1
|
Jain A, Borz-Baba C, Wakefield D. Hospital Utilization and Mortality Post-electrical Cardioversion in Patients With Atrial Fibrillation in a Community Hospital. Cureus 2024; 16:e66919. [PMID: 39280380 PMCID: PMC11401630 DOI: 10.7759/cureus.66919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 09/18/2024] Open
Abstract
Background Electrical cardioversion (EC) is a procedure that restores normal sinus rhythm in patients with atrial fibrillation (AF). Data on post-EC outcomes relative to the success of inpatient EC is limited. Methods This is a retrospective study of patients admitted for AF who underwent inpatient EC from January 1, 2017, to January 1, 2021. We collected demographics and clinical, biochemical, and echocardiographic parameters that impact the success of EC. Outcome events were 30-day readmissions and mortality. Results Our study included 54 unique patients who either had EC in the emergency room or as part of their hospital admission course for atrial fibrillation. Most patients were men with an average age of 70 years with traditional risk factors for cardiovascular disease including heart failure, coronary artery disease, and chronic kidney disease. The group who had unsuccessful cardioversion was older than those in the ineffective EC. Mortality at 30 days (p < 0.01), 1 year (p < 0.01), and 30-day readmission rate (p < 0.01) were higher in patients with unsuccessful EC. Conclusion A predictive model for successful EC remains difficult to establish. Patients with unsuccessful in-hospital EC are at high risk for mortality and readmission at 30 days and require a comprehensive pre-discharge multidisciplinary approach and prioritized and individualized post-discharge integrated care.
Collapse
Affiliation(s)
- Ashali Jain
- Department of Medicine, Saint Mary's Hospital, Waterbury, USA
| | | | - Dorothy Wakefield
- Department of Statistics, Saint Francis Hospital & Medical Center, Hartford, USA
| |
Collapse
|
2
|
Okhotin A, Osipov M, Osipov V, Barchuk A. Atrial fibrillation: real-life experience of a rhythm control with electrical cardioversion in a community hospital. BMC Cardiovasc Disord 2024; 24:213. [PMID: 38632510 PMCID: PMC11022487 DOI: 10.1186/s12872-024-03885-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Atrial fibrillation is the most prevalent sustained cardiac arrhythmia. Electrical cardioversion, a well-established part of the rhythm control strategy, is probably underused in community settings. Here, we describe its use, safety, and effectiveness in a cohort of patients with atrial fibrillation treated in rural settings. METHODS It is a retrospective cohort study. Data on all procedures from January 1, 2016, till December 1, 2022, in Tarusa Hospital, serving mostly a rural population of 15,000 people, were extracted from electronic health records. Data on the procedure's success, age, gender, body mass index, comorbidities, previous procedures, echocardiographic parameters, type and duration of arrhythmia, anticoagulation, antiarrhythmic drugs, transesophageal echocardiography, and settings were available. RESULTS Altogether, 1,272 procedures in 435 patients were performed during the study period. The overall effectiveness of the procedure was 92%. Effectiveness was similar across all prespecified subgroups. Electrical cardioversion was less effective in patients undergoing the procedure for the first time (86%, 95% CI: 82-90) compared to repeated procedures (95%, 95% CI: 93-96), OR 0.39 (95% CI: 0.26-0.59). Complications were encountered in 13 (1.02%) procedures but were not serious. CONCLUSIONS Electrical cardioversion is an immediately effective procedure that can be safely performed in community hospitals, both in inpatient and outpatient settings. Further studies with longer follow-up are needed to investigate the rate of sinus rhythm maintenance in these patients.
Collapse
Affiliation(s)
- Artemiy Okhotin
- ITMO University, Kronverkskiy Prospekt, 49, 197101, St. Petersburg, Russia.
