1
|
Westergaard LM, Alhakak A, Rørth R, Fosbøl EL, Kristensen SL, Svendsen JH, Graff C, Nielsen JB, Gislason GH, Køber L, Torp-Pedersen C, Lee CJY, Weeke PE. Ventricular rate in atrial fibrillation and the risk of heart failure and death. Europace 2023; 25:euad088. [PMID: 37083042 PMCID: PMC10228534 DOI: 10.1093/europace/euad088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/20/2023] [Indexed: 04/22/2023] Open
Abstract
AIMS While clinical trials have suggested that a high ventricular rate is associated with increased risk of heart failure (HF) and mortality, all-comers studies are warranted. OBJECTIVE To assess 1-year risk of new-onset diagnosed HF and all-cause mortality among rate-control treated patients presenting with atrial fibrillation (AF) on an electrocardiogram (ECG) according to ventricular rate. METHODS AND RESULTS ECGs recorded at the Copenhagen General Practitioners Laboratory (2001-15) were used to identify patients with AF. Multivariate Cox proportional hazard regression models were used to compare risk of new-onset HF and all-cause mortality after first ECG presenting with AF according to ventricular rate on ECG [<60, 60-79, 80-99, and 100-110, > 110 beats per minute (bpm)]. We identified 7408 patients in treatment with rate control drugs at time of first ECG presenting with AF [median age 78 years (Q1,Q3 = 70-85 years)], 45.8% male, median ventricular rate 83 bpm, (Q1,Q3 = 71-101 bpm)]. During 1-year follow-up, 666 (9.0%) of all patients with AF developed HF and 858 (11.6%) died. Patients with AF ventricular rates 100-110 bpm and >110 bpm had a hazard ratio (HR) of 1.46 (CI: 1.10-1.95) and 2.41 (CI: 1.94-3.00) respectively for new-onset HF, compared with 60-79 bpm. Similarly, patients with AF ventricular rates 100-110 bpm and >110 bpm had a HR of 1.44 (CI: 1.13-1.82) and 1.34 (CI: 1.08-1.65) respectively for all-cause mortality, compared with 60-79 bpm. CONCLUSIONS Ventricular rates ≥100 bpm among patients presenting with AF on ECG in treatment with rate control drugs were associated with greater risk of both new-onset HF and all-cause mortality.
Collapse
Affiliation(s)
- Lucas Malta Westergaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen East, Denmark
| | - Amna Alhakak
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen East, Denmark
| | - Rasmus Rørth
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen East, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen East, Denmark
| | - Søren L Kristensen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen East, Denmark
| | - Jesper H Svendsen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen East, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen North, Denmark
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7K, 9220 Aalborg East, Denmark
| | - Jonas B Nielsen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen East, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Copenhagen University Hospital—Herlev and Gentofte, Borgmester Ib Juuls Vej 11, 2730 Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen North, Denmark
- Department of Cardiovascular Epidemiology and Research, The Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen East, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen North, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology and Clinical Research, Copenhagen University Hospital—North Zealand, Dyrehavevej 29, 3400 Hillerød, Denmark
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen, Denmark
| | - Christina J Y Lee
- Department of Cardiology and Clinical Research, Copenhagen University Hospital—North Zealand, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Peter E Weeke
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen East, Denmark
| |
Collapse
|
2
|
Xu W, Song Q, Zhang H, Wang J, Shao X, Wu S, Zhu J, Cai J, Yang Y. Impact of baseline blood pressure on all-cause mortality in patients with atrial fibrillation: results from a multicenter registry study. Chin Med J (Engl) 2023; 136:683-689. [PMID: 36914952 PMCID: PMC10129153 DOI: 10.1097/cm9.0000000000002627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND The ideal blood pressure (BP) target for patients with atrial fibrillation (AF) is still unclear. The present study aimed to assess the effect of the baseline BP on all-cause mortality in patients with AF. METHODS This registry study included 20 emergency centers across China and consecutively enrolled patients with AF from 2008 to 2011. All participants were followed for 1 year ± 1 month. The primary endpoint was all-cause mortality. RESULTS During the follow-up, 276 (13.9%) all-cause deaths occurred. Kaplan-Meier curves showed that a systolic blood pressure (SBP) ≤110 mmHg or >160 mmHg was associated with a higher risk of all-cause mortality (log-rank test, P = 0.014), and a diastolic blood pressure (DBP) <70 mmHg was associated with the highest risk of all-cause mortality (log-rank test, P = 0.002). After adjusting for confounders, the multivariable Cox regression model suggested that the risk of all-cause mortality was increased in the group with SBP ≤110 mmHg (hazard ratio [HR], 1.963; 95% confidence interval [CI], 1.306-2.951), and DBP <70 mmHg (HR, 1.628; 95% CI, 1.163-2.281). In the restricted cubic splines, relations between baseline SBP or DBP and all-cause mortality showed J-shaped associations (non-linear P <0.001 and P = 0.010, respectively). The risk of all-cause mortality notably increased at a lower baseline SBP and DBP. CONCLUSIONS Having a baseline SBP ≤110 mmHg or DBP <70 mmHg was associated with a significantly higher risk of all-cause mortality in patients with AF. An excessively low BP may not be an optimal target for patients with AF.
