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Khalilian Ekrami N, Baron DK, Benjamin EJ, Mulder BA, Van Gelder IC, Rienstra M. Participation of women in clinical studies of atrial fibrillation in the Northern Netherlands. Neth Heart J 2024; 32:326-331. [PMID: 39105898 PMCID: PMC11335698 DOI: 10.1007/s12471-024-01887-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 08/07/2024] Open
Abstract
INTRODUCTION Concerns exist of women underrepresentation in atrial fibrillation (AF) studies, potentially limiting the generalisability of study findings to women with AF. We assessed the participation of women in AF clinical studies performed at a tertiary care centre in the Northern Netherlands. METHODS Eight AF clinical studies with screening logs were available for analysis. To identify sex-specific differences, patient inclusion and exclusion and reasons for exclusion were assessed. Participation-to-prevalence ratios (PPRs) were calculated to evaluate the representation of women in the studies relative to the AF sex distribution of the general population in the Netherlands (2019 Global Burden of Disease study). RESULTS We included 1739 screened patients with AF in the analysis, of whom 722 (41.5%) were women. Of the patients screened, 161 (9%) were enrolled. Median age of screened patients was 69 years (interquartile range (IQR): 61-77), and women were older than men (71 years; IQR: 63-79 vs 68 years; IQR: 60-75; p < 0.001). Women were not underscreened compared with men (PPR: 1.09; 95% confidence interval (CI): 1.08-1.10), disproportionally excluded (92% vs 90%; p = 0.10) or less willing to participate (17% vs 15%; p = 0.36). Women had an overall PPR of 1.05 (95% CI: 1.05-1.06) compared with the general AF population. CONCLUSION At our tertiary hospital in the Northern Netherlands, women appeared to be well-represented in AF studies. The current study advocates for the adoption of a more comprehensive measure of equity, such as the PPR, and screening log evaluation to improve the generalisability of study findings to the entire clinical AF population.
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Affiliation(s)
- Neda Khalilian Ekrami
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Dawid K Baron
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Emelia J Benjamin
- Department of Medicine, Boston Medical Centre, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Bart A Mulder
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Isabelle C Van Gelder
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands.
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Bethell MA, Taylor KA, Burke CA, Smith DE, Kiwinda LV, Badejo M, DeBaun MR, Fleming M, Péan CA. Racial and Ethnic Disparities in Providing Guideline-Concordant Care After Hip Fracture Surgery. JAMA Netw Open 2024; 7:e2429691. [PMID: 39190309 DOI: 10.1001/jamanetworkopen.2024.29691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/28/2024] Open
Abstract
Importance Institutions have adopted protocol-driven standardized hip fracture programs (SHFPs). However, concerns persist regarding bias in adherence to guideline-concordant care leading to disparities in implementing high-quality care for patients recovering from surgery for hip fracture. Objective To assess disparities in the implementation of guideline-concordant care for patients after hip fracture surgery in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Targeted Hip Fracture (THF) Database. Design, Setting, and Participants This cross-sectional study was conducted using the ACS-NSQIP THF database from 2016 to 2021 for patients aged 65 years and older with hip fractures undergoing surgical fixation. Care outcomes of racial and ethnic minority patients (including American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Pacific Islander, or multiple races and Hispanic ethnicity) were compared with non-Hispanic White patients via risk difference, stratified by care institution SHFP status. Modified Poisson regression was used to measure interactions. Statistical analysis was performed from November 2022 to June 2024. Main Outcomes and Measures The primary outcomes of interest encompassed weight-bearing as tolerated (WBAT) on postoperative day 1 (POD1), venous thromboembolism (VTE) prophylaxis, bone-protective medication, and the presence of SHFP at the institution. Results Among 62 194 patients (mean [SD] age, 82.4 [7.3] years; 43 356 [69.7%] female) who met inclusion criteria and after multiple imputation, 11.2% (95% CI, 10.8%-11.5%) were racial and ethnic minority patients, 3.3% (95% CI, 3.1%-3.4%) were Hispanic patients, and 92.0% (95% CI, 91.7%-92.2%) were White. Receiving care at an institution with an SHFP was associated with improved likelihood of receiving guideline-concordant care for all patients to varying degrees across care outcomes. SHFP was associated with higher probability of being WBAT-POD1 (risk difference for racial and ethnic minority patients, 0.030 [95% CI, 0.004-0.056]; risk difference for non-Hispanic White patients, 0.037 [95% CI, 0.029-0.45]) and being prescribed VTE prophylaxis (risk difference for racial and ethnic minority patients, 0.066 [95% CI, 0.040-0.093]; risk difference for non-Hispanic White patients, 0.080 [95% CI, 0.071-0.089]), but SHFP was associated with the largest improvements in receipt of bone-protective medications (risk difference for racial and ethnic minority patients, 0.149 [95% CI, 0.121-0.178]; risk difference for non-Hispanic White patients, 0.181 [95% CI, 0.173-0.190]). While receiving care at an SHFP was associated with improved probability of receiving guideline-concordant care in both race and ethnicity groups, greater improvements were seen among non-Hispanic White patients compared with racial and ethnic minority patients. Conclusions and Relevance Older adults who received care at an institution with an SHFP were more likely to receive guideline-concordant care (bone-protective medication, WBAT-POD1, and VTE prophylaxis), regardless of race and ethnicity. However, the probability of receiving guideline-concordant care at an institution with an SHFP increased more for non-Hispanic White patients than racial and ethnic minority patients.
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Affiliation(s)
| | - Kenneth A Taylor
- Duke University School of Medicine, Department of Orthopaedic Surgery, Durham, North Carolina
- Duke University School of Medicine, Duke Clinical Research Institute, Durham, North Carolina
| | - Colleen A Burke
- Duke University School of Medicine, Department of Orthopaedic Surgery, Durham, North Carolina
- Duke University School of Medicine, Department of Population Health Sciences, Durham, North Carolina
| | - Denise E Smith
- Duke University School of Medicine, Durham, North Carolina
| | | | - Megan Badejo
- Duke University School of Medicine, Durham, North Carolina
| | | | - Mark Fleming
- Duke University School of Medicine, Department of Orthopaedic Surgery, Durham, North Carolina
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Saw J, Vij V, Galea R, Piayda K, Nelles D, Vogt L, Gloekler S, Fürholz M, Meier B, Räber L, O'Hara G, Arzamendi D, Agudelo V, Asmarats L, Freixa X, Flores-Umanzor E, De Backer O, Sondergaard L, Nombela-Franco L, Salinas P, Korsholm K, Nielsen-Kudsk JE, Zeus T, Operhalski F, Schmidt B, Montalescot G, Guedeney P, Iriart X, Miton N, Gilhofer T, Fauchier L, Veliqi E, Meincke F, Petri N, Nordbeck P, Gonzalez-Ferreiro R, Cruz-González I, Bhatt DL, Laricchia A, Mangieri A, Omran H, Schrickel JW, Beiert T, Rodes-Cabau J, Nickenig G, Sievert H, Sedaghat A, Afzal S. Impact of gender in patients with device-related thrombosis after left atrial appendage closure - A sub-analysis from the multicenter EUROC-DRT-registry. Echocardiography 2024; 41:e15888. [PMID: 39042643 DOI: 10.1111/echo.15888] [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: 04/21/2024] [Revised: 06/21/2024] [Accepted: 06/29/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Device-related thrombosis (DRT) is a common finding after left atrial appendage closure (LAAC) and is associated with worse outcomes. As women are underrepresented in clinical studies, further understanding of sex differences in DRT patients is warranted. METHODS AND RESULTS This sub-analysis from the EUROC-DRT-registry compromises 176 patients with diagnosis of DRT after LAAC. Women, who accounted for 34.7% (61/176) of patients, were older (78.0 ± 6.7 vs. 74.9 ± 9.1 years, p = .06) with lower rates of comorbidities. While DRT was detected significantly later in women (173 ± 267 vs. 127 ± 192 days, p = .01), anticoagulation therapy was escalated similarly, mainly with initiation of novel oral anticoagulant (NOAC), vitamin K antagonist (VKA) or heparin. DRT resolution was achieved in 67.5% (27/40) of women and in 75.0% (54/72) of men (p = .40). In the remaining cases, an intensification/switch of anticoagulation was conducted in 50.% (9/18) of men and in 41.7% (5/12) of women. Final resolution was achieved in 72.5% (29/40) cases in women, and in 81.9% (59/72) cases in men (p = .24). Women were followed-up for a similar time as men (779 ± 520 vs. 908 ± 687 days, p = .51). Kaplan-Meier analysis revealed no difference in mortality rates in women (Hazard Ratio [HR]: 1.73, 95%-Confidence interval [95%-CI]: .68-4.37, p = .25) and no differences in stroke (HR: .83, 95%-CI: .30-2.32, p = .72) within 2 years after LAAC. CONCLUSION Evaluation of risk factors and outcome revealed no differences between men and women, with DRT in women being diagnosed significantly later. Women should be monitored closely to assess for DRT formation/resolution. Treatment strategies appear to be equally effective.
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Affiliation(s)
| | - Vivian Vij
- Heart Center, University Hospital Bonn, Bonn, Germany
| | - Roberto Galea
- Department of Cardiology, Inselspital, Bern, Switzerland
| | | | | | - Lara Vogt
- Heart Center, University Hospital Bonn, Bonn, Germany
| | | | - Monika Fürholz
- Department of Cardiology, Inselspital, Bern, Switzerland
| | - Bernhard Meier
- Department of Cardiology, Inselspital, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern, Switzerland
| | - Gilles O'Hara
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
| | | | | | - Lluis Asmarats
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | | | | | | | - Kasper Korsholm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Tobias Zeus
- Klinik für Kardiologie, Angiologie und Pneumologie, University Hospital Düsseldorf, Germany
| | | | - Boris Schmidt
- Agaplesion Bethanien Krankenhaus, CBB, Frankfurt, Germany
| | - Gilles Montalescot
- ACTION Study Group, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne University, Paris, France
| | - Paul Guedeney
- ACTION Study Group, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne University, Paris, France
| | - Xavier Iriart
- Paediatric and Congenital Cardiology Department, Bordeaux University Hospital, Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Bordeaux University Foundation, Pessac, France
| | - Noelie Miton
- Paediatric and Congenital Cardiology Department, Bordeaux University Hospital, Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, Bordeaux University Foundation, Pessac, France
| | - Thomas Gilhofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Laurent Fauchier
- Department of Cardiology, University Hospital Tours, Tours, France
| | | | | | - Nils Petri
- Heart Center, University Hospital Würzburg, Würzburg, Germany
| | - Peter Nordbeck
- Heart Center, University Hospital Würzburg, Würzburg, Germany
| | | | | | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alessandra Laricchia
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy and Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy and Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Heyder Omran
- Department of Cardiology, Marienkrankenhaus, Bonn, Germany
| | | | - Thomas Beiert
- Heart Center, University Hospital Bonn, Bonn, Germany
| | - Josep Rodes-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
| | | | | | | | - Shazia Afzal
- Heart Center, Krankenhaus der Barmherzigen Brüder, Trier, Germany
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González-Ferrero T, Bergonti M, Marcon L, Minguito-Carazo C, Tilves Bellas C, Pesquera Lorenzo JC, Martínez-Sande JL, González-Melchor L, García-Seara FJ, Fernández-López JA, González-Juanatey JR, Heidbuchel H, Sarkozy A, Rodríguez-Mañero M. Characterization of patients with extensive left atrial myopathy referred for atrial fibrillation ablation: incidence, predictors, and outcomes. Clin Res Cardiol 2024:10.1007/s00392-024-02467-6. [PMID: 38922425 DOI: 10.1007/s00392-024-02467-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 05/16/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Although atrial fibrosis has a relevant impact on ablation success rate, experimental studies have reported that extensive fibrosis may be accompanied by a reduced burden secondary to a prominent depression of atrial excitability. OBJECTIVES We aimed to identify clinical and echocardiographic factors associated with extensive left atrial myopathy (ELAM), to analyze the predictive ability of established scores (AF score, APPLE, and DR-FLASH) and assess outcomes in terms of AF recurrence, left atrial flutter, and post-procedural heart failure admissions. METHODS A total of 950 consecutive patients undergoing the first AF ablation were included. A 3D electroanatomical mapping system (CARTO3, Biosense Webster) was created using a multipolar mapping catheter (PentaRay, Biosense Webster). ELAM was defined as ≥ 50% low voltage area. A subanalysis with four groups was also created (< 10%; 10-20%; 10-20%; and > 30%). Logistic regressions, Cox proportional hazards models, and log-rank test were used to test the predictors independently associated with the presence of ELAM and AF recurrence. The model was prospectively validated in a cohort of 150 patients obtaining an excellent ability for prediction AUC 0.90 (CI 95% 0.84-0.96). RESULTS Overall, 78 (8.42%) presented ELAM. Age, female sex, persistent AF, first-degree AV block, and E/e' were significant predictors. The model incorporating these factors outperformed the existing scores (AUC = 0.87). During a mean follow-up of 20 months (IQR 9 to 36), patients with ELAM presented a higher rate of AF recurrence (42.02% vs 26.01%, p = 0.030), left atrial flutter (26.03% vs 8.02%, p < 0.001), and post-procedural heart failure admissions (12.01% vs 0.61%, p < 0.001) than non-ELAM patients. CONCLUSIONS This study reveals the incidence and clinical factors associated with ELAM in AF, highlighting age, female, persistent AF, first-degree AV block, and E/e'. Importantly, the presence of ELAM is associated with poorer outcomes in terms of recurrence and HF admission.
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Affiliation(s)
- Teba González-Ferrero
- Division of Cardiac Electrophysiology, Department of Cardiology, University Hospital Lucus Augusti, Lugo, Spain
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Marco Bergonti
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900, Lugano, Switzerland
| | - Lorenzo Marcon
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Cardiovascular Research, GENCOR, University of Antwerp, Antwerp, Belgium
| | - Carlos Minguito-Carazo
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Carlos Tilves Bellas
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
| | - Juan Carlos Pesquera Lorenzo
- Division of Cardiac Electrophysiology, Department of Cardiology, University Hospital Lucus Augusti, Lugo, Spain
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900, Lugano, Switzerland
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Heart Rhythm Management Center, University Hospital of Brussels, Brussels, Belgium
- Cardiovascular Research, GENCOR, University of Antwerp, Antwerp, Belgium
| | - José Luis Martínez-Sande
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Laila González-Melchor
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco Javier García-Seara
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jesús Alberto Fernández-López
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Ramón González-Juanatey
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain
- CIBERCV, Institute of Health Carlos III, Madrid, Spain
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium
- Cardiovascular Research, GENCOR, University of Antwerp, Antwerp, Belgium
| | - Andrea Sarkozy
- Heart Rhythm Management Center, University Hospital of Brussels, Brussels, Belgium
| | - Moisés Rodríguez-Mañero
- Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Travesía da Choupana S/N, 15706, Santiago de Compostela, A Coruña, Spain.
- CIBERCV, Institute of Health Carlos III, Madrid, Spain.
- Cardiovascular Area and Coronary Unit, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
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Xia L, He S, Huang YF, Ma H. Multiscale dilated convolutional neural network for Atrial Fibrillation detection. PLoS One 2024; 19:e0301691. [PMID: 38829846 PMCID: PMC11146707 DOI: 10.1371/journal.pone.0301691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/20/2024] [Indexed: 06/05/2024] Open
Abstract
Atrial Fibrillation (AF), a type of heart arrhythmia, becomes more common with aging and is associated with an increased risk of stroke and mortality. In light of the urgent need for effective automated AF monitoring, existing methods often fall short in balancing accuracy and computational efficiency. To address this issue, we introduce a framework based on Multi-Scale Dilated Convolution (AF-MSDC), aimed at achieving precise predictions with low cost and high efficiency. By integrating Multi-Scale Dilated Convolution (MSDC) modules, our model is capable of extracting features from electrocardiogram (ECG) datasets across various scales, thus achieving an optimal balance between precision and computational savings. We have developed three MSDC modules to construct the AF-MSDC framework and assessed its performance on renowned datasets, including the MIT-BIH Atrial Fibrillation Database and Physionet Challenge 2017. Empirical results unequivocally demonstrate that our technique surpasses existing state-of-the-art (SOTA) methods in the AF detection domain. Specifically, our model, with only a quarter of the parameters of a Residual Network (ResNet), achieved an impressive sensitivity of 99.45%, specificity of 99.64% (on the MIT-BIH AFDB dataset), and an [Formula: see text] score of 85.63% (on the Physionet Challenge 2017 AFDB dataset). This high efficiency makes our model particularly suitable for integration into wearable ECG devices powered by edge computing frameworks. Moreover, this innovative approach offers new possibilities for the early diagnosis of AF in clinical applications, potentially improving patient quality of life and reducing healthcare costs.
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Affiliation(s)
- Lingnan Xia
- Henan High-speed Railway Operation and Maintenance Engineering Research Center, Zhengzhou Railway Vocational and Technical College, Zhengzhou, China
| | - Sirui He
- Department of Big Data Management and Application, Dalian Polytechnic University, Dalian, Liaoning, China
| | - Y-F Huang
- Henan High-speed Railway Operation and Maintenance Engineering Research Center, Zhengzhou Railway Vocational and Technical College, Zhengzhou, China
| | - Hua Ma
- Henan High-speed Railway Operation and Maintenance Engineering Research Center, Zhengzhou Railway Vocational and Technical College, Zhengzhou, China
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Springer J, Pejska M, Homenda W, Zdrojewski T, Daniłowicz-Szymanowicz L, Kozłowski D. Effectiveness of antazoline versus amiodarone, flecainide and propafenone in restoring sinus rhythm at the emergency department. Adv Med Sci 2024; 69:248-255. [PMID: 38649031 DOI: 10.1016/j.advms.2024.04.003] [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: 09/02/2023] [Revised: 02/13/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Little is known about the effectiveness of pharmacological cardioversion (PCV) with antazoline in comparison to flecainide. The aim of this study was to compare the effectiveness of antazoline in restoring sinus rhythm (SR) versus amiodarone, flecainide and propafenone in a group of emergency department (ED) patients. MATERIALS/METHODS This was a single-centre retrospective analysis of patient records from an ED in a large hospital in Poland. We analysed a total of 1878 patient records, divided based on the anti-arrhythmic drug (AAD) administered during PCV: antazoline (n = 1080), antazoline + β-blocker (n = 479), amiodarone (n = 129), flecainide (n = 102), propafenone (n = 88). Of the patients, 63.5 % were female (median 65 years, [19-100]). RESULTS The percentage of successful PCV was significantly higher in the antazoline group (84.3 %) than in the antazoline + β-blocker (75.8 %, p = 0.0001), propafenone (75.6 %, p = 0.0364) and amiodarone (68.8 %, p < 0.0001) groups. Post-hoc analysis revealed that patients who received PCV with antazoline, antazoline + β-blocker, flecainide and propafenone had significantly shorter time to SR than those who received amiodarone (p < 0.0001). Univariate regression analysis revealed that patients who underwent PCV with antazoline were almost twice as likely to return to SR compared to the other groups (p < 0.0001, OR 1.81, 95 % CI 1.44-2.27). CONCLUSIONS This is the first study comparing the effectiveness of antazoline in PCV versus flecainide in addition to the previously studied amiodarone and propafenone. Our results indicate that antazoline is more effective in restoring SR than amiodarone, flecainide and propafenone. In addition, antazoline restored SR significantly faster than amiodarone or propafenone.
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Affiliation(s)
- Janusz Springer
- Division of Preventive Medicine and Education, Medical University of Gdańsk, Gdańsk, Poland.
| | - Michalina Pejska
- Institute of Health Sciences, Pomeranian University in Słupsk, Słupsk, Poland
| | - Wojciech Homenda
- Institute of Health Sciences, Pomeranian University in Słupsk, Słupsk, Poland
| | - Tomasz Zdrojewski
- Division of Preventive Medicine and Education, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Dariusz Kozłowski
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
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Chi H, Woolley KA, Allahabadi S, Fluet A, Roach C, Ward DT, Wong SE. Sex-based Differences in Patient Perspectives and Experiences With Shoulder, Hip, and Knee Arthroplasty. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202404000-00020. [PMID: 38648447 PMCID: PMC11037734 DOI: 10.5435/jaaosglobal-d-24-00083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Sex disparities in presentation of osteoarthritis and utilization of joint replacement surgery (JRS) have been demonstrated. The role of patients' unique perspectives on JRS on their treatment decisions is poorly understood. METHODS JRS candidates who were offered JRS but declined surgical treatment completed this survey. Survey questions included demographic information, patient experiences and current opinions around JRS, patient experiences with providers, goals and concerns, and barriers to JRS. RESULTS More women experience barriers to undergoing JRS compared with men (53% versus 16%; P = 0.014). While both men and women indicated pain relief as their primary goal for treatment, women were significantly more likely to prioritize regaining the ability to complete daily tasks and responsibilities when compared with men (P = 0.007). Both men and women indicated that low symptom severity and nonsurgical treatment options were the reasons for not undergoing JRS (P = 0.455). Compared with men, women trended toward feeling that they were not sufficiently educated about JRS (P = 0.051). CONCLUSION Women have unique perspectives and goals for JRS that may pose sex-specific barriers to care. A better understanding of how patients' gendered experiences affect their decision making is necessary to improve treatment of osteoarthritis and decrease disparities in care.
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Affiliation(s)
- Hannah Chi
- From the San Francisco School of Medicine, University of California, (Dr. Chi, Dr. Fluet, and Mr. Roach), and the San Francisco Department of Orthopedic Surgery, University of California, San Francisco, CA (Dr. Woolley, Dr. Allahabadi, Dr. Ward, and Dr. Wong)
| | - Katherine A. Woolley
- From the San Francisco School of Medicine, University of California, (Dr. Chi, Dr. Fluet, and Mr. Roach), and the San Francisco Department of Orthopedic Surgery, University of California, San Francisco, CA (Dr. Woolley, Dr. Allahabadi, Dr. Ward, and Dr. Wong)
| | - Sachin Allahabadi
- From the San Francisco School of Medicine, University of California, (Dr. Chi, Dr. Fluet, and Mr. Roach), and the San Francisco Department of Orthopedic Surgery, University of California, San Francisco, CA (Dr. Woolley, Dr. Allahabadi, Dr. Ward, and Dr. Wong)
| | - Angelina Fluet
- From the San Francisco School of Medicine, University of California, (Dr. Chi, Dr. Fluet, and Mr. Roach), and the San Francisco Department of Orthopedic Surgery, University of California, San Francisco, CA (Dr. Woolley, Dr. Allahabadi, Dr. Ward, and Dr. Wong)
| | - Colin Roach
- From the San Francisco School of Medicine, University of California, (Dr. Chi, Dr. Fluet, and Mr. Roach), and the San Francisco Department of Orthopedic Surgery, University of California, San Francisco, CA (Dr. Woolley, Dr. Allahabadi, Dr. Ward, and Dr. Wong)
| | - Derek T. Ward
- From the San Francisco School of Medicine, University of California, (Dr. Chi, Dr. Fluet, and Mr. Roach), and the San Francisco Department of Orthopedic Surgery, University of California, San Francisco, CA (Dr. Woolley, Dr. Allahabadi, Dr. Ward, and Dr. Wong)
| | - Stephanie E. Wong
- From the San Francisco School of Medicine, University of California, (Dr. Chi, Dr. Fluet, and Mr. Roach), and the San Francisco Department of Orthopedic Surgery, University of California, San Francisco, CA (Dr. Woolley, Dr. Allahabadi, Dr. Ward, and Dr. Wong)
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8
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Kashimura S, Ikemura N, Kohsaka S, Katsumata Y, Kimura T, Shinmura D, Fukumoto K, Negishi K, Ueda I, Takatsuki S, Ieda M. Clinical Utility of Baseline Brain Natriuretic Peptide Levels on Health Status Outcomes after Catheter Ablation for Atrial Fibrillation in Individuals without Heart Failure. J Clin Med 2024; 13:407. [PMID: 38256541 PMCID: PMC10816027 DOI: 10.3390/jcm13020407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Catheter ablation (CA) benefits atrial fibrillation (AF) patients with heart failure (HF). Brain natriuretic peptide (BNP), a marker of left-ventricular pressure load, may serve as a potential surrogate for predicting quality of life (QOL) in a broader range of patients. METHODS Within the multicenter KiCS-AF registry, 491 AF patients underwent CA without clinical HF (e.g., documented history of HF, left ventricular ejection fraction ≤ 40%, or BNP levels ≥ 100 pg/mL). Participants, aged 61 ± 10 years, were categorized by baseline BNP quartiles. Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) questionnaire assessments were assessed at baseline and 1 year. RESULTS A lower baseline BNP correlated with reduced AFEQT scores. Post CA, all groups showed significant AFEQT score improvements. The lower-BNP group displayed notable enhancements (18.2 ± 1.2, 15.0 ± 1.1, 12.6 ± 1.2, 13.6 ± 1.2, p < 0.005), especially in symptom and treatment concern areas. Even those with normal BNP levels (≤18.4 pg/mL) exhibited significant QOL improvements. Comparing paroxysmal AF (PAF) and non-PAF groups, the PAF group, especially with higher BNP levels, showed greater AFEQT score improvements. CONCLUSIONS This study establishes BNP as a predictive marker for QOL enhancement in non-HF patients undergoing CA for AF. BNP levels represent AF stages, with individuals in earlier stages, especially within normal BNP levels, experiencing greater QOL improvements.
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Affiliation(s)
- Shin Kashimura
- Department of Cardiology, Yokohama Municipal Citizen’s Hospital, 1-1, Mitsuzawa-nishicho, Kanagawa-ku, Yokohama 221-0855, Japan (K.N.)
| | - Nobuhiro Ikemura
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan (Y.K.); (T.K.); (I.U.); (M.I.)
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan (Y.K.); (T.K.); (I.U.); (M.I.)
| | - Yoshinori Katsumata
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan (Y.K.); (T.K.); (I.U.); (M.I.)
| | - Takehiro Kimura
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan (Y.K.); (T.K.); (I.U.); (M.I.)
| | - Daisuke Shinmura
- Department of Cardiology, Yokohama Municipal Citizen’s Hospital, 1-1, Mitsuzawa-nishicho, Kanagawa-ku, Yokohama 221-0855, Japan (K.N.)
| | - Kotaro Fukumoto
- Department of Cardiology, Yokohama Municipal Citizen’s Hospital, 1-1, Mitsuzawa-nishicho, Kanagawa-ku, Yokohama 221-0855, Japan (K.N.)
| | - Koji Negishi
- Department of Cardiology, Yokohama Municipal Citizen’s Hospital, 1-1, Mitsuzawa-nishicho, Kanagawa-ku, Yokohama 221-0855, Japan (K.N.)
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan (Y.K.); (T.K.); (I.U.); (M.I.)
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan (Y.K.); (T.K.); (I.U.); (M.I.)
| | - Masaki Ieda
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan (Y.K.); (T.K.); (I.U.); (M.I.)
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9
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Chen C, da Silva B, Yang C, Ma C, Li J, Liu C. AutoMLP: A Framework for the Acceleration of Multi-Layer Perceptron Models on FPGAs for Real-Time Atrial Fibrillation Disease Detection. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2023; 17:1371-1386. [PMID: 37494158 DOI: 10.1109/tbcas.2023.3299084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Cardiovascular diseases are a leading cause of death globally, and atrial fibrillation (AF) is a common arrhythmia that affects many people. Detecting AF in real-time using hardware acceleration can prompt timely medical intervention. Multi-layer perceptron (MLP) has demonstrated the ability to detect AF accurately. However, implementing MLP on Field-Programmable Gate Array (FPGA) for real-time detection poses challenges due to the complex hardware design requirements. This study presents a novel framework for generating hardware accelerators to detect AF in real-time using MLP on FPGA. The framework automates evaluating MLP model topology, data type, and bit-widths to generate parallel acceleration. The generated solutions are evaluated using two AF datasets, PhysioNet MIT-BIH atrial fibrillation (AFDB) and China Physiological Signal Challenge 2018 (CPSC2018), regarding execution time, resource utilization, and accuracy. The evaluation results demonstrate that the hardware MLP can achieve a speedup higher than 1500× and around 25000× lower energy consumption than an embedded CPU. These satisfactory results prove the framework's suitability and convenience for the online detection of AF in an accelerated and automatic way through FPGA hardware implementation.
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10
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van Kempen J, Glatz C, Wolfes J, Frommeyer G, Boentert M. Detecting atrial fibrillation in the polysomnography-derived electrocardiogram: a software validation study. Sleep Breath 2023; 27:1753-1757. [PMID: 36680625 PMCID: PMC10539451 DOI: 10.1007/s11325-023-02779-3] [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: 11/17/2022] [Revised: 11/17/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE The present study validated a software-based electrocardiogram (ECG) analysis tool for detection of atrial fibrillation (AF) and risk for AF using polysomnography (PSG)-derived ECG recordings. METHODS The Stroke Risk Analysis® (SRA®) software was applied to 3-channel ECG tracings from diagnostic PSG performed in enrolled subjects including a subgroup of subjects with previously documented AF. No subjects used positive airway pressure therapy. All ECG recordings were visually analyzed by a blinded cardiologist. RESULTS Of subjects enrolled in the study, 93 had previously documented AF and 178 of 186 had an ECG that could be analyzed by either method. In subjects with known history of AF, automated analysis using SRA® classified 47 out of 87 ECG as either manifest AF or showing increased risk for paroxysmal AF (PAF) by SRA® (sensitivity 0.54, specificity 0.86). On visual analysis, 36/87 ECG showed manifest AF and 51/87 showed sinus rhythm. Among the latter subgroup, an increased risk for PAF was ascribed by SRA® in 11 cases (sensitivity 0.22, specificity 0.78) and by expert visual analysis in 5 cases (sensitivity 0.1, specificity 0.90). Among 36/178 ECG with manifest AF on visual analysis, 33 were correctly identified by the SRA® software (sensitivity and specificity 0.92). CONCLUSION Sleep studies provide a valuable source of ECG recordings that can be easily subjected to software-based analysis in order to identify manifest AF and automatically assess the risk of PAF. For optimal evaluability of data, multiple channel ECG tracings are desirable. For assessment of PAF risk, the SRA® analysis probably excels visual analysis, but sensitivity of both methods is low, reflecting that repeated ECG recording remains essential.
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Affiliation(s)
- Julia van Kempen
- Department of Neurology with Institute of Translational Neurology, Münster University Hospital (UKM), Münster, Germany
| | - Christian Glatz
- Department of Neurology with Institute of Translational Neurology, Münster University Hospital (UKM), Münster, Germany
| | - Julian Wolfes
- Department of Cardiology II - Electrophysiology, Münster University Hospital (UKM), Münster, Germany
| | - Gerrit Frommeyer
- Department of Cardiology II - Electrophysiology, Münster University Hospital (UKM), Münster, Germany
| | - Matthias Boentert
- Department of Neurology with Institute of Translational Neurology, Münster University Hospital (UKM), Münster, Germany.
- Department of Medicine, UKM Marienhospital Steinfurt, Steinfurt, Germany.
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11
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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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12
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Zeitler EP, Li Y, Silverstein AP, Russo AM, Poole JE, Daniels MR, Al‐Khalidi HR, Lee KL, Bahnson T, Anstrom KJ, Packer DL, Mark DB. Effects of Ablation Versus Drug Therapy on Quality of Life by Sex in Atrial Fibrillation: Results From the CABANA Trial. J Am Heart Assoc 2023; 12:e027871. [PMID: 36688367 PMCID: PMC9973617 DOI: 10.1161/jaha.122.027871] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/13/2022] [Indexed: 01/24/2023]
Abstract
Background Women with atrial fibrillation (AF) demonstrate more AF-related symptoms and worse quality of life (QOL). Whether increased use of ablation in women reduces sex-related QOL differences is unknown. Sex-related outcomes for ablation versus drug therapy was a prespecified analysis in the CABANA (Catheter Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation) trial. Methods and Results Symptoms were assessed periodically over 60 months with the Mayo AF-Specific Symptom Inventory (MAFSI) frequency score, and QOL was assessed with the Atrial Fibrillation Effect on Quality of Life (AFEQT) summary and component scores. Women had lower baseline QOL scores than men (mean AFEQT scores 55.9 and 65.6, respectively). Ablation patients improved more than drug therapy patients with similar treatment effect by sex: AFEQT 12-month mean adjusted treatment difference in women 6.1 points (95% CI, 3.5-8.6) and men 4.9 points (95% CI, 3.0-6.9). Participants with baseline AFEQT summary scores <70 had greater QOL improvement, with a mean treatment difference at 12 months of 7.6 points for women (95% CI, 4.3-10.9) and 6.4 points for men (95% CI, 3.3-9.4). The mean adjusted difference in MAFSI frequency score between women randomized to ablation versus drug therapy at 12 months was -2.5 (95% CI, -3.4 to -1.6); for men, the difference was -1.3 (95% CI, -2.0 to -0.6). Conclusions Compared with drug therapy for AF, ablation resulted in more QOL improvement in both sexes, primarily driven by improvements in those with lower baseline QOL. Ablation did not eliminate the AF-related QOL gap between women and men. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00911508.
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Affiliation(s)
| | - Yanhong Li
- Duke Clinical Research Institute, Duke UniversityDurhamNCUSA
| | | | - Andrea M. Russo
- Division of Cardiovascular DiseaseCooper Medical School of Rowan UniversityCamdenNJUSA
| | | | | | - Hussein R. Al‐Khalidi
- Duke Clinical Research Institute, Duke UniversityDurhamNCUSA
- Department of Biostatistics and BioinformaticsDuke UniversityDurhamNCUSA
| | - Kerry L. Lee
- Duke Clinical Research Institute, Duke UniversityDurhamNCUSA
- Department of Biostatistics and BioinformaticsDuke UniversityDurhamNCUSA
| | - Tristram D. Bahnson
- Duke Clinical Research Institute, Duke UniversityDurhamNCUSA
- Division of Cardiology, Department of MedicineDuke University Medical CenterDurhamNCUSA
| | | | | | - Daniel B. Mark
- Duke Clinical Research Institute, Duke UniversityDurhamNCUSA
- Division of Cardiology, Department of MedicineDuke University Medical CenterDurhamNCUSA
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13
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Gender Differences in Atrial Fibrillation: From the Thromboembolic Risk to the Anticoagulant Treatment Response. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020254. [PMID: 36837457 PMCID: PMC9963174 DOI: 10.3390/medicina59020254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/11/2023] [Accepted: 01/19/2023] [Indexed: 01/31/2023]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia associated with an increased thromboembolic risk. The impact of the female sex as an independent risk factor for thromboembolic events in AF is still debated. Background and Objectives: The aim of this review is to evaluate the gender-related differences in cardioembolic risk and response to anticoagulants among AF patients. Materials and Methods: The PubMed database is used to review the reports about gender differences and thromboembolic risk in atrial fibrillation. Results: Non-vitamin K oral anticoagulants (NOACs) represent the gold standard for thromboembolic risk prevention in patients with non-valvular atrial fibrillation (NVAF). Despite a similar rate of stroke and systemic embolism (SE) among men and women in NOACs or vitamin K antagonists (VKAs) treatment, the use of NOACs in AF women is associated with a lower risk of intracranial bleeding, major bleeding, and all-cause mortality than in men. Conclusions: The female sex can be defined as a stroke risk modifier rather than a stroke risk factor since it mainly increases the thromboembolic risk in the presence of other risk factors. Further studies about the efficacy and safety profile of NOACs according to sex are needed to support clinicians in performing the most appropriate and tailored anticoagulant therapy, either in male or female AF patients.
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14
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Santos H, Santos M, Paula SB, Figueiredo M, Almeida I, Miranda H, Chin J, Sá C, Neto M, Almeida S, Sousa C, Almeida L. Acute coronary syndrome and stress: Is there a relationship? Rev Port Cardiol 2023; 42:9-17. [PMID: 36115803 DOI: 10.1016/j.repc.2021.09.016] [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: 02/24/2021] [Revised: 07/22/2021] [Accepted: 09/04/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Acute coronary syndrome (ACS) is the result of a complex pathophysiological process with various dynamic factors. The 10-item Perceived Stress Scale (PSS-10) is a validated instrument for estimating stress levels in clinical practice and may be useful in the assessment of ACS. METHODS We carried out a single-center prospective study engaging patients hospitalized with ACS between March 20, 2019 and March 3, 2020. The PSS-10 was completed during the hospitalization period. The ACS group was compared to a control group (the general Portuguese population), and a subanalysis in the stress group were then performed. RESULTS A total of 171 patients with ACS were included, of whom 36.5% presented ST-elevation myocardial infarction (STEMI), 38.1% were female and the mean PSS score was 19.5±7.1. Females in the control group scored 16.6±6.3 on the PSS-10 and control males scored 13.4±6.5. The female population with ACS scored 22.8±9.8 on the PSS-10 (p<0.001). Similarly, ACS males scored a mean of 17.4±6.4 (p<0.001). Pathological stress levels were not a predictor of major adverse cardiovascular events or severity at admission. CONCLUSIONS ACS patients had higher perceived stress levels compared to the control group. Perceived stress level was not associated with worse prognosis in ACS patients.
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Affiliation(s)
- Hélder Santos
- Department of Cardiology, Centro Hospitalar Barreiro-Montijo, Barreiro, Portugal.
| | - Mariana Santos
- Department of Cardiology, Centro Hospitalar Barreiro-Montijo, Barreiro, Portugal
| | - Sofia B Paula
- Department of Cardiology, Centro Hospitalar Barreiro-Montijo, Barreiro, Portugal
| | - Margarida Figueiredo
- Department of Cardiology, Centro Hospitalar Barreiro-Montijo, Barreiro, Portugal
| | - Inês Almeida
- Department of Cardiology, Centro Hospitalar Universitário Lisboa Central - Hospital de Santa Marta, Lisboa, Portugal
| | - Hugo Miranda
- Department of Intensive Care, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Joana Chin
- Department of Cardiology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Catarina Sá
- Department of Cardiology, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Micaela Neto
- Department of Cardiology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Samuel Almeida
- Department of Cardiology, Centro Hospitalar Barreiro-Montijo, Barreiro, Portugal
| | - Catarina Sousa
- Department of Cardiology, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Lurdes Almeida
- Department of Cardiology, Centro Hospitalar Barreiro-Montijo, Barreiro, Portugal
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15
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Population-Level Provider Compliance With Provincial Treatment Guidelines for the Management of Gonorrhea in Adolescents and Adults in Alberta, Canada; 2000 to 2019. Sex Transm Dis 2023; 50:11-20. [PMID: 36215118 DOI: 10.1097/olq.0000000000001721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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16
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Carnlöf C, Iwarzon M, Jensen-Urstad M, Gadler F, Insulander P. Women with atrial fibrillation undergoing pulmonary vein isolation are more symptomatic but improve more in health-related quality of life and symptom burden than men. SCAND CARDIOVASC J 2022; 56:316-324. [PMID: 35941825 DOI: 10.1080/14017431.2022.2107235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Gender differences in symptoms and perceived health-related quality of life (HRQOL) in patients with atrial fibrillation (AF) referred to pulmonary vein isolation (PVI) have been reported previously. Women experience a lower HRQOL, faster heart rate, and more symptoms such as palpitation and dyspnea than men. Furthermore, they experience worse physical functioning independently of other heart diseases or age. This study evaluates referral patterns and symptoms, morbidity, functional impairment, and HRQOL from a gender perspective in patients with AF before and 6 months after PVI. The study includes 242 patients (121 men), mean age 62 ± 9 years, referred for PVI. Symptoms were assessed with the Symptom Checklist: Frequency and Severity (SCL), HRQOL with Short Form 36 (SF-36), and the functional impairment with Sickness Impact Profile (SIP). The patients' own experiences of the referral process and history of their disease were evaluated with a supplementary questionnaire. The results showed that women improved more than men in HRQOL, SIP, and SCL 6 months post PVI. There were no sex differences in proportion of paroxysmal and persistent AF or ablation outcome. At baseline, women scored higher than men in both scales of the SCL (p < 0.001), scored lower in all components in SF-36, and scored higher in five categories of the SIP. Women were not more reluctant to accept referral for ablation when offered. The conclusion is that women with AF undergoing PVI are more symptomatic but also improve more in HRQOL and in symptom burden than men.
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Affiliation(s)
- Carina Carnlöf
- Karolinska Institutet and Heart, Vascular & Neurology Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Iwarzon
- Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden
| | - Mats Jensen-Urstad
- Karolinska Institutet and Heart, Vascular & Neurology Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Gadler
- Karolinska Institutet and Heart, Vascular & Neurology Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Per Insulander
- Karolinska Institutet and Heart, Vascular & Neurology Theme, Karolinska University Hospital, Stockholm, Sweden
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17
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Gomez SE, Fazal M, Nunes JC, Shah S, Perino AC, Narayan SM, Tamirisa KP, Han JK, Rodriguez F, Baykaner T. Racial, ethnic, and sex disparities in atrial fibrillation management: rate and rhythm control. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01383-x. [PMID: 36224481 PMCID: PMC10097842 DOI: 10.1007/s10840-022-01383-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) affects around 6 million Americans. AF management involves pharmacologic therapy and/or interventional procedures to control rate and rhythm, as well as anticoagulation for stroke prevention. Different populations may respond differently to distinct management strategies. This review will describe disparities in rate and rhythm control and their impact on outcomes among women and historically underrepresented racial and/or ethnic groups. METHODS This is a narrative review exploring the topic of sex and racial and/or ethnic disparities in rate and rhythm management of AF. We describe basic terminology, summarize AF epidemiology, discuss diversity in clinical research, and review landmark clinical trials. RESULTS Despite having higher rates of traditional AF risk factors, Black and Hispanic adults have lower risk of AF than non-Hispanic White (NHW) patients, although those with AF experience more severe symptoms and report lower quality-of-life scores than NHW patients with AF. NHW patients receive antiarrhythmic drugs, cardioversions, and invasive therapies more frequently than Black and Hispanic patients. Women have lower rates of AF than men, but experience more severe symptoms, heart failure, stroke, and death after AF diagnosis. Women and people from diverse racial and ethnic backgrounds are inadequately represented in AF trials; prevalence findings may be a result of underdetection. CONCLUSION Race, ethnicity, and gender are social determinants of health that may impact the prevalence, evolution, and management of AF. This impact reflects differences in biology as well as disparities in treatment and representation in clinical trials.
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Affiliation(s)
- Sofia E Gomez
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | - Muhammad Fazal
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | - Julio C Nunes
- Stanford Center for Clinical Research, Stanford University, Stanford, CA, USA.,Department of Psychiatry, Yale University, New Haven, CT, USA.,Cardiac Arrhythmia Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Shayena Shah
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | - Alexander C Perino
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | - Sanjiv M Narayan
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | | | - Janet K Han
- Cardiac Arrhythmia Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,David Geffen School of Medicine, UCLA Cardiac Arrhythmia Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Fatima Rodriguez
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA
| | - Tina Baykaner
- Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA.
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18
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Atrial Fibrillation in Women: from Epidemiology to Treatment. CURRENT CARDIOVASCULAR RISK REPORTS 2022. [DOI: 10.1007/s12170-022-00707-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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19
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Tan JL, Johnson L, Dziubinski M, Napiorkowski N, Witkowska O, Slusarczyk ME, Healey JS, Russo AM. Sex differences in presentation of atrial fibrillation: Findings from 30-day ambulatory monitoring in real-world practice. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 22:100208. [PMID: 38558904 PMCID: PMC10978428 DOI: 10.1016/j.ahjo.2022.100208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/04/2022] [Accepted: 09/14/2022] [Indexed: 04/04/2024]
Abstract
Background Women are less likely to receive oral anticoagulation or ablation for treatment of atrial fibrillation (AF). Identification of sex differences in arrhythmia characteristics and symptoms may lead to a better understanding of potential reasons for these differences. Objectives To determine sex differences in AF with respect to heart rate, duration, burden, and symptoms in patients undergoing mobile cardiac telemetry (MCT) monitoring. Methods All patients who registered for ≤30-day MCT using PocketECG (MediLynx) in the USA in 2017 were included (n = 27,512, 58 % women). PocketECG records and transmits a three-lead ambulatory electrocardiogram (ECG) with real-time beat-to-beat analysis. Sex-related differences were analyzed with Chi2 and Spearmans rho. Results Fewer women than men were diagnosed with AF lasting ≥30s (13.7 % versus [vs] 19.0 %, p < 0.001). AF burden was lower in women in all age groups <90 years (all p < 0.01). Women were older at the time of AF diagnosis (median 76 vs 73 years, p < 0.001), had faster heart rate during AF (mean: 104.7 ± 26.0 vs 96.7 ± 26.7 bpm, p < 0.001), and shorter AF duration (mean: 96.2 ± 176.0 vs 121.6 ± 189.9 min, p < 0.001). There was a non-significant trend toward more symptoms (such as dizziness, racing heart, fatigue, or palpitations) during AF in women compared to men (46.5 % vs 43.7 %, p = 0.062). Conclusions AF was less prevalent and occurred at lower burdens in women than men in each age strata. Despite faster heart rates in AF in women, there were no significant sex differences in reported symptoms during AF. Sex differences in therapy cannot be explained by differences in symptoms or rates in AF. Condensed abstract Real-world data on sex differences in AF using a 30-day MCT monitoring device remain scarce. We aim to determine the sex differences in AF with respect to prevalence, burden, heart rate, and symptom in patients undergoing ≤30-day MCT monitoring. Our data analysis suggests that fewer women than men had AF, women were older at diagnosis of AF, and women with AF had higher mean heart rate, shorter mean AF duration, and lower mean AF burden than men. Further studies are needed to examine reasons for sex differences, specifically in relation to AF therapy and its impact on clinical outcomes.
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Affiliation(s)
- Jian Liang Tan
- Cardiovascular Division, Cooper University Health System, Cooper Medical School of Rowan University, United States of America
| | - Linda Johnson
- Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | | | | | | | | | - Jeff S. Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Andrea M. Russo
- Cardiovascular Division, Cooper University Health System, Cooper Medical School of Rowan University, United States of America
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20
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Khatib R, Glowacki N, Byrne J, Brady P. Impact of social determinants of health on anticoagulant use among patients with atrial fibrillation: Systemic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29997. [PMID: 36107589 PMCID: PMC9439798 DOI: 10.1097/md.0000000000029997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A growing body of literature now exists examining associations between social determinants of health (SDOH) and adverse outcomes in patients with atrial fibrillation; however, little is available on anticoagulant prescriptions and the impact of SDOH. PURPOSE Evaluate the impact of SDOH on anticoagulant prescriptions in patients with atrial fibrillation. DATA SOURCES Medline and Embase databases up to January 2021. STUDY SELECTION Noninterventional studies were included if they reported associations between at least 1 of 14 SDOH domains and anticoagulant prescription in patients with atrial fibrillation. Two investigators independently screened and collected data. DATA EXTRACTION Two investigators independently screened and collected data. DATA SYNTHESIS Meta-analyses using random-effect models evaluated associations between SDOH and receiving an anticoagulant prescription. We included 13 studies, 11 of which were included in meta-analyses that reported on the impact of 9 of the 14 SDOH included in the search. Pooled estimates indicate a 0.85 (95% confidence interval [CI]: 0.75, 0.97) lower odds of receiving anticoagulant prescriptions among Black compared to non-Black patients (reported in 6 studies); 0.42 (95% CI: 0.32, 0.55) lower odds of receiving anticoagulant prescriptions among patients with mental illness compared to those without mental illness (2 studies); and a 0.64 (95% CI: 0.42, 0.96) lower likelihood of receiving oral anticoagulant prescription among employed patients compared to unemployed patients (2 studies). LIMITATIONS SDOH lack consistent definitions and measures within the electronic health record. CONCLUSION The literature reports on only half of the SDOH domains we searched for, indicating that many SDOH are not routinely assessed. Second, social needs impact the decision to prescribe anticoagulants, confirming the need to screen for and address social needs in the clinical setting to support clinicians in providing guideline concordant care to their patients. REGISTRATION This systematic review and meta-analysis was registered with PROSPERO.
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Affiliation(s)
- Rasha Khatib
- Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, IL
- *Correspondence: Rasha Khatib, PhD, Advocate Aurora Research Institute, Advocate Aurora Health, 3075 Highland Parkway, Suite 600, Downers Grove, IL 60515, USA (e-mail: )
| | - Nicole Glowacki
- Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, IL
| | - John Byrne
- School of Molecular & Cellular Biology, University of Illinois at Urbana-Champaign, Urbana, IL
| | - Peter Brady
- Department of Cardiovascular Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL
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21
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Liblik K, Dhali A, Kipkorir V, Avanthika C, Manan MR, Găman MA. Underrepresentation and undertreatment of women in hematology: An unsolved issue. Res Pract Thromb Haemost 2022; 6:e12767. [PMID: 35873219 PMCID: PMC9301474 DOI: 10.1002/rth2.12767] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/18/2022] [Accepted: 06/22/2022] [Indexed: 11/08/2022] Open
Abstract
Gender disparity is pervasive and persisting in research. Despite gender being recognized as one of the primary determinants of health, inadequate representation of women in clinical trials has resulted in a deficit pertaining to equity in health care. This gross underrepresentation has exposed women to unforeseen health-related outcomes, and as evident through historic records, unequal distribution of opportunities has further widened this gender gap in health care.
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Affiliation(s)
- Kiera Liblik
- Queen's School of Medicine Kingston Ontario Canada
| | - Arkadeep Dhali
- Institute of Postgraduate Medical Education and Research Kolkata India
| | - Vincent Kipkorir
- Department of Human Anatomy and Physiology University of Nairobi Nairobi Kenya
| | | | | | - Mihnea-Alexandru Găman
- Faculty of Medicine "Carol Davila" University of Medicine and Pharmacy Bucharest Romania.,Department of Hematology Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute Bucharest Romania
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22
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Hermida A, Burtin J, Kubala M, Fay F, Lallemand PM, Buiciuc O, Lieu A, Zaitouni M, Beyls C, Hermida JS. Sex Differences in the Outcomes of Cryoablation for Atrial Fibrillation. Front Cardiovasc Med 2022; 9:893553. [PMID: 35665259 PMCID: PMC9157614 DOI: 10.3389/fcvm.2022.893553] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background The literature data on the outcomes of radiofrequency catheter ablation for atrial fibrillation (AF) in women are contradictory. Aim To determine and compare the outcomes and complications of cryoballoon pulmonary vein isolation (cryo-PVI) in men vs. women, and to identify predictors of atrial tachyarrhythmia (ATa) recurrence. Methods We included all consecutive patients having undergone cryo-PVI for the treatment of symptomatic AF in our center since 2012. Peri-operative complications were documented. All patients were prospectively monitored for the recurrence of ATa, and predictors were assessed. Results A total of 733 patients were included (550 men (75%) and 183 (25%) women). Paroxysmal AF was recorded in 112 (61%) female patients and 252 male patients (46%; p < 0.001). Female patients were older (p < 0.001) and had a greater symptom burden (p = 0.04). Female patients were more likely to experience complications (p = 0.02). After cryo-PVI for paroxysmal AF, 66% of the female patients and 79% of the male patients were free of ATa at 24 months (p = 0.001). Female sex was the only independent predictive factor for ATa recurrence (hazard ratio [95% confidence interval] = 1.87 [1.28; 2.73]; p = 0.001). After cryo-PVI for non-paroxysmal AF, 37% of the male patients and 39% of the female patients were free of ATa at 36 months (p = 0.73). Female patients were less likely than male patients to undergo repeat ablation after an index cryo-PVI for non-paroxysmal AF (p = 0.019). Conclusion A single cryo-PVI procedure for paroxysmal AF was significantly less successful in female patients than in male patients. Overall, the complication rate was higher in women than in men.
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Affiliation(s)
- Alexis Hermida
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | - Jacqueline Burtin
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | - Maciej Kubala
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | - Floriane Fay
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | | | - Otilia Buiciuc
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | - Audrey Lieu
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | - Mustafa Zaitouni
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
| | - Christophe Beyls
- Cardiac Arrhythmia Service, Amiens-Picardie University Hospital, Amiens, France
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23
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Israeli A, Gal D, Younis A, Ehrenberg S, Rozner E, Turgeman Y, Naami E, Naami R, Koren O. Sex-Differences in Atrial Fibrillation Patients: Bias or Proper Management? Vasc Health Risk Manag 2022; 18:347-358. [PMID: 35546968 PMCID: PMC9084509 DOI: 10.2147/vhrm.s366285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background Studies analyze the degree to which gender-based differences are affected by age and comorbidities show mixed results. Methods Using a retrospective cohort study, we analyzed 327 consecutive patients who presented to the emergency department (ED) due to Atrial Fibrillation (AF) from 2014 to 2017 with follow-up at one year. Results Females with AF were older (p < 0.001), with higher Body Mass Indexes (BMI) (p < 0.001), and a higher rate of hypertension (p < 0.001), hyperlipidemia (p = 0.01), diabetes mellitus (p = 0.05), valvular heart disease (p = 0.05), and thyroid dysfunction (18.3% vs 1.8%, p < 0.001). AF males had higher rate of coronary artery disease (p < 0.001) and heart failure with reduced ejection fraction (p < 0.001). Females were managed with rate control medications more frequently than with antiarrhythmic (p < 0.001). After adjusting gender to age and comorbidities, females continued to have higher rates of heart failure hospitalization (Odds Ratio (OR) 2.73 95% Confidence Interval (CI) 1.04-5.89, P-value <0.001) and recurrent AF (OR 3.86, P-value=0.02). Thyroid dysfunction and the lack of antiarrhythmic treatments significantly increased the risk of AF (OR 5.95 95% CI 3.15-9.73, OR 3.42, respectively, P-value <0.001 for both) regardless of gender. The mortality rate differs only in a sub-group of females ≥75 years of age (OR 1.60, P < 0.001). Conclusion AF males and females differ significantly in baseline characteristics and tend to be treated unnecessarily differently for AF. Heart failure hospitalizations and recurrent AF continued to be associated with female AF patients, even after adjusting gender to age and comorbidities. Thyroid dysfunction and AF treatment may explain the higher rates of recurrent AF in female patients.
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Affiliation(s)
- Asaf Israeli
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Danna Gal
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Autba Younis
- Internal Medicine E, Emek Medical Center, Afula, Israel
| | - Scott Ehrenberg
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ehud Rozner
- Heart Institute, Emek Medical Center, Afula, Israel
| | - Yoav Turgeman
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Heart Institute, Emek Medical Center, Afula, Israel
| | - Edmund Naami
- Department of Medicine, University of Illinois College of Medicine, Chicago, IL, USA
| | - Robert Naami
- Department of Medicine, University Hospitals Cleveland Medical center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ofir Koren
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Heart Institute, Emek Medical Center, Afula, Israel
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24
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Xiong J, Shao W, Yu P, Ma J, Liu M, Huang S, Liu X, Mei K. Hyperuricemia Is Associated With the Risk of Atrial Fibrillation Independent of Sex: A Dose-Response Meta-Analysis. Front Cardiovasc Med 2022; 9:865036. [PMID: 35463784 PMCID: PMC9021846 DOI: 10.3389/fcvm.2022.865036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/18/2022] [Indexed: 01/10/2023] Open
Abstract
Background: Conflicting findings of the association between serum uric acid (SUA) and atrial fibrillation (AF) have been reported in both men and women. The sex-specific associations between SUA and the risk of AF are unclear, although hyperuricemia is independently associated with the risk of AF. We performed this meta-analysis to assess the sex-specific effect of SUA on the risk of AF. Methods The PubMed, EMBASE, and Cochrane Library databases were searched up to October 3, 2021, for studies that reported sex-specific associations of SUA levels with AF. Linear relationships were assessed by the generalized least squares trend estimation. This study was registered with PROSPERO (42020193013). Results Ten eligible studies with 814,804 participants (415,779 men and 399,025 women) were identified. In the category analysis, high SUA was associated with an increased risk of AF in both men (OR: 1.42; 95% CI, 1.18–1.71, I2 = 34%) and women (OR: 2.02; 95% CI, 1.29–3.16, I2 = 70%). In the dose-response analysis, for each 60 μmol/L (1 mg/dL) increase in the SUA level, the risk of AF increased by 15% (OR: 1.15; 95% CI, 1.07–1.25, I2 = 74%) in men and 35% (OR: 1.35; 95% CI, 1.18–1.53, I2 = 73%) in women. There was a borderline difference in the impact of SUA on the risk of AF between men and women (P for interaction = 0.05). A significant linear relationship between SUA and the risk of AF was observed in men (P for non-linearity = 0.91) and women (P for non-linearity = 0.92). Conclusions This study suggested that there was a significant linear relationship between SUA and the risk of AF among men and women, with a higher risk estimate for women. Additional trials are required to assess the effect of reduced SUA therapy on AF incidence. Systematic Review Registration https:www.crd.york.ac.uk/PROSPERO/, identifier: CRD 42020193013.
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Affiliation(s)
- Jianhua Xiong
- Department of Cardiology, The Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, China
- Key Laboratory of Cardiovascular Diseases in Chinese Medicine, Nanchang, China
| | - Wen Shao
- Department of Endocrine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Peng Yu
- Department of Endocrine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianyong Ma
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Menglu Liu
- Department of Cardiology, The Seventh Hospital of Zhengzhou, Zhengzhou, China
| | - Shan Huang
- Department of Psychiatry, The Third People's Hospital of Gan Zhou, Ganzhou, China
| | - Xiao Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
- *Correspondence: Xiao Liu
| | - Kaibo Mei
- Department of Anesthesia, The People's Hospital of Shangrao, Shangrao, China
- Kaibo Mei
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25
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Choi SY, Kim MH, Kim HB, Kang SY, Lee KM, Hyun KY, Yun SC. Validation of the CHA2DS2-VA Score (Excluding Female Sex) in Nonvalvular Atrial Fibrillation Patients: A Nationwide Population-Based Study. J Clin Med 2022; 11:1823. [PMID: 35407433 PMCID: PMC8999893 DOI: 10.3390/jcm11071823] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/21/2022] [Accepted: 03/22/2022] [Indexed: 11/17/2022] Open
Abstract
Sex (i.e., female sex) confers one point for the CHA2DS2-VASc score. For this reason, females with atrial fibrillation (AF) always have a CHA2DS2-VASc score of at least 1. To compare the CHA2DS2-VA (excluding female sex) and CHA2DS2-VASc scores in Korean AF patients using the Korean National Health Insurance Service database, we analyzed the risk of ischemic stroke in nonvalvular AF patients between 2013 and 2017. The predictive values of the CHA2DS2-VA and CHA2DS2-VASc scores for ischemic stroke were evaluated using the C-statistic and net reclassification improvement (NRI). The primary outcome was the occurrence of ischemic stroke. A total of 185,637 patients with AF (49.7% women) were included in this study. The mean ages were 66.5 years for females and 64.9 years for males. The incidence of ischemic stroke in male patients was similar to females (3.63%/year vs. 3.72%/year, p = 0.273, respectively). In addition, no sex difference was apparent for stroke risk in AF patients stratified by risk factor component and age group. In the C-statistic analysis, the predictive ability of the CHA2DS2-VA score for ischemic stroke was similar to the CHA2DS2-VASc score. Additionally, CHA2DS2-VA performed better for predicting ischemic stroke in AF patients with risk scores of ≥2 (AUC 0.701 vs. 0.689, z = 4.596, p < 0.001) or those aged ≥75 years (AUC 0.715 vs. 0.701, z = 4.957, p < 0.001). In Korean AF patients, female sex is not a specific risk factor that contributes to the development of ischemic stroke. The CHA2DS2-VA score, which excludes female sex, may be a more suitable risk score for guiding anticoagulation decisions in Korean AF patients.
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Affiliation(s)
- Sun Young Choi
- Department of Cardiology, Dong-A University Hospital, Busan 49201, Korea; (S.Y.C.); (H.B.K.); (S.Y.K.); (K.M.L.)
- Department of Biomedical Laboratory Science, Daegu Health College, Daegu 41453, Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan 49201, Korea; (S.Y.C.); (H.B.K.); (S.Y.K.); (K.M.L.)
| | - Hyo Bin Kim
- Department of Cardiology, Dong-A University Hospital, Busan 49201, Korea; (S.Y.C.); (H.B.K.); (S.Y.K.); (K.M.L.)
| | - Sa Yul Kang
- Department of Cardiology, Dong-A University Hospital, Busan 49201, Korea; (S.Y.C.); (H.B.K.); (S.Y.K.); (K.M.L.)
| | - Kwang Min Lee
- Department of Cardiology, Dong-A University Hospital, Busan 49201, Korea; (S.Y.C.); (H.B.K.); (S.Y.K.); (K.M.L.)
| | - Kyung-Yae Hyun
- Department of Clinical Laboratory Science, Dong-Eui University, Busan 47340, Korea;
| | - Sung-Cheol Yun
- Asan Medical Center, Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Seoul 05505, Korea;
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Ono K, Iwasaki YK, Akao M, Ikeda T, Ishii K, Inden Y, Kusano K, Kobayashi Y, Koretsune Y, Sasano T, Sumitomo N, Takahashi N, Niwano S, Hagiwara N, Hisatome I, Furukawa T, Honjo H, Maruyama T, Murakawa Y, Yasaka M, Watanabe E, Aiba T, Amino M, Itoh H, Ogawa H, Okumura Y, Aoki-Kamiya C, Kishihara J, Kodani E, Komatsu T, Sakamoto Y, Satomi K, Shiga T, Shinohara T, Suzuki A, Suzuki S, Sekiguchi Y, Nagase S, Hayami N, Harada M, Fujino T, Makiyama T, Maruyama M, Miake J, Muraji S, Murata H, Morita N, Yokoshiki H, Yoshioka K, Yodogawa K, Inoue H, Okumura K, Kimura T, Tsutsui H, Shimizu W. JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias. Circ J 2022; 86:1790-1924. [DOI: 10.1253/circj.cj-20-1212] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Yu-ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Masaharu Akao
- Department of Cardiovascular Medicine, National Hospital Organization Kyoto Medical Center
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
| | - Kuniaki Ishii
- Department of Pharmacology, Yamagata University Faculty of Medicine
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshinori Kobayashi
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | | | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | | | - Tetsushi Furukawa
- Department of Bio-information Pharmacology, Medical Research Institute, Tokyo Medical and Dental University
| | - Haruo Honjo
- Research Institute of Environmental Medicine, Nagoya University
| | - Toru Maruyama
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital
| | - Yuji Murakawa
- The 4th Department of Internal Medicine, Teikyo University School of Medicine, Mizonokuchi Hospital
| | - Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center
| | - Eiichi Watanabe
- Department of Cardiology, Fujita Health University School of Medicine
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Mari Amino
- Department of Cardiovascular Medicine, Tokai University School of Medicine
| | - Hideki Itoh
- Division of Patient Safety, Hiroshima University Hospital
| | - Hisashi Ogawa
- Department of Cardiology, National Hospital Organisation Kyoto Medical Center
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Chizuko Aoki-Kamiya
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center
| | - Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Eitaro Kodani
- Department of Cardiovascular Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Takashi Komatsu
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine
| | | | | | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Yukio Sekiguchi
- Department of Cardiology, National Hospital Organization Kasumigaura Medical Center
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Noriyuki Hayami
- Department of Fourth Internal Medicine, Teikyo University Mizonokuchi Hospital
| | | | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University, Faculty of Medicine
| | - Takeru Makiyama
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Mitsunori Maruyama
- Department of Cardiovascular Medicine, Nippon Medical School Musashi Kosugi Hospital
| | - Junichiro Miake
- Department of Pharmacology, Tottori University Faculty of Medicine
| | - Shota Muraji
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | | | - Norishige Morita
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | - Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Sapporo City General Hospital
| | - Koichiro Yoshioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
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Abstract
This review on sex, gender, and cardiovascular diseases in chronic kidney disease attempts to summarize what we know and what we do not know about the effects of sex and gender on cardiovascular disease in chronic kidney disease. We discuss and define the terminology of sex and gender, and the underlying physiology for differences observed. We explore how sex and gender affect specific cardiovascular diseases such as coronary artery disease, congestive heart failure, arrhythmias, cardiovascular mortality, and pre-eclampsia. We conclude with a review of recent randomized controlled trials and highlight the pharmacokinetic and pharmacodynamic differences in both sexes.
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Affiliation(s)
- Tae Won Yi
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; Clinician Investigator Program, University of British Columbia, Vancouver, Canada; Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada; BC Renal, Provincial Health Services Authority, Vancouver, British Columbia, Canada
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Rhythm control versus rate control in a contemporary ambulatory atrial fibrillation cohort: Post-hoc analysis of the IMPACT-AF Trial. CJC Open 2022; 4:551-557. [PMID: 35734517 PMCID: PMC9207778 DOI: 10.1016/j.cjco.2022.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background We examined the characteristics and outcomes in a contemporary ambulatory population of patients with atrial fibrillation (AF), comparing rate control with rhythm control. Methods This is a post hoc analysis of a cluster-randomized trial (Integrated Management Program Advancing Community Treatment of Atrial Fibrillation [IMPACT-AF]) in ambulatory AF patients from 2016 to 2018, which compared use of a clinical decision support tool for general practitioners to usual care. This analysis compared patients managed with rate vs rhythm control, at entry into the study. Outcomes included AF-related emergency department (ED) visits, unplanned cardiovascular hospitalizations, and bleeding events at 12 months. Results A total of 870 patients were included in this analysis, 99 (11.4%) in the rhythm-control group, and 40% women. In the rhythm-control group, the mean age was younger (70 ± 11.4 vs 72.7 ± 9.5 years, P = 0.03), a higher number were paroxysmal (80% vs 43%, P < 0.001), and CHADS2 scores were lower. The rate of AF-related ED visits was higher in the rhythm-control group (17.2 vs 7.3%, P = 0.003), and repeat visits (rate ratio 3.03, 95% confidence interval [1.99-4.52], P < 0.001). The number of repeat ED visits was independently associated with female sex and being in the rhythm-control group. Conclusions Both rate- and rhythm-control patients have recurrent ED visits, with a higher rate in patients treated with rhythm control. These findings are observational, but taken in the context of current guidelines could help develop further therapies aimed at improving symptom burden in both rhythm- and rate-control patients to broadly improve healthcare utilization in the AF population.
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Rodrigues DA, Plácido AI, Tavares AB, Azevedo D, Mateos-Campos R, Figueiras A, Herdeiro MT, Roque F. Potentially Inappropriate Medication Prescribing in Older Adults According to EU(7)-Potentially Inappropriate Medication List: A Nationwide Study in Portugal. Curr Ther Res Clin Exp 2022; 97:100681. [PMID: 35937773 PMCID: PMC9350873 DOI: 10.1016/j.curtheres.2022.100681] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/04/2022] [Indexed: 10/25/2022] Open
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Subramanya V, Claxton JS, Lutsey PL, MacLehose RF, Chen LY, Chamberlain AM, Norby FL, Alonso A. Sex differences in treatment strategy and adverse outcomes among patients 75 and older with atrial fibrillation in the MarketScan database. BMC Cardiovasc Disord 2021; 21:598. [PMID: 34915858 PMCID: PMC8679994 DOI: 10.1186/s12872-021-02419-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 12/03/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Women with atrial fibrillation (AF) experience greater symptomatology, worse quality of life, and have a higher risk of stroke as compared to men, but are less likely to receive rhythm control treatment. Whether these differences exist in elderly patients with AF, and whether sex modifies the effectiveness of rhythm versus rate control therapy has not been assessed. METHODS We studied 135,850 men and 139,767 women aged ≥ 75 years diagnosed with AF in the MarketScan Medicare database between 2007 and 2015. Anticoagulant use was defined as use of warfarin or a direct oral anticoagulant. Rate control was defined as use of rate control medication or atrioventricular node ablation. Rhythm control was defined by use of anti-arrhythmic medication, catheter ablation or cardioversion. We used multivariable Poisson and Cox regression models to estimate the association of sex with treatment strategy and to determine whether the association of treatment strategy with adverse outcomes (bleeding, heart failure and stroke) differed by sex. RESULTS At the time of AF, women were on average (SD) 83.8 (5.6) years old and men 82.5 (5.2) years, respectively. Compared to men, women were less likely to receive an anticoagulant or rhythm control treatment. Rhythm control (vs. rate) was associated with a greater risk for heart failure with a significantly stronger association in women (HR women = 1.41, 95% CI 1.34-1.49; HR men = 1.21, 95% CI 1.15-1.28, p < 0.0001 for interaction). No sex differences were observed for the association of treatment strategy with the risk of bleeding or stroke. CONCLUSION Sex differences exist in the treatment of AF among patients aged 75 years and older. Women are less likely to receive an anticoagulant and rhythm control treatment. Women were also at a greater risk of experiencing heart failure as compared to men, when treated with rhythm control strategies for AF. Efforts are needed to enhance use AF therapies among women. Future studies will need to delve into the mechanisms underlying these differences.
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Affiliation(s)
- Vinita Subramanya
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
| | - J'Neka S Claxton
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Richard F MacLehose
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Alanna M Chamberlain
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Faye L Norby
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
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López-Sendón JL, Alonso-Rodríguez D, Barón-Esquivias G, Cosin-Sales J, Marín F, Galera-Llorca J, Jiménez N, Marler S, Huisman MV, Lip GYH. Gender differences in antithrombotic treatment in patients with atrial fibrillation from Spain versus the rest of Western Europe. GLORIA-AF Program. Med Clin (Barc) 2021; 159:177-182. [PMID: 34895750 DOI: 10.1016/j.medcli.2021.09.016] [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: 06/28/2021] [Revised: 09/27/2021] [Accepted: 09/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Thromboembolic risk is higher in women than men with non-valvular atrial fibrillation (NVAF). Published data indicate variability in antithrombotic use by gender and region. We analyzed gender-specific antithrombotic treatment patterns in Spain and rest of Western Europe (rWE) in patients with NVAF. METHODS GLORIA-AF (Phase III) is a global, prospective, observational study which enrolled newly diagnosed NVAF patients with CHA2DS2-VAScs≥1 (2014-2016). Analyses were performed comparing antithrombotic treatments by gender in Spain and rWE. RESULTS This analysis included 1163 and 7972 patients from Spain and rWE, respectively. Stroke risk was higher in women than men in both Spain and rWE. While in rWE, bleeding risk and antithrombotic treatment pattern were similar between genders, in Spain bleeding risk in women was lower and more females compared to men received OACs (95.0% versus 92.4%, d=-0.1078, respectively). Fewer Spanish patients received direct oral anticoagulants (DOACs) (women 32.1%, men 25.3%) than vitamin-K-antagonists (VKAs) (women 63.0%, men 67.1%) vs. rWE patients. In Spain women received more DOACs compared to men (56.0% versus 44.0%). CONCLUSIONS OAC rates were higher in Spain as compared to rWE. More women received OACs in Spain, while in rWE no difference by gender was observed. DOACs in rWE are the most prescribed OAC while in Spain, due to prescription barriers, its use remains low for both genders and VKAs are preferred. Spanish women received more DOACs compared to men. (NCT01468701).
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Affiliation(s)
- José L López-Sendón
- Hospital Universitario La Paz, IDIPAZ, CIBER-CV, Paseo de la Castellana 261, 28046 Madrid, Spain.
| | | | | | - Juan Cosin-Sales
- Hospital Arnau de Vilanova, Carrer de Sant Clement, 12, 46015 Valencia, Spain
| | - Francisco Marín
- Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBERCV, Ctra. Madrid-Cartagena, s/n, Murcia, Spain
| | | | - Natalia Jiménez
- Boehringer Ingelheim Spain, Carrer de Prat de la Riba, 50, 08174 Sant Cugat del Vallès, Barcelona, Spain
| | - Sabrina Marler
- Boehringer Ingelheim Pharmaceuticals Inc, 900 Ridgebury Rd, Ridgefield, CT 06877, USA
| | - Menno V Huisman
- Leiden University Medical Centre, Leiden, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Gregory Y H Lip
- University of Liverpool and Liverpool Heart & Chest, Thomas Dr, Liverpool L14 3PE, UK
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Lazazzera R, Laguna P, Gil E, Carrault G. Proposal for a Home Sleep Monitoring Platform Employing a Smart Glove. SENSORS 2021; 21:s21237976. [PMID: 34883979 PMCID: PMC8659764 DOI: 10.3390/s21237976] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022]
Abstract
The present paper proposes the design of a sleep monitoring platform. It consists of an entire sleep monitoring system based on a smart glove sensor called UpNEA worn during the night for signals acquisition, a mobile application, and a remote server called AeneA for cloud computing. UpNEA acquires a 3-axis accelerometer signal, a photoplethysmography (PPG), and a peripheral oxygen saturation (SpO2) signal from the index finger. Overnight recordings are sent from the hardware to a mobile application and then transferred to AeneA. After cloud computing, the results are shown in a web application, accessible for the user and the clinician. The AeneA sleep monitoring activity performs different tasks: sleep stages classification and oxygen desaturation assessment; heart rate and respiration rate estimation; tachycardia, bradycardia, atrial fibrillation, and premature ventricular contraction detection; and apnea and hypopnea identification and classification. The PPG breathing rate estimation algorithm showed an absolute median error of 0.5 breaths per minute for the 32 s window and 0.2 for the 64 s window. The apnea and hypopnea detection algorithm showed an accuracy (Acc) of 75.1%, by windowing the PPG in one-minute segments. The classification task revealed 92.6% Acc in separating central from obstructive apnea, 83.7% in separating central apnea from central hypopnea and 82.7% in separating obstructive apnea from obstructive hypopnea. The novelty of the integrated algorithms and the top-notch cloud computing products deployed, encourage the production of the proposed solution for home sleep monitoring.
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Affiliation(s)
- Remo Lazazzera
- Laboratoire Traitement du Signal et de l’Image (LTSI-Inserm UMR 1099), Université de Rennes 1, 35000 Rennes, France;
| | - Pablo Laguna
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, I3A, IIS Aragón, University of Zaragoza, and with the CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 50018 Zaragoza, Spain; (P.L.); (E.G.)
| | - Eduardo Gil
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, I3A, IIS Aragón, University of Zaragoza, and with the CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 50018 Zaragoza, Spain; (P.L.); (E.G.)
| | - Guy Carrault
- Laboratoire Traitement du Signal et de l’Image (LTSI-Inserm UMR 1099), Université de Rennes 1, 35000 Rennes, France;
- Correspondence:
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Chen C, Ma C, Xing Y, Li Z, Gao H, Zhang X, Yang C, Liu C, Li J. An atrial fibrillation detection system based on machine learning algorithm with mix-domain features and hardware acceleration . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:1423-1426. [PMID: 34891552 DOI: 10.1109/embc46164.2021.9629700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This paper presents a real-time electrocardiogram (ECG) analysis system that can detect atrial fibrillation (AF) using machine learning algorithms without a cloud server. The system takes advantage of the heterogeneous structure of the Zynq system-on-chip (SoC) to optimize the tasks of local implementation of AF detection. The features extraction is based on multi-domain features including entropy features and RR interval features, which is conducted using the embedded micro controller to generate significant features for AF detection. An AF classifier based on artificial neural network (ANN) algorithm is then implemented in the programmable logic of the SoC for acceleration. The validation of the proposed system is performed by using the real-world ECG data from MIT-BIH database and CPSC 2018 database. The experimental results show an accuracy 93.60% and 97.78% when tested on these two databases respectively. The AF detection performance of the embedded algorithm is majorly identical to that of the PC-based algorithm, indicating a robust performance of hardware implementation of the AF detection.
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Yi JE, Seo SM, Lim S, Choo EH, Choi IJ, Lee KY, Hwang BH, Kim CJ, Park MW, Kim DB, Her SH, Lee JM, Park CS, Kim PJ, Kim HY, Yoo KD, Jeon DS, Chung WS, Jeong MH, Ahn Y, Chang K. Gender Differences in the Impact of New-Onset Atrial Fibrillation on Long-Term Risk of Ischemic Stroke after Acute Myocardial Infarction. J Clin Med 2021; 10:jcm10215141. [PMID: 34768661 PMCID: PMC8584956 DOI: 10.3390/jcm10215141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/27/2021] [Accepted: 10/30/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) has been identified as a major risk factor for mortality after acute coronary syndrome (ACS). However, the long-term risk of ischemic stroke associated with new-onset atrial fibrillation (NOAF) in ACS remains controversial, and its gender-specific association is unknown. METHODS We analyzed the data of 10,137 ACS survivors included in a multicenter, prospective registry for Korean patients with acute myocardial infarction (AMI) between January 2004 and August 2014. Subjects were categorized into three groups (non-AF vs. NOAF vs. previous AF) based on medical history and electrocardiographic evidence of AF, either at admission or during hospitalization. RESULTS Among the total study population (72.3% men), 370 patients (3.6%) had NOAF and 130 (1.3%) had previous AF. During a median follow-up of 61 months (interquartile range, 38.8 to 89.3 months), 245 (2.4%) patients (218 (2.3%) non-AF vs. 15 (4.1%) NOAF vs. 12 (9.2%) previous AF, p < 0.001) experienced ischemic stroke. After adjustment for confounding variables, both NOAF (adjusted hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.09-3.24, p = 0.024) and previous AF (adjusted HR 4.00, 95% CI 2.03-7.87, p < 0.001), along with older age, diabetes, current smoker, and previous stroke were independent risk factors of ischemic stroke. In the gender-stratified analysis, men with previous AF but not NOAF had a significantly higher risk of ischemic stroke (adjusted HR 4.14, 95% CI 1.79-9.55, p = 0.001) than those without AF. In women, NOAF (adjusted HR 2.54, 95% CI 1.21-5.35, p = 0.014) as well as previous AF (adjusted HR 3.72, 95% CI 1.16-11.96, p = 0.028) was a strong predictor of ischemic stroke, and the predictive value was comparable to that of previous AF among patients with a CHA2DS2-VASc score ≥ 2. CONCLUSIONS Both NOAF and previous AF were associated with ischemic stroke after AMI, but the impact of NOAF as a risk factor of ischemic stroke was significant only in women.
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Affiliation(s)
- Jeong-Eun Yi
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.-E.Y.); (P.-J.K.)
| | - Suk-Min Seo
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.-E.Y.); (P.-J.K.)
- Correspondence: ; Tel.: +82-2-2030-2599
| | - Sungmin Lim
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.L.); (C.-J.K.); (J.-M.L.)
| | - Eun-Ho Choo
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (E.-H.C.); (K.-Y.L.); (B.-H.H.); (W.-S.C.); (K.C.)
| | - Ik-Jun Choi
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (I.-J.C.); (D.-S.J.)
| | - Kwan-Yong Lee
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (E.-H.C.); (K.-Y.L.); (B.-H.H.); (W.-S.C.); (K.C.)
| | - Byung-Hee Hwang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (E.-H.C.); (K.-Y.L.); (B.-H.H.); (W.-S.C.); (K.C.)
| | - Chan-Joon Kim
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.L.); (C.-J.K.); (J.-M.L.)
| | - Mahn-Won Park
- Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Dong-Bin Kim
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (D.-B.K.); (H.-Y.K.)
| | - Sung-Ho Her
- Division of Cardiology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.-H.H.); (K.-D.Y.)
| | - Jong-Min Lee
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.L.); (C.-J.K.); (J.-M.L.)
| | - Chul-Soo Park
- Division of Cardiology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Pum-Joon Kim
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.-E.Y.); (P.-J.K.)
| | - Hee-Yeol Kim
- Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (D.-B.K.); (H.-Y.K.)
| | - Ki-Dong Yoo
- Division of Cardiology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (S.-H.H.); (K.-D.Y.)
| | - Doo-Soo Jeon
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (I.-J.C.); (D.-S.J.)
| | - Wook-Sung Chung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (E.-H.C.); (K.-Y.L.); (B.-H.H.); (W.-S.C.); (K.C.)
| | - Myung-Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju 61748, Korea; (M.-H.J.); (Y.A.)
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju 61748, Korea; (M.-H.J.); (Y.A.)
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (E.-H.C.); (K.-Y.L.); (B.-H.H.); (W.-S.C.); (K.C.)
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Zakeri R, Morgan AD, Sundaram V, Bloom C, Cleland JGF, Quint JK. Under-recognition of heart failure in patients with atrial fibrillation and the impact of gender: a UK population-based cohort study. BMC Med 2021; 19:179. [PMID: 34372832 PMCID: PMC8353868 DOI: 10.1186/s12916-021-02048-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with atrial fibrillation (AF) complicated by heart failure (HF) have a poor prognosis. We investigated whether long term loop-diuretic therapy in patients with AF and no known diagnosis of HF, as a potential surrogate marker of undiagnosed HF, is also associated with worse outcomes. METHODS Adults with incident AF were identified from UK primary and secondary care records between 2004 and 2016. Repeat prescriptions for loop diuretics, without a diagnosis of HF or documented non-cardiac indication, were classified as 'isolated' loop diuretic use. RESULTS Amongst 124,256 people with incident AF (median 76 years, 47% women), 22,001 (17.7%) had a diagnosis of HF, and 22,325 (18.0%) had isolated loop diuretic use. During 2.9 (LQ-UQ 1-6) years' follow-up, 12,182 patients were diagnosed with HF (incidence rate 3.2 [95% CI 3.1-3.3]/100 person-years). Of these, 3999 (32.8%) had prior isolated loop diuretic use, including 31% of patients diagnosed with HF following an emergency hospitalisation. The median time from AF to HF diagnosis was 3.6 (1.2-7.7) years in men versus 5.1 (1.8-9.9) years in women (p = 0.0001). In adjusted models, patients with isolated loop diuretic use had higher mortality (HR 1.42 [95% CI 1.37-1.47], p < 0.0005) and risk of HF hospitalisation (HR 1.60 [95% CI 1.42-1.80], p < 0.0005) than patients with no HF or loop diuretic use, and comparably poor survival to patients with diagnosed HF. CONCLUSIONS Loop diuretics are commonly prescribed to patients with AF and may indicate increased cardiovascular risk. Targeted evaluation of these patients may allow earlier HF diagnosis, timely intervention, and better outcomes, particularly amongst women with AF, in whom HF appears to be under-recognised and diagnosed later than in men.
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Affiliation(s)
- Rosita Zakeri
- Department of Population Science and Gene Health, National Heart and Lung Institute, Imperial College London, London, UK. .,School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre for Research Excellence, 125 Coldharbour Lane, London, SE5 9NU, UK.
| | - Ann D Morgan
- Department of Population Science and Gene Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - Varun Sundaram
- Department of Population Science and Gene Health, National Heart and Lung Institute, Imperial College London, London, UK.,Department of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Chloe Bloom
- Department of Population Science and Gene Health, National Heart and Lung Institute, Imperial College London, London, UK
| | - John G F Cleland
- Department of Population Science and Gene Health, National Heart and Lung Institute, Imperial College London, London, UK.,Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK
| | - Jennifer K Quint
- Department of Population Science and Gene Health, National Heart and Lung Institute, Imperial College London, London, UK
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Andersen ZJ, Cramer J, Jørgensen JT, Dehlendorff C, Amini H, Mehta A, Cole-Hunter T, Mortensen LH, Westendorp R, So R, Li S, Hoffmann B, Loft S, Bräuner EV, Ketzel M, Hertel O, Brandt J, Jensen SS, Christensen JH, Geels C, Frohn LM, Backalarz C, Simonsen MK, Lim YH. Long-Term Exposure to Road Traffic Noise and Air Pollution, and Incident Atrial Fibrillation in the Danish Nurse Cohort. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:87002. [PMID: 34338552 PMCID: PMC8327770 DOI: 10.1289/ehp8090] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Associations between long-term exposure to air pollution and road traffic noise have been established for ischemic heart disease, but findings have been mixed for atrial fibrillation (AF). OBJECTIVES The goal of the study was to examine associations of long-term exposure to road traffic noise and air pollution with AF. METHODS Time-varying Cox regression models were used to estimate associations of 1-, 3-, and 23-y mean road traffic noise and air pollution exposures with AF incidence in 23,528 women enrolled in the Danish Nurse Cohort (age >44y at baseline in 1993 or 1999). AF diagnoses were ascertained via the Danish National Patient Register. Annual mean weighted 24-h average road traffic noise levels (Lden) at the nurses' residences, since 1970, were estimated using the Nord2000 model, and annual mean levels of particulate matter with a diameter <2.5μm (PM2.5) and nitrogen dioxide (NO2) were estimated using the DEHM/UBM/AirGIS model. RESULTS Of 23,528 nurses with no prior AF diagnosis at the cohort baseline, 1,522 developed AF during follow-up. In a fully adjusted model (including PM2.5), the estimated risk of AF was 18% higher [hazard ratio (HR); 95% confidence interval (CI): 1.18; 1.02, 1.36] in nurses with residential 3-y mean Lden levels >58 dB vs. <48 dB, with similar findings for 1-y mean exposures. A 3.9-μg/m3 increase in 3-y mean PM2.5 was associated with incident AF before and after adjustment for concurrent exposure to road traffic noise (HR 1.09; 95% CI: 1.00, 1.20 and 1.08; 95% CI: 0.97, 1.19, respectively). Associations with 1-y mean PM2.5 exposures were positive but closer to the null and not significant. Associations with NO2 were null for all time periods before and after adjustment for road traffic noise and inverse when adjusted for concurrent PM2.5. CONCLUSION Our analysis of prospective data from a cohort of Danish female nurses followed for up to 14 y provided suggestive evidence of independent associations between incident AF and 1- and 3-y exposures to road traffic noise and PM2.5. https://doi.org/10.1289/EHP8090.
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Affiliation(s)
- Zorana J. Andersen
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Johannah Cramer
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette T. Jørgensen
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Dehlendorff
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Heresh Amini