- Tarusa Hospital, K. Libknekhta ulitsa, 16, 249100, Tarusa, Russia.
| | - Maxim Osipov
- Tarusa Hospital, K. Libknekhta ulitsa, 16, 249100, Tarusa, Russia
| | - Vasilij Osipov
- Tarusa Hospital, K. Libknekhta ulitsa, 16, 249100, Tarusa, Russia
| | - Anton Barchuk
- ITMO University, Kronverkskiy Prospekt, 49, 197101, St. Petersburg, Russia
- Institute for Interdisciplinary Health Research, European University at St. Petersburg, Shpalernaya Ulitsa 1, 191187, St. Petersburg, Russia
| |
Collapse
|
3
|
Hatala R, Hlivák P. Atrial fibrillation in chronic coronary syndromes: a neglected challenge. Eur Heart J 2024; 45:376-378. [PMID: 38104273 DOI: 10.1093/eurheartj/ehad781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Affiliation(s)
- Robert Hatala
- Department of Cardiology and Angiology, National Institute of Cardiovascular Diseases and the Slovak Medical University School of Medicine, Pod Krásnou hôrkou 1, SK-83348 Bratislava, Slovakia
| | - Peter Hlivák
- Department of Cardiology and Angiology, National Institute of Cardiovascular Diseases and the Slovak Medical University School of Medicine, Pod Krásnou hôrkou 1, SK-83348 Bratislava, Slovakia
| |
Collapse
|
4
|
Kłosiewicz T, Cholerzyńska H, Zasada WA, Shadi A, Olszewski J, Konieczka P, Podlewski R, Puślecki M. Impact of Various Atrial Fibrillation Treatment Strategies on Length of Stay in the Emergency Department and Early Complications-3 Years of a Single-Center Experience. J Clin Med 2023; 13:190. [PMID: 38202197 PMCID: PMC10779744 DOI: 10.3390/jcm13010190] [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: 10/27/2023] [Revised: 11/29/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia presenting in emergency departments (EDs), vastly increasing mainly due to society's lifestyles leading to numerous comorbidities. Its management depends on many factors and is still not unified. Aims: The aim of this study was to compare different AF management strategies in the ED and to evaluate their influence on the length of stay (LOS) in the ED and their safety. We analyzed medical records over 3 years of data collection, including age, primary AF diagnosis, an attempt to restore sinus rhythm, complications, and length of stay. Patients were divided into three groups according to the treatment method received: only pharmacological cardioversion (MED), only electrical cardioversion (EC), and patients who received medications followed by electrical cardioversion (COMB). We included 599 individuals in the analysis with a median age of 71. The restoration of sinus rhythm and LOS were as follows: MED: 64.95%, 173 min; COMB: 87.91%, 295 min; SH: 92.40%, 180 min. The difference between the MED and EC strategies, as well as MED and COMB, was statistically significant (p < 0.001 in both). The total number of complications was 16, with a rate of 32.67%. The majority of them followed a drug administration, and the most common complication was bradycardia. Electrical cardioversion is a safe and effective treatment strategy in stable patients with AF in the ED. It is associated with a shortened LOS. Medication administration preceded the majority of complications.
Collapse
Affiliation(s)
- Tomasz Kłosiewicz
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
| | - Hanna Cholerzyńska
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
| | - Wiktoria Antonina Zasada
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
| | - Amira Shadi
- College of Emergency Physicians in Poland, 5 Truflowa Street, 62-070 Dopiewiec, Poland; (A.S.); (J.O.)
| | - Jakub Olszewski
- College of Emergency Physicians in Poland, 5 Truflowa Street, 62-070 Dopiewiec, Poland; (A.S.); (J.O.)
| | - Patryk Konieczka
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
| | - Roland Podlewski
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
| | - Mateusz Puślecki
- Department of Emergency Medicine, Poznan University of Medical Sciences, 7 Rokietnicka Street, 60-608 Poznań, Poland; (H.C.); (W.A.Z.); (P.K.); (R.P.); (M.P.)
| |
Collapse
|
5
|
Knudsen Pope M, Hall TS, Virdone S, Atar D, John Camm A, Pieper KS, Jansky P, Haas S, Goto S, Panchenko E, Baron-Esquivias G, Angchaisuksiri P, Kakkar AK. Rhythm versus rate control in patients with newly diagnosed atrial fibrillation - Observations from the GARFIELD-AF registry. IJC HEART & VASCULATURE 2023; 49:101302. [PMID: 38020059 PMCID: PMC10656718 DOI: 10.1016/j.ijcha.2023.101302] [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: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023]
Abstract
Background Investigate real-world outcomes of early rhythm versus rate control in patients with recent onset atrial fibrillation. Methods The Global Anticoagulant Registry in the FIELD-AF (GARFIELD-AF) is an international multi-centre, non-interventional prospective registry of newly diagnosed (≤6 weeks' duration) atrial fibrillation patients at risk for stroke. Patients were stratified according to treatment initiated at baseline (≤48 days post enrolment), and outcome risks evaluated by overlap propensity weighted Cox proportional-hazards models. Results Of 45,382 non-permanent atrial fibrillation patients, 23,858 (52.6 %) received rhythm control and 21,524 (47.4 %) rate control. Rhythm-controlled patients had lower median age (68.0 [Q1;Q3: 60.0;76.0] versus 73.0 [65.0;79.0]), fewer histories of stroke/transient ischemic attack/systemic embolism (9.4 % versus 13.0 %), and lower expected probabilities of death (median GARFIELD-AF death score 4.0 [2.3;7.5] versus 5.1 [2.8;9.2]). The two groups had the same median CHA2DS2-VASc scores (3.0 [2.0;4.0]) and similar proportions of anticoagulated patients (rhythm control: 66.0 %, rate control: 65.5 %). The propensity-score-weighted hazard ratios of rhythm vs rate control (reference) were 0.85 (95 % CI: 0.79-0.92, p-value < 0.0001) for all-cause mortality, 0.84 (0.72-0.97, p-value 0.020) for non-haemorrhagic stroke/systemic embolism and 0.90 (0.78-1.04, p-value 0.164) for major bleeding. Conclusion Rhythm control strategy was initiated in about half of the patients with newly diagnosed non-valvular non-permanent atrial fibrillation. After balancing confounders, significantly lower risks of all-cause mortality and non-haemorrhagic stroke were observed in patients who received early rhythm control.
Collapse
Affiliation(s)
| | - Trygve S. Hall
- Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Saverio Virdone
- Thrombosis Research Institute, London, the United Kingdom of Great Britain and Northern Ireland
| | - Dan Atar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - A. John Camm
- Cardiology Clinical Academic Group Molecular & Clinical Sciences Research Institute, St. George’s University of London, London, the United Kingdom of Great Britain and Northern Ireland
| | - Karen S Pieper
- Thrombosis Research Institute, London, the United Kingdom of Great Britain and Northern Ireland
| | - Petr Jansky
- Department of Cardiovascular Surgery, Motol University Hospital, Prague, Czech Republic
| | - Sylvia Haas
- Sylvia Haas: Formerly Department of Medicine, Technical University of Munich, Munich, Germany
| | | | - Elizaveta Panchenko
- National Medical Research Center of Cardiology of Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Gonzalo Baron-Esquivias
- Servicio de Cardiología y Cirugía Cardíaca, Hospital Universitario Virgen del Rocío., Universidad de Sevilla., Sevilla. Departamento Cardiovascular, Instituto de Biotecnología de Sevilla (IBIS), Spain
| | | | - Ajay K Kakkar
- Thrombosis Research Institute, London, the United Kingdom of Great Britain and Northern Ireland
| | | |
Collapse
|
6
|
Han S, Jia R, Cen Z, Guo R, Zhao S, Bai Y, Xie M, Cui K. Early rhythm control vs. rate control in atrial fibrillation: A systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:978637. [PMID: 36815025 PMCID: PMC9939510 DOI: 10.3389/fcvm.2023.978637] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 01/19/2023] [Indexed: 02/08/2023] Open
Abstract
Objective It has long been debated whether rhythm control vs. rate control strategies have differing effects on mortality and morbidity for atrial fibrillation (AF). Recently, several randomized controlled studies (RCTs) and observational trials described that an early rhythm management method was linked to a lower likelihood of negative clinical outcomes in individuals with AF. We wanted to see if an early rhythm management method may help patients with AF. Methods We performed a systematic search to retrieve studies assessing the outcomes of early rhythm control vs. rate control in AF by using PubMed, Web of Science, Cochrane Library, and Embase published between 01/01/2000 and 15/04/2022. Results Finally, two RCTs, one retrospective analysis of RCTs, and four observational studies were identified. Compared with rate control, early rhythm control has been linked to lower all-cause mortality. [risk ratio (RR), 0.76; 95% CI 0.69-0.83; P < 0.00001; I 2 = 77%]. The early rhythm control group was also associated with a lower risk of cardiovascular mortality (RR, 0.68; 95% CI 0.63-0.74; P < 0.00001; I 2 = 33), stroke (RR, 0.77; 95% CI 0.67-0.87; P < 0.001; I 2 = 64), and heart failure hospitalization (RR, 0.74; 95% CI 0.59-0.93; P = 0.0009; I 2 = 93%). We found no significant difference in nights spent in hospital per year, acute coronary syndrome, major bleeding, and cardiac arrest/ventricular arrhythmia between the groups. Conclusion In this meta-analysis, early rhythm therapy was linked to a lower risk of all-cause mortality, cardiovascular mortality, stroke, and heart failure hospitalization compared with the rate control group. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022333592.
Collapse
Affiliation(s)
- Shaojie Han
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ruikun Jia
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhifu Cen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ran Guo
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Shenyu Zhao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yixuan Bai
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Min Xie
- Department of Cardiology, Chengdu Seventh People’s Hospital, Chengdu, Sichuan, China
| | - Kaijun Cui
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
7
|
Zhu W, Wu Z, Dong Y, Lip GYH, Liu C. Effectiveness of early rhythm control in improving clinical outcomes in patients with atrial fibrillation: a systematic review and meta-analysis. BMC Med 2022; 20:340. [PMID: 36224587 PMCID: PMC9558983 DOI: 10.1186/s12916-022-02545-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 09/01/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Current guidelines recommend rhythm control for improving symptoms and quality of life in symptomatic patients with atrial fibrillation (AF). However, the long-term prognostic outcomes of rhythm control compared with rate control are still inconclusive. In this meta-analysis, we aimed to assess the effects of early rhythm control compared with rate control on clinical outcomes in newly diagnosed AF patients. METHODS We systematically searched the PubMed and Embase databases up to August 2022 for randomized and observational studies reporting the associations of early rhythm control (defined as within 12 months of AF diagnosis) with effectiveness outcomes. The primary outcome was a composite of death, stroke, admission to hospital for heart failure (HF), or acute coronary syndrome (ACS). Hazard ratios (HRs) and 95% confidence intervals (CIs) from each study were pooled using a random-effects model, complemented with an inverse variance heterogeneity or quality effects model. RESULTS A total of 8 studies involving 447,202 AF patients were included, and 23.5% of participants underwent an early rhythm-control therapy. In the pooled analysis using the random-effects model, compared with rate control, the early rhythm-control strategy was significantly associated with reductions in the primary composite outcome (HR = 0.88, 95% CI: 0.86-0.89) and secondary outcomes, including stroke or systemic embolism (HR = 0.78, 95% CI: 0.71-0.85), ischemic stroke (HR = 0.81, 95% CI: 0.69-0.94), cardiovascular death (HR = 0.83, 95% CI: 0.70-0.99), HF hospitalization (HR = 0.90, 95% CI: 0.88-0.92), and ACS (HR = 0.86, 95% CI: 0.76-0.98). Reanalyses using the inverse variance heterogeneity or quality effects model yielded similar results. CONCLUSIONS Our current meta-analysis suggested that early initiation of rhythm control treatment was associated with improved adverse effectiveness outcomes in patients who had been diagnosed with AF within 1 year. REGISTRATION The study protocol was registered to PROSPERO (CRD42021295405).
Collapse
Affiliation(s)
- Wengen Zhu
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People's Republic of China. .,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, People's Republic of China. .,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, People's Republic of China.
| | - Zexuan Wu
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People's Republic of China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, People's Republic of China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, People's Republic of China
| | - Yugang Dong
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People's Republic of China.,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, People's Republic of China.,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, People's Republic of China
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Sciences, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK. .,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Chen Liu
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People's Republic of China. .,NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, People's Republic of China. .,National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, People's Republic of China.
| |
Collapse
|