Collapse
Affiliation(s)
- Wei Xu
- Emergency Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease of China, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Qirui Song
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease of China, National Center for Cardiovascular Diseases of China, National Clinical Research Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Han Zhang
- Emergency Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease of China, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Juan Wang
- Emergency Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease of China, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xinghui Shao
- Emergency Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease of China, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shuang Wu
- Emergency Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease of China, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jun Zhu
- Emergency Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease of China, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jun Cai
- Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease of China, National Center for Cardiovascular Diseases of China, National Clinical Research Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yanmin Yang
- Emergency Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease of China, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| |
Collapse
|
3
|
Alahmed AA, Lauffenburger JC, Vaduganathan M, Aldemerdash A, Ting C, Fatani N, Fanikos J, Buckley LF. Contemporary Trends in the Use of and Expenditures on Digoxin in the United States. Am J Cardiovasc Drugs 2022; 22:567-575. [PMID: 35739347 PMCID: PMC10263277 DOI: 10.1007/s40256-022-00540-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Digoxin is indicated for the management of heart failure with reduced ejection fraction and atrial fibrillation. Despite stronger guideline recommendations for other pharmacologic and device therapies, digoxin retains a role in select patients unable to tolerate or refractory to standard therapies. Contemporary utilization of and costs related to digoxin in the United States of America (USA) remain uncharacterized. The objective of this study was to estimate trends in digoxin use and expenditures across the USA from 2010 to 2017. METHODS We utilized the Medical Expenditure Panel Survey to estimate trends in digoxin use and expenditures across the USA from 2010 to 2017. The Medical Expenditure Panel Survey is an overlapping panel survey that interviews households in the USA to ascertain their healthcare utilization and expenditures. Complex sampling procedures allow for nationally representative estimates of utilization and expenditures. We report the number of digoxin users and expenditures across key subgroups in 2-year increments from 2010 to 2017. RESULTS The number of digoxin users in the USA declined by 47% from 766 users per 100,000 adults in 2010-11 to 402 users per 100,000 adults in 2016-17. While digoxin use declined among women and self-identified White adults, adults living at or below the federal poverty level and those who self-identified as Asian or Hispanic represent an increasing proportion of overall digoxin users. While nationwide digoxin expenditures declined by 26% from 2010-11 to 2012-13, they peaked at $260.3 million in 2014-15 and remained elevated at $188.7 million in 2016-17. CONCLUSIONS Despite a nationwide trend towards declining use, digoxin remains prevalent amongst people of Asian and Hispanic descent in the USA. After a spike in cost in 2013, digoxin prices have yet to return to pre-spike levels. The role of digoxin in contemporary heart failure and arrhythmia management will continue to evolve as additional randomized and observational analyses become available.
Collapse
Affiliation(s)
- Abdullah A Alahmed
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
- Department of Pharmacy Services, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA
| | - Julie C Lauffenburger
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA
| | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ahmed Aldemerdash
- Department of Clinical Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Clara Ting
- Department of Pharmacy Services, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA
| | - Nayyra Fatani
- Department of Pharmacy Practice, College of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - John Fanikos
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Leo F Buckley
- Department of Pharmacy Services, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA.
| |
Collapse
|