Screening and management of atrial fibrillation in primary care

Fed-CL- an atrial fibrillation prediction system using ECG signals employing federated learning mechanism

Deep learning has shown great promise in predicting Atrial Fibrillation using ECG signals and other vital signs. However, a major hurdle lies in the privacy concerns surrounding these datasets, which often contain sensitive patient information. Balancing accurate AFib prediction with robust user privacy remains a critical challenge to address. We suggest Federated Learning , a privacy-preserving machine learning technique, to address this privacy barrier. Our approach makes use of FL by presenting Fed-CL, a advanced method that combines Long Short-Term Memory networks and Convolutional Neural Networks to accurately predict AFib. In addition, the article explores the importance of analysing mean heart rate variability to differentiate between healthy and abnormal heart rhythms. This combined approach within the proposed system aims to equip healthcare professionals with timely alerts and valuable insights. Ultimately, the goal is to facilitate early detection of AFib risk and enable preventive care for susceptible individuals.

Delayed diagnosis and missed opportunities in the early detection of atrial fibrillation: a cross-sectional study

INTRODUCTION

We analysed the frequency of atrial fibrillation (AF) delayed diagnosis and the factors associated with it in newly diagnosed patients.

METHODS

This was a descriptive, cross-sectional, multicentre study. Data were collected from newly diagnosed patients with AF through medical records review and interviews during cardiology, internal medicine, primary care and emergency department consultations in Spain.

RESULTS

A total of 201 physicians participated in the study (64.2% cardiologists, 21.4% internists). 948 patients (58% men; mean age 72.8 years) were included. In 41.8% of patients, AF was classified as paroxysmal at diagnosis, 30.9% as persistent and 27.3% as permanent. The diagnosis was coincidental in 37%. It was considered that a delayed diagnosis occurred in 49.3% of patients. This delay was associated with the presence of permanent or persistent AF, older age or valvular disease. 74.8% of patients had some contact with the healthcare system in the preceding year. The diagnosis could have been established between 1 and 6 months earlier in 50.7% of cases and more than six months earlier in 20.1%. 54.4% of the patients had experienced AF compatible symptomatology previously. Of these, 32.6% had a consultation without a diagnosis.

CONCLUSIONS

In a significant proportion of AF cases, there is a diagnostic delay. Many people with compatible symptoms neither seek consultations nor contact the healthcare system facilities. Consequently, the opportunity for early diagnosis is lost.

The safety and efficacy of third- and fourth-generation cryoballoons for atrial fibrillation: a systematic review and meta-analysis

Objectives

An increasing number of studies have shown that third (CB3)- and fourth-generation cryoballoons (CB4) have been used to treat various types of atrial fibrillation (AF), but previous research regarding the safety and efficacy of CB3 or CB4 ablation remains controversial. Therefore, a meta-analysis was performed to further evaluate the safety and efficacy of pulmonary vein isolation (PVI) using the CB3 and CB4 in the treatment of AF.

Methods

We searched PubMed, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database, and Clinicaltrials.gov up to December 2023 for qualified trials and data extraction according to inclusion and exclusion criteria. All analyses were carried out using Review Manager 5.3 software.

Results

The meta-analysis included 13 observational studies consisting of 3,281 subjects and did not include a randomized controlled trial. Overall analyses indicated that the CB3 significantly reduced total procedure time [weighted mean difference (WMD) = -8.69 min, 95% confidence interval (CI) = -15.45 to -1.94 min, I2 = 93%], increased the PVI recording [relative risk (RR) = 1.24, 95% CI = 1.03-1.49, I2 = 90%], and increased the mean nadir temperature of overall PVs (WMD = 2.80°C, 95% CI = 1.08-4.51°C, I2 = 89%) compared with the CB2. Moreover, the CB4 significantly reduced the total procedure time (WMD = -14.50 min, 95% CI = -20.89 to -8.11 min, I2 = 95%), reduced the fluoroscopy time (WMD = -2.37 min, 95% CI = -4.28 to -0.46 min, I2 = 95%), increased the PVI recording (RR = 1.40, 95% CI = 1.15-1.71, I2 = 90%) compared with the CB2. Time-to-isolation, the success rate of PVI, AF recurrence, and complications in the CB3 and CB4 were not significantly different compared with the CB2.

Conclusion

These findings demonstrated that the CB3 and CB4 tended to be more effective than the CB2 in the treatment of AF, with shorter procedure times, more PVI recording, and similar safety endpoints.

Screening and detection of atrial fibrillation in primary care: current practice and future perspectives

Atrial fibrillation (AF) is a common arrhythmia associated with an increased risk of stroke, which can be effectively reduced by prophylaxis initiation and integrated care to reduce cardiovascular risk and AF-related complications. Screening for AF has the potential to improve long-term clinical outcomes through timely AF detection in asymptomatic patients. With the central role of primary care in most European healthcare systems in terms of disease detection, treatment, as well as record keeping, primary care is ideally situated as a setting for AF screening efforts. In this review, we provide an overview of evidence relating to AF screening in primary care. We discuss current practices of AF detection and screening, evidence from AF screening trials conducted in primary care settings, stakeholder views on barriers and facilitators for AF screening in primary care, and important aspects that will likely shape routine primary care AF detection as well as AF screening efforts. Finally, we present a potential outline for a primary care-centred AF screening trial coupled to integrated AF care that could further improve the benefit of AF screening.

Correlates and consequences of atrial fibrillation in a prospective study of 25 000 participants in the China Kadoorie Biobank

Aims

The prevalence of atrial fibrillation (AF) is positively correlated with prior cardiovascular diseases (CVD) and CVD risk factors but is lower in Chinese than Europeans despite their higher burden of CVD. We examined the prevalence and prognosis of AF and other electrocardiogram (ECG) abnormalities in the China Kadoorie Biobank.

Methods and results

A random sample of 25 239 adults (mean age 59.5 years, 62% women) had a 12-lead ECG recorded and interpreted using a Mortara VERITAS™ algorithm in 2013-14. Participants were followed up for 5 years for incident stroke, ischaemic heart disease, heart failure (HF), and all CVD, overall and by CHA2DS2-VASc scores, age, sex, and area. Overall, 1.2% had AF, 13.6% had left ventricular hypertrophy (LVH), and 28.1% had ischaemia (two-thirds of AF cases also had ischaemia or LVH). The prevalence of AF increased with age, prior CVD, and levels of CHA₂DS₂-VASc scores (0.5%, 1.3%, 2.1%, 2.9%, and 4.4% for scores <2, 2, 3, 4, and ≥5, respectively). Atrial fibrillation was associated with two-fold higher hazard ratios (HR) for CVD (2.15; 95% CI, 1.71-2.69) and stroke (1.88; 1.44-2.47) and a four-fold higher HR for HF (3.79; 2.21-6.49). The 5-year cumulative incidence of CVD was comparable for AF, prior CVD, and CHA₂DS₂-VASc scores ≥ 2 (36.7% vs. 36.2% vs. 37.7%, respectively) but was two-fold greater than for ischaemia (19.4%), LVH (18.0%), or normal ECG (14.1%), respectively.

Conclusion

The findings highlight the importance of screening for AF together with estimation of CHA₂DS₂-VASc scores for prevention of CVD in Chinese adults.

Knowledge, attitude and practice toward oral anticoagulants among patients with atrial fibrillation

Background

Atrial fibrillation (AF) is a common cardiac arrhythmia that increases the risk of stroke and other cardiovascular complications. Oral anticoagulants (OACs) are effective in reducing this risk. To investigate the knowledge, attitude and practice (KAP) toward OACs among patients with AF.

Methods

This web-based cross-sectional study was conducted at local Hospital between April 2023 and May 2023, and enrolled AF patients.

Results

A total of 491 valid questionnaires were collected, with 293 (59.67%) male and 73.93% resided in urban areas. The KAP scores were 4.64 ± 3.28, 21.09 ± 2.33 and 26.18 ± 2.15, respectively. Multivariate logistic regression analysis showed that junior high school [odd ratio (OR) = 0.346, 95% confidence interval (CI) = 0.145-0.825, P = 0.017], junior college/bachelor and above (OR = 6.545, 95% CI = 2.863-14.963, P < 0.001), monthly income ≥5,000 (OR = 2.343, 95% CI = 1.074-5.111, P = 0.032), never taken OACs (OR = 0.015, 95% CI = 0.004-0.059, P < 0.001), and having been diagnosed AF (6-10 months, OR = 4.003, 95% CI = 1.653-9.692, P = 0.002;over 20 months, OR = 4.046, 95% CI = 1.753-9.340, P = 0.001) were independently associated with knowledge. Knowledge (OR = 1.376, 95% CI = 1.162-1.629, P < 0.001), junior high school (OR = 0.258, 95% CI = 0.084-0.792, P = 0.018), monthly income ≥5,000 (OR = 5.486, 95% CI = 1.834-16.412, P = 0.002), and never undergone AF ablation (OR = 0.214, 95% CI = 0.097-0.471, P < 0.001) were independently associated with attitude. Knowledge (OR = 1.128, 95% CI = 1.030-1.235, P = 0.009), 70-79 years (OR = 2.193, 95% CI = 1.166-4.124, P = 0.015) and ≥80 years (OR = 4.375, 95% CI = 2.034-9.411, P < 0.001) were independently associated with proactive practice.

Conclusion

Patients with AF had inadequate knowledge, suboptimal attitude and inactive practice towards AF and OACs. Improving patient education, especially among those with lower education levels, enhances understanding and management of AF and OACs.

Effect of miR-499-5p/SOX6 axis on atrial fibrosis in rats with atrial fibrillation

Atrial fibrosis is involved in the progression of atrial fibrillation (AF). miR-499-5p is the most downregulated microRNA in arrhythmogenic cardiomyopathy hearts. Sry-related high-mobility-group box 6 (SOX6) is associated with apoptosis, inflammatory responses, and fibrosis. This study investigated the mechanism of miR-499-5p in ameliorating AF rats by regulating SOX6. AF rat models were established by injecting Ach-CaCl₂ mixture, and the rats were treated with Lv-miR-499-5p/oe-SOX6/si-SOX6 before modeling. AF duration was recorded using electrocardiogram. miR-499-5p and SOX6 expression levels in the myocardium were determined by reverse transcription-quantitative polymerase chain reaction. The binding of miR-499-5p and SOX6 was validated. The atrial fibrosis degree and cardiomyocyte apoptosis were assessed using the Masson and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling staining methods. Levels of SOX6, atrial fibrosis markers (collage I/α-SMA/TGFβ1), cell cycle-related proteins (p21/CDC25/Cyclin B1), and cell senescence markers (SA-β-gal/γ-H2AX) were measured using Western blotting and immunohistochemistry. miR-499-5p was downregulated and SOX6 was upregulated in AF rats. miR-499-5p overexpression shortened the AF duration, alleviated atrial fibrosis, and decreased collage I/α-SMA/TGFβ1. miR-499-5p targeted SOX6 to ameliorate atrial fibrosis. AF rats exhibited increased p21/CDC25/Cyclin B1/SA-β-gal/γ-H2AX levels and raised cardiomyocyte apoptosis. SOX6 silencing downregulated p21 and alleviated cardiomyocyte cycle arrest, cell senescence, and apoptosis in AF rats. Shortly, miR-499-5p suppresses atrial fibrosis and cardiomyocyte senescence by targeting SOX6 and downregulating p21, thus mitigating AF in rats.

Integrated Care for Atrial Fibrillation Management: The Role of the Pharmacist

Within Europe and the Asia-Pacific, the Atrial Fibrillation Better Care (ABC) pathway is the gold standard integrated care strategy for atrial fibrillation management. Atrial fibrillation diagnosis should be confirmed and characterized (CC) prior to implementation of ABC pathway components: 1) "A"- Anticoagulation/Avoid stroke; 2) "B"- Better symptom management; and 3) "C"- Cardiovascular and other comorbidity optimization. Pharmacists have the potential to expedite integrated care for atrial fibrillation across the health care continuum: hospital, community pharmacy, and general practice. This review summarizes the available evidence base for pharmacist-led implementation of the "CC to ABC" model.

Associations of new-onset atrial fibrillation and severe visual impairment in type 2 diabetes: A multicenter nationwide study

BACKGROUND

Many studies have demonstrated an association between type 2 diabetes mellitus (T2DM) and atrial fibrillation (AF). However, the potential independent contributions of T2DM and AF to the prevalence of visual impairment have not been evaluated.

AIM

To determine whether such an association between T2DM and incident AF with visual impairment exists, and if so, the prevalence and magnitude of this association.

METHODS

We conducted a nationwide cross-sectional study based on the DM/HT study of the Medical Research Network of the Consortium of Thai Medical Schools. This study had evaluated adult T2DM patients from 831 public hospitals in Thailand in the year 2013. T2DM patients were categorized into two groups: patients without and with incident AF. T2DM patients without AF were selected as the reference group. The association between incident AF and visual impairment among T2DM patients was assessed using multivariate logistic regression.

RESULTS

A total of 27281 T2DM patients with available eye examination data were included in this analysis. The mean age was 60.7 ± 10.5 years, and 31.2% were male. The incident AF was 0.2%. The prevalence of severe visual impairment in all T2DM patients, T2DM patients without AF, and T2DM patients with incident AF were 1.4%, 1.4%, and 6.3%, respectively. T2DM patients with incident AF were associated with an increased OR of 3.89 (95%CI: 1.17-13.38) for severe visual impairment compared with T2DM patients without AF.

CONCLUSION

T2DM patients with incident AF were independently associated with increased severe visual impairment. Therefore, early eye screening should be provided for these high-risk individuals.