has gained a negative appreciation over the last decades, its value in the treatment of disabling vasomotor symptoms is still undisputed. Cardiovascular risk assessment has become a matter of precision medicine, which is helpful for safe menopausal hormone therapy prescription. With a multidisciplinary approach the current available hormone regimens can be even given to women at intermediate cardiovascular risk, when risk factors such as hypertension and dyslipidemia are adequately monitored and treated.
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Affiliation(s)
- Angela H E M Maas
- Chair Women's Cardiovascular Health Program, Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
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Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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16
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Crea F. Light and noise pollution and socioeconomic status: the risk factors individuals cannot change. Eur Heart J 2021; 42:801-804. [PMID: 33611398 DOI: 10.1093/eurheartj/ehab074] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Affiliation(s)
- Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Isabelle C Van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, The Netherlands
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