Age-specific atrial fibrillation incidence, attributable risk factors and risk of stroke and mortality: results from the MORGAM Consortium

Considering User Experience and Behavioral Approaches in the Design of mHealth Interventions for Atrial Fibrillation: Systematic Review

BACKGROUND

Atrial fibrillation (AF) is a leading chronic cardiac disease associated with an increased risk of stroke, cardiac complications, and general mortality. Mobile health (mHealth) interventions, including wearable devices and apps, can aid in the detection, screening, and management of AF to improve patient outcomes. The inclusion of approaches that consider user experiences and behavior in the design of health care interventions can increase the usability of mHealth interventions, and hence, hopefully, yield an increase in positive outcomes in the lives of users.

OBJECTIVE

This study aims to show how research has considered user experiences and behavioral approaches in designing mHealth interventions for AF detection, screening, and management; the phases of designing complex interventions from the UK Medical Research Council (MRC) were referenced: namely, identification, development, feasibility, evaluation, and implementation.

METHODS

Studies published until September 7, 2022, that examined user experiences and behavioral approaches associated with mHealth interventions in the context of AF were extracted from multiple databases. The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were used.

RESULTS

A total of 2219 records were extracted, with only 55 records reporting on usability, user experiences, or behavioral approaches more widely for designing mHealth interventions in the context of AF. When mapping the studies onto the phases of the UK MRC's guidance for developing and evaluating complex interventions, the following was found: in the identification phase, there were significant differences between the needs of patients and health care workers. In the development phase, user perspectives guided the iterative development of apps, interfaces, and intervention protocols in 4 studies. Most studies (43/55, 78%) assessed the usability of interventions in the feasibility phase as an outcome, although the data collection tools were not designed together with users and stakeholders. Studies that examined the evaluation and implementation phase entailed reporting on challenges in user participation, acceptance, and workflows that could not be captured by studies in the previous phases. To realize the envisaged human behavior intended through treatment, review results highlight the scant inclusion of behavior change approaches for mHealth interventions across multiple levels of sociotechnical health care systems. While interventions at the level of the individual (micro) and the level of communities (meso) were found in the studies reviewed, no studies were found intervening at societal levels (macro). Studies also failed to consider the temporal variation of user goals and feedback in the design of long-term behavioral interventions.

CONCLUSIONS

In this systematic review, we proposed 2 contributions: first, mapping studies to different phases of the MRC framework for developing and evaluating complex interventions, and second, mapping behavioral approaches to different levels of health care systems. Finally, we discuss the wider implications of our results in guiding future mHealth research.

Is breathing frequency a potential means for monitoring exercise intensity in people with atrial fibrillation and coronary heart disease when heart rate is mitigated?

PURPOSE

Moderate-intensity aerobic exercise is safe and beneficial in atrial fibrillation (AF) and coronary heart disease (CHD). Irregular or rapid heart rates (HR) in AF and other heart conditions create a challenge to using HR to monitor exercise intensity. The purpose of this study was to assess the potential of breathing frequency (BF) to monitor exercise intensity in people with AF and CHD without AF.

METHODS

This observational study included 30 AF participants (19 Male, 70.7 ± 8.7 yrs) and 67 non-AF CHD participants (38 Male, 56.9 ± 11.4 yrs). All performed an incremental maximal exercise test with pulmonary gas exchange.

RESULTS

Peak aerobic power in AF ( V ˙ O2peak; 17.8 ± 5.0 ml.kg-1.min-1) was lower than in CHD (26.7 ml.kg-1.min-1) (p < .001). BF responses in AF and CHD were similar (BF peak: AF 34.6 ± 5.4 and CHD 36.5 ± 5.0 breaths.min-1; p = .106); at the 1st ventilatory threshold (BF@VT-1: AF 23.2 ± 4.6; CHD 22.4 ± 4.6 breaths.min-1; p = .240). % V ˙ O2peak at VT-1 were similar in AF and CHD (AF: 59%; CHD: 57%; p = .656).

CONCLUSION

With the use of wearable technologies on the rise, that now include BF, this first study provides an encouraging potential for BF to be used in AF and CHD. As the supporting data are based on incremental ramp protocol results, further research is required to assess BF validity to manage exercise intensity during longer bouts of exercise.

Management of atrial fibrillation in older adults

Most people with atrial fibrillation are older adults, in whom atrial fibrillation co-occurs with other chronic conditions, polypharmacy, and geriatric syndromes such as frailty. Yet most randomized controlled trials and expert guidelines use an age agnostic approach. Given the heterogeneity of aging, these data may not be universally applicable across the spectrum of older adults. This review synthesizes the available evidence and applies rigorous principles of aging science. After contextualizing the burden of comorbidities and geriatric syndromes in people with atrial fibrillation, it applies an aging focused approach to the pillars of atrial fibrillation management, describing screening for atrial fibrillation, lifestyle interventions, symptoms and complications, rate and rhythm control, coexisting heart failure, anticoagulation therapy, and left atrial appendage occlusion devices. Throughout, a framework is suggested that prioritizes patients' goals and applies existing evidence to all older adults, whether atrial fibrillation is their sole condition, one among many, or a bystander at the end of life.

Risk of incident atrial fibrillation after COVID-19 infection: A systematic review and meta-analysis

BACKGROUND

Data regarding the risk of atrial fibrillation (AF) during the post-acute phase of COVID-19 are lacking.

OBJECTIVE

We assessed the risk of incident AF in COVID-19 recovered patients by performing a systematic review and meta-analysis of the available data.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched Medline and Scopus to locate all articles published up to December 1, 2023, reporting the risk of AF in patients recovered from COVID-19 infection compared with noninfected patients in whom the arrhythmia developed during the same follow-up period. AF risk was evaluated by the Mantel-Haenszel random effects model with hazard ratio as the effect measure with 95% confidence interval (CI); heterogeneity was assessed by Higgins I2 statistic.

RESULTS

Overall, 19,478,173 patients (mean age, 56.5 years; 63.0% male) enrolled in 5 observational studies were included in the analysis. Of these, 5,692,510 recovered from severe acute respiratory syndrome coronavirus 2 infection. During a mean follow-up of 14.5 ± 3.2 months, a random effects model revealed a pooled incidence of new-onset AF in 2.6% of cases (95% CI, 1.8%-6.18%). Recovered COVID-19 patients presented with a higher risk of incident AF (hazard ratio, 1.57; 95% CI, 1.24-1.99; P < .0001; I2 = 77.9%) compared with noninfected patients during the same follow-up period. Sensitivity analyses confirmed the yielded results. A multivariable metaregression including age, male sex, history of hypertension, coronary artery disease, and length of follow-up was able to explain a significant part of the heterogeneity (R2 = 54.3%; P = .01).

CONCLUSION

Recovered COVID-19 patients have a higher risk of AF events compared with individuals from the general population.

Atrial Fibrillation Prevalence Rates and Its Association with Cardiovascular-Kidney-Metabolic Factors: SIMETAP-AF Study

Background and Objectives: Atrial fibrillation (AF) is the most frequent arrhythmia and the main cause of hospital admissions for cardioembolic stroke. The SIMETAP research project aims to update the prevalence rates of cardiovascular, renal, or metabolic factors and to evaluate their respective associations with factors that could be related. The present study aims to assess the AF prevalence rates in an adult population and its association with cardiovascular-kidney-metabolic (CKM) factors. Materials and Methods: This cross-sectional observational study was conducted in a primary care setting, with a population-based random sample of 6588 people aged 18.0-102.8 years. Crude and adjusted prevalence rates of AF were calculated. The associations of CKM factors with AF were assessed using bivariate and multivariate analysis. Results: The age- and sex-adjusted prevalence rates of AF were 2.9% in the overall adult population, 6.1% in the population aged ≥50 years, and 12.9% in the population aged ≥70 years, with no significant differences by sex. AF prevalence in the population under 50 years of age barely reached 1‰. Heart failure (HF), hypertension, chronic kidney disease (CKD), stroke, low HDL-cholesterol, and prediabetes were independent CKM factors associated with AF in the overall population, as were the same factors, except prediabetes, in the population ≥50 years old (p < 0.001). High or very high vascular risk was present in 92.4% [95% CI: 89.1-95.7]) of the population with AF. Conclusions: The adjusted prevalence rate of AF in the population aged 50 years or older was 6.1%, twice that of the overall adult population and half that of the population aged 70 years or older. The main independent CKM factors associated with AF were HF, stroke, CKD, hypertension, and low HDL-cholesterol.

Exploring Diet-Based Treatments for Atrial Fibrillation: Patient Empowerment and Citizen Science as a Model for Quality-of-Life-Centered Solutions

Atrial fibrillation (AF) is the most common heart rhythm disorder in the Western world. Between the years 2010 and 2019, the global prevalence of AF rose from 33.5 million to 59 million, highlighting the importance of developing equitable treatments for patients. The disease is associated with symptoms such as palpitations, dizziness, fatigue, shortness of breath, and cognitive dysfunction. In addition, AF increases the risk of developing a stroke and heart failure. Despite new insights into risk factors that can lead to the development of AF, the success of current treatments is suboptimal. Numerous risk factors, such as hypertension, diabetes, and obesity, have been associated with the development and progression of AF. As these can be lifestyle-related risk factors, lifestyle modification may be a solution to reduce AF-related symptoms as well as episodes. Research results show that certain dietary changes can reduce AF and numerous risk factors for AF. Increasing attention is being given to Mediterranean and whole, plant-based eating patterns, which emphasize eating grains, legumes, vegetables, fruits, and nuts, while excluding most-or all-animal products. Hence, what are the beneficial aspects of a Mediterranean and plant-based diet which consists mainly of unprocessed foods? In the current review, we discuss the outcomes of diet-based treatments. Moreover, other diet-related treatments, brought up by patient initiatives, are highlighted. These patient-initiated studies include L-glutamine and electrolytes as options to manage AF. Also, we highlight the emerging importance of valuing patient needs and a quality-of-life-centered approach to medicine. As indicated by recent studies and patient experiences, citizen science can create inclusive solutions that lead to patient empowerment and a holistic approach for AF management.

Impact of prior oral anticoagulation on admission stroke severity in patients with atrial fibrillation

BACKGROUND AND AIMS

In patients with atrial fibrillation, oral anticoagulation therapy is indicated for both primary and secondary prevention of stroke/systemic embolism. Though direct oral anticoagulants with greater safety and efficacy than warfarin were introduced into clinical practice at the beginning of the last decade, even now not all patients with AF have adequate preventative anticoagulant treatment. The primary goal of this study was to evaluate the impact of prior use of oral anticoagulants on admission stroke severity in those with AF. Other aims were, inter alia, to assess the trend in atrial fibrillation prevalence in the years of the HISTORY trials 2012-2021 carried out in the Czech Republic and use of oral anticoagulants (OAC) in ischemic stroke (IS) patients.

METHODS

We analyzed consecutive ischemic stroke patients who had been enrolled in the HISTORY (Heart and Ischemic STrOke Relationship studY) study registered on ClinicalTrials.gov (identifier NCT01541163) in the year 2012 and carried out a yearly comparison (detailed in the text).

RESULTS

In total, there were 1059 patients (55.9% males, mean age 71.7±12.8). There was no significant difference over the time period in rate of known (18.3 vs. 16.5%, P=0.442) or newly detected AF (17.0 vs. 16.0%, P=0.665), but sigificantly more patients with known AF were treated with oral anticoagulants before IS in the year 2021 (32.1 vs. 70.7%, P<0.0001), and direct oral anticoagulants (3.6 vs. 35.4%, P<0.0001). The number of patients with atrial fibrillation had not changed significantly over the years (26.2 vs. 31.3%). Patients on OAC had a lower median admission score on the National Institutes of Health Stroke Scale (NIHSS) than those not using an oral anticoagulant (6 vs. 16, P=0.0004) in 2021.

CONCLUSIONS

There was no significant upward trend in atrial fibrillation in stroke patients admitted between 2012 and 2021, but patients with known AF were significantly more frequently treated with oral anticoagulants and direct oral anticoagulants (DOAC) in 2021. Patients on OAC had lower admission NIHSS scores than those not using any anticoagulent in the year 2021. The difference in the median admission NIHSS between the patients on OAC and those without OAC treatment was not significant in the year 2012 (6 vs. 12, P=0.066). This might be related to the fact that substantially fewer patients in 2012 were on DOACs, which are considered more effective than warfarin.

Therapeutic inertia in rhythm control strategies in hospitalized patients with fibrillation: Insights from Hellenic Cardiorenal Morbidity Snapshot (HECMOS) study

BACKGROUND

Current guidelines recommend a rhythm control strategy in patients with symptomatic atrial fibrillation (AF) while catheter ablation has been shown to be a safer and more efficacious approach than antiarrhythmic medications.

METHODS

HECMOS was a nationwide snapshot survey of cardiorenal morbidity in hospitalized cardiology patients. In this sub-study, we included 276 cases who had a history of AF, particularly on the rhythm strategy, and catheter ablation procedures had been performed before the index admission.

RESULTS

Among 276 AF patients (mean age: 76.4 ± 11.5 years, 58 % male), 60.9 % (N = 168) had persistent AF and 39.1 % (N = 108) had paroxysmal AF. Heart failure was the main cause of admission in 54.3 % (N = 145) of the patients, while 14.1 % (N = 39) were admitted due to paroxysmal AF, 7.3 % (N = 20) due to bradyarrhythmic reasons, and 6.5 % (N = 18) suffered from acute coronary syndrome. Most importantly, heart failure with reduced ejection fraction was present in 76 (27 %) patients. Only 10 patients out of the total (3 %, mean age 59.7 years) had undergone AF ablation while electrical cardioversion had been attempted in 37 (13.4 %) patients. Interestingly, in this AF population with heart failure, 3.6 % (N = 10) had a defibrillator implanted (4 single-chamber), and only 1.5 % (N = 4) had a cardiac resynchronization therapy defibrillator (CRT-D).

CONCLUSION

High prevalence of persistent AF was detected in hospitalized patients, with heart failure being the leading cause of admission and main co-morbidity. Rhythm control strategies are notably underused, along with CRT-D implantation in patients with AF and heart failure.

Factors Influencing Stroke Internal Stigma Among Stroke Survivors

Introduction

Poststroke internal stigmatization in patients is often overlooked, yet it makes significant contribution to their recovery and quality of life. After stroke, the survivors often have negative perception toward themselves triggered by the internal stigma. Consequently, it affects the rehabilitation outcomes and increases the risk of long-term complications. Therefore, deeper analysis related to the factors influencing the internal stigma was crucial in order to develop an appropriate and innovative strategy to overcome this issue and optimize the recovery in stroke survivors.

Objective

This study aimed to identify predominant factors influencing the internal stigma in stroke survivors in Indonesia.

Methods

This study used descriptive analytical design and applied stratified nonprobability consecutive sampling involving 439 poststroke respondents from nine hospitals in Bali throughout 2023. This study used various instruments, namely stroke stigma scale (SSS), perceived family support, stroke self-efficacy scale (SSEQ), stroke awareness questionnaire, self-acceptance scale, knowledge of stroke and the respondents' demographic data. The analysis was conducted using Pearson product-moment correlation and multiple regression.

Results

The results from multiple regression analysis showed that self-acceptance (β = .374, p = .000), self-awareness (β = .132, p = .000), self-efficacy (β = .154, p = .000), family support (β = .090, p = .015), age (β = .083, p = .000), and stroke symptoms (β = -.347, p = .000) could explain the internal stigma for 62.8% (F = 124.266, p = .000).

Conclusion

Self-acceptance became the most predominant factor towards internal stigma in the stroke survivors because it showed the ability in accepting changes after stroke, which eventually helped them to overcome the challenge and free themselves from internal stigma that interrupted the process of recovery and adaptation to poststroke physical and psychosocial changes.

Association of adiponectin gene expression with atrial fibrillation in a Pakistani populace

Adiponectin, an adipocytokine produced and secreted by adipose tissue, has anti-diabetic, anti-atherogenic, and anti-inflammatory properties. This case-control study was aimed to assess the expression and serum levels of adiponectin in subject suffereing from atrial fibrillation (AF). The study's subjects (n = 690) were enrolled from the Punjab Institute of Cardiology, Lahore and were grouped into control, AF without Metabolic syndrome (MetS), and AF with MetS groups. Along with the collection of demographic data, an analysis of adiponectin and biochemical parameters were performed. A highly significant difference in serum levels of adiponectin was observed among the control, AF without MetS, and AF with MetS groups (61.61 ± 45.30 ng/ml, 37.20 ± 19.46 ng/ml, 63.78 ± 61.69 ng/ml). The expression analysis of adiponectin was decreased (n-fold = ̴ 0.30) in AF without MetS group as compared to control group (n-fold =  ~ 1.16) but increased in AF with MetS group (n-fold = ̴ 6.26). The correlation analysis revealed a highly significant positive relationship between the expression of the adiponectin gene with waist-to-hip ratio (WHR) in AF without MetS group. Whereas, serum adiponectin was negatively related to serum triglycerides (TG) in AF with MetS group. In multiple regression analysis using adiponectin expression as the dependent variable, WHR was a determinant in AF without MetS. Whereas, when serum adiponectin was used as the dependent variable, serum TG was the determinant in group AF with MetS. The present study implicates that decreased expression and serum levels of adiponectin were associated with the development of AF in which WHR and serum TG also contributed towards the onset of atrial fibrillation.

Acquired risk factors and incident atrial fibrillation according to age and genetic predisposition

BACKGROUND AND AIMS

Atrial fibrillation (AF) is the most common sustained arrhythmia in adults. Investigations of risk factor profiles for AF according to age and genetic risk groups are essential to promote individualized strategies for the prevention and control of AF.

METHODS

A total of 409 661 participants (mean age, 56 years; 46% men) free of AF at baseline and with complete information about risk factors were included from the UK Biobank cohort. The hazard ratios and population-attributable risk (PAR) percentages of incident AF associated with 23 risk factors were examined, including 3 social factors, 7 health behaviours, 6 cardiometabolic factors, 6 clinical comorbidities, and the genetic risk score (GRS), across 3 age groups (40-49, 50-59, and 60-69 years) and 3 genetic risk groups (low, moderate, and high GRS).

RESULTS

After a follow-up of 5 027 587 person-years, 23 847 participants developed AF. Most cardiometabolic factors and clinical comorbidities showed a significant interaction with age, whereby the associations were generally strengthened in younger groups (Pinteraction < .002). However, only low LDL cholesterol, renal dysfunction, and cardiovascular disease showed a significant interaction with genetic risk, and the associations with these factors were stronger in lower genetic risk groups (Pinteraction < .002). Cardiometabolic factors consistently accounted for the largest number of incident AF cases across all age groups (PAR: 36.2%-38.9%) and genetic risk groups (34.0%-41.9%), with hypertension and overweight/obesity being the two leading modifiable factors. Health behaviours (PAR: 11.5% vs. 8.7%) and genetic risk factors (19.1% vs. 14.3%) contributed to more AF cases in the 40-49 years group than in the 60-69 years group, while the contribution of clinical comorbidities remained relatively stable across different age groups. The AF risk attributable to overall cardiometabolic factors (PAR: 41.9% in the low genetic risk group and 34.0% in the high genetic risk group) and clinical comorbidities (24.7% and 15.9%) decreased with increasing genetic risk. The impact of social factors on AF was relatively low across the groups by age and genetic risk.

CONCLUSIONS

This study provided comprehensive information about age- and genetic predisposition-related risk factor profiles for AF in a cohort of UK adults. Prioritizing risk factors according to age and genetic risk stratifications may help to achieve precise and efficient prevention of AF.

Functional outcomes of patients with ischaemic stroke with known atrial fibrillation not on therapeutic anticoagulation

BACKGROUND

Anticoagulation significantly reduces the risk of ischaemic stroke in patients with atrial fibrillation (AF). There are a proportion of patients with known AF who remain off anticoagulation. Aims This study aims to retrospectively compare the baseline characteristics, treatments and functional outcomes between patients with ischaemic stroke and known AF based on their anticoagulation status.

METHODS

A single-centre, retrospective review of consecutive patients with an ischaemic stroke and a known history of AF was conducted.

RESULTS

Two hundred four patients with an ischaemic stroke had documented AF prior to the index admission, of which 126 were anticoagulated. Median admission National Institutes of Health Stroke Scale score was lower for anticoagulated patients, though not statistically significant (5.1 vs 7.0, P = 0.09). Median baseline modified Rankin score (mRS) did not significantly differ. Nonanticoagulated patients were more likely to have large vessel occlusions (37.2% vs 23.8%, P = 0.04) and more likely to receive intravenous thrombolysis (15.4% vs 1.6%, P < 0.01). There was no difference in rates of endovascular clot retrieval between groups (P > 0.05). Unfavourable functional outcome at 90 days (mRS ≥ 3) did not significantly differ between groups (P = 0.51). A total of 38.5% of nonanticoagulated patients had no documented reason for this. Of the patients who survived the index admission, 81.5% of patients who were not anticoagulated on admission received anticoagulation.

CONCLUSIONS

Baseline anticoagulation was associated with milder stroke severity in ischaemic stroke patients with known AF. There was no significant difference in functional outcomes at 90 days between groups. Larger observational studies are required to further assess this cohort.

Opioid Impacts on Cardiovascular Health

The prevalence of opioid use in the current opioid epidemic era has led to a public health emergency due to the ties to mortality and morbidity. Studies have investigated opioids' impacts on different aspects of cardiovascular health, although there seems to be a lack of a current concise review. Therefore, the aim of this literature review is to provide a summary of the most recent studies from the past decade that postulate a connection between opioids and their impact on cardiovascular health while highlighting conflicting areas among published research. For this literature review, three databases, PubMed (NLM), EMBASE, and Web of Science (Core Collection), were searched for full peer-reviewed articles written in English about human subjects and published between 2013 and 2023 inclusive. The following initial approach was to search for terms in the title of articles: "opioid AND ("vascular" OR "artery" OR "vein" OR "heart rate" OR "infarct" OR "stroke" OR "aortic" OR "cardiovascular disease"). After assessing for duplicate articles from the three databases, the remaining articles were assessed for inclusion eligibility. In the present review, a brief description of the overall role of opioid receptors is provided followed by the literature findings. These findings indicate potentially important negative impacts of opioid use on cardiovascular health in a number of areas. These include opioid-associated increases in the following: (1) vascular aging based on demonstrated increases in arterial stiffness, (2) opioid-related reductions in heart rate variability (HRV) and its implications on morbidity and mortality, (3) opioid's impacts on coronary artery and coronary heart disease (CHD), (4) opioids as a risk factor for atrial fibrillation (AF) and (5) opioid use as a risk factor for vascular occlusion processes. In addition to these broad cardiovascular effects, other aspects of concern are related to the potential impacts of withdrawal from opioid use, which, when done rapidly, are associated with increases in blood pressure and a decrease in HRV.

Management of atrial fibrillation in German military aircrew

INTRODUCTION

Arrhythmias are one of the most common causes of loss of flying privileges for both military and civilian pilots in the Western World, and atrial fibrillation (AF) is one of the most common arrhythmias worldwide. Aircrew, and particularly pilots, are subject to a unique and exacting working environment, especially in high-performance military aircraft. This manuscript analyzes AF cases in German military aircrew from both a clinical and occupational perspective to point out specific characteristics in this comparatively young, highly selected, and closely monitored group, and to discuss AF management with the aim of a return to flying duties.

METHODS

The digital information systems of the German Air Force Centre of Aerospace Medicine (GAFCAM) were searched for aircrew (pilot and non-pilot aircrew from German Air Force, Army, and Navy) with the diagnosis of AF. Evaluation results for underlying disease, AF characteristics, important clinical findings, and occupational decisions were analyzed in the light of current clinical guidelines and aeromedical regulations.

RESULTS

In a 34-year period, between March 1989 and January 2023, 42 aircrew with at least one episode of AF were registered, all of them were male. The median age at initial diagnosis was 47 years (min 22 years, max 62 years). The median follow-up period was 5.35 years. 19 of them (45%) were pilots. The breakdown of events and occurrence was found to be: single (23), paroxysmal (16), persistent (2), permanent (1). In 27 aircrew (64%) AF terminated spontaneously. Long-term recurrence prevention was variable with catheter ablations in 8 cases. 36/42 aircrew were returned to flight status with restrictions, while 6/42 were permanently disqualified from flying.

CONCLUSION

Management of AF in military aircrew requires a comprehensive approach regarding the flight environment as well as clinical guidance. Aeromedical disposition should be case-by-case based on aeromedical regulations, individual clinical findings, and specific occupational requirements in this challenging field of work.

Assessment of the general public's knowledge of atrial fibrillation through social media: a cross-sectional study

BACKGROUND

Early detection and timely treatment of atrial fibrillation (AF) remains pivotal to preventing AF-related complications. Public involvement in recognising potential AF symptoms and managing AF is vital for early detection and treatment of AF.

OBJECTIVE

The aim of the study is to assess the general public's knowledge of AF using an online survey, disseminated via social media.

METHODS

A cross-sectional online survey of the general public was conducted between November to December 2021. The survey's URL was shared on National University Heart Centre, Singapore's official Facebook page. Digital marketing strategies were employed to recruit members of the public. The 27-item survey assessed public's knowledge across five domains: basic information about AF, risk factors of AF, detection of AF, prevention of AF, and management of AF.

RESULTS

The survey involved 620 participants. Approximately two-thirds were between the ages 21 to 40 years (64.5%), female (60%) and had at least a degree (64.7%) as their highest level of education. Participants obtained a mean percentage score of 63.3 ± 26.0 for their AF knowledge. One-way ANOVA was done to examine the associations between the participants' characteristics and their knowledge of AF. There were no statistically significant differences in the AF knowledge scores across the various sociodemographic subgroups.

CONCLUSIONS

Members of the public recruited from Facebook and via digital marketing had moderately good knowledge of AF. However, public awareness pertaining to preventing AF has potential for improvement. The utility of social media in reaching the general public was illustrated through this study.

Stroke: Molecular mechanisms and therapies: Update on recent developments

Stroke, a neurological disease, is one of the leading causes of death worldwide, resulting in long-term disability in most survivors. Annual stroke costs in the United States alone were estimated at $46 billion recently. Stroke pathophysiology is complex, involving multiple causal factors, among which atherosclerosis, thrombus, and embolus are prevalent. The molecular mechanisms involved in the pathophysiology are essential to understanding targeted drug development. Some common mechanisms are excitotoxicity and calcium overload, oxidative stress, and neuroinflammation. In addition, various modifiable and non-modifiable risk factors increase the chances of stroke manifolds. Once a patient encounters a stroke, complete restoration of motor ability and cognitive skills is often rare. Therefore, shaping therapeutic strategies is paramount for finding a viable therapeutic agent. Apart from tPA, an FDA-approved therapy that is applied in most stroke cases, many other therapeutic strategies have been met with limited success. Stroke therapies often involve a combination of multiple strategies to restore the patient's normal function. Certain drugs like Gamma-aminobutyric receptor agonists (GABA), Glutamate Receptor inhibitors, Sodium, and Calcium channel blockers, and fibrinogen-depleting agents have shown promise in stroke treatment. Recently, a drug, DM199, a recombinant (synthetic) form of a naturally occurring protein called human tissue kallikrein-1 (KLK1), has shown great potential in treating stroke with fewer side effects. Furthermore, DM199 has been found to overcome the limitations presented when using tPA and/or mechanical thrombectomy. Cell-based therapies like Neural Stem Cells, Hematopoietic stem cells (HSCs), and Human umbilical cord blood-derived mesenchymal stem cells (HUCB-MSCs) are also being explored as a treatment of choice for stroke. These therapeutic agents come with merits and demerits, but continuous research and efforts are being made to develop the best therapeutic strategies to minimize the damage post-stroke and restore complete neurological function in stroke patients.

Burden of atrial fibrillation and its attributable risk factors from 1990 to 2019: An analysis of the Global Burden of Disease study 2019

BACKGROUND

Understanding the pattern and trend of the atrial fibrillation (AF) burden are essential for developing effective preventive strategies. The purpose of this study was to estimate AF burdens and risk factors in 204 countries and territories between 1990 and 2019.

MATERIALS AND METHODS

Data were extracted from the Global Burden of Disease 2019, including incidence, death, disability-adjusted life-years (DALYs), and the attributable risk factors. In order to quantify changes in the age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), and age-standardized DALY rate between 1990 and 2019, the estimated annual percentage change (EAPC) was used. Also, AF burden was assessed in relation to the Socio-demographic Index (SDI).

RESULTS

Globally, there were 4,720,324 incident cases, 117,038 deaths and 8,393,635 DALYs in 2019. There were no significant changes in ASIR, ASDR, or age-standardized DALY rates from 1990 to 2019. Although the burden and trend of AF varied in different regions and countries, the ASIR, ASDR and age-standardized DALY rate were positively correlated with SDI. Furthermore, the burden of AF was higher in males and elderly. The age-standardized DALY rate worldwide was primarily attributable to high systolic blood pressure, followed by high body-mass index, alcohol use, smoking, diet high in sodium and lead exposure.

CONCLUSION

AF remained a major public health challenge worldwide, with substantial variation at regional and national levels. There is an urgent need to increase public awareness about AF risk factors and to bring about cost-effective interventions for AF in order to reduce its future burden.

Shift work is associated with 10-year incidence of atrial fibrillation in younger but not older individuals from the general population: results from the Tromsø Study

OBJECTIVES

Shift work is associated with myocardial infarction and stroke. We studied if shift work is also associated with incident atrial fibrillation (AF) and if this association differs, depending on sex and age.

METHODS

We studied 22 339 participants (age 37.0±9.8 years, 49% women) with paid work from the third (1986-1987), fourth (1994-1995), fifth (2001) and sixth (2007-2008) surveys of the population-based Tromsø Study, Norway. Participants were followed up for ECG-confirmed AF through 2016. Shift work was assessed by questionnaire at each survey. We used unadjusted and multivariable-adjusted Cox regression models to study the association of shift work with 10-year incident AF and incident AF during extensive follow-up up to 31 years. Interactions with sex and age were tested in the multivariable model.

RESULTS

Shift work was reported by 21% of participants at the first attended survey. There was an interaction between shift work and age for 10-year incident AF (p=0.069). When adjusted for AF risk factors, shift work was significantly associated with 10-year incident AF in participants <40 years (HR 2.90, 95% CI 1.12 to 7.49) but not≥40 years of age (HR 0.90, 95% CI 0.53 to 1.51). Shift work was not associated with incident AF during extensive follow-up (HR 1.03, 95% CI 0.89 to 1.20). There was no interaction between shift work and sex.

CONCLUSIONS

Shift work was associated with 10-year incident AF in individuals <40 years but not ≥40 years of age. Shift work was not associated with incident AF during extensive follow-up up to 31 years, and there were no sex differences.

Long-term mortality of patients ablated for atrial fibrillation: a retrospective, population-based epidemiological study in Apulia, Italy

OBJECTIVES

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia associated with substantial morbidity and mortality. Data on long-term risk and mortality after catheter ablation for AF are lacking. The aim of this study was to evaluate all-cause mortality and the long-term risk of death in patients who underwent catheter ablation for AF compared with the general population.

DESIGN

Retrospective, population-based epidemiological study.

SETTING

We analysed data from patients residing in Apulia region who underwent AF ablation between January 2009 and June 2019.

PARTICIPANTS

1260 patients (914 male, mean age 60±11 years).

OUTCOMES

Vital status and dates of death to 31 December 2019 were obtained by using regional Health Information System. The expected number of deaths was derived using mortality rates from the general regional population by considering age-specific and gender-specific death probability provided for each calendar year by the Italian National Institute of Statistics. Standardised mortality ratios (SMRs) were calculated by dividing the observed number of deaths among patients by the expected number of deaths estimated from the general population.

RESULTS

During follow-up (6449 person-years), 95 deaths were observed (1.47 deaths per 100 person-years). Although overall long-term mortality after AF ablation was not different to that of the general population (SMR 1.05 (95% CI 0.86 to 1.28; p=0.658)), the number of observed events was significantly increased in patients with heart failure (HF) at baseline or who developed HF during follow-up (SMR 2.40 (1.69 to 3.41; p<0.001) and 1.75 (1.17 to 2.64; p=0.007), respectively) and reduced in those without (SMR 0.63 (0.47 to 0.86; p=0.003)).

CONCLUSION

Long-term mortality of patients undergoing AF ablation is similar to that of the general population. Patients with HF had an increased risk while those without seem to have a better risk profile.

The association of education and household income with the lifetime risk of incident atrial fibrillation: The Framingham Heart study

Background

Methods

Results

Conclusion

A Contemporary Review of Epidemiology, Risk Factors, Etiology, and Outcomes of Premature Stroke

PURPOSE OF REVIEW

Recent data identifies increases in young ischemic and hemorrhagic strokes. We provide a contemporary overview of current literature on stroke among young patients or premature stroke along with directions for future investigation.

RECENT FINDINGS

Strokes in the young are highly heterogenous and often cryptogenic. Sex distribution and risk factors shift from women among the youngest age groups (< 35) to men over the age of 45, with a coinciding rise in traditional vascular risk factors. Incidence is higher in minority and socioeconomically disadvantaged populations, and the impact of stroke among these communities may be exaggerated by disparities in symptom recognition and access to care. Special diagnostic work-up may be needed, and a lower threshold for diagnosis is warranted as potential misdiagnosis is a concern and may preclude necessary triage and management. Although "premature strokes" form a relatively small proportion of total incidence, they vary greatly across subgroups and present an outsized impact on quality of life and productivity.

The Effect of Obesity, Hypertension, Diabetes Mellitus, Alcohol, and Sleep Apnea on the Risk of Atrial Fibrillation

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia associated with a two-fold increase in mortality caused by a higher risk of stroke and heart failure. Currently, AF is present in ~ 2 % of the general population, and its incidence and prevalence are increasing. Obesity, hypertension, diabetes mellitus, obstructive sleep apnea, and alcohol consumption increase the risk of AF. Each unit of increase in BMI increases the risk of AF by 3 %, and intensive weight loss is also associated with reduced AF recurrence. Hypertension increases the risk of AF by 50 % in men and by 40 % in women, and explains ≈ 20 % of new AF cases. Patients with obstructive sleep apnea are at four times higher risk of developing AF than subjects without sleep apnea. Higher concentrations of pro-inflammatory cytokines, higher amounts of epicardial adipose tissue, and a higher degree of ventricular diffuse myocardial fibrosis are present in AF patients and patients with the aforementioned metabolic disorders. Several prospective cohort studies and randomized trials have been initiated to show whether weight loss and treatment of other risk factors will be associated with a reduction in AF recurrences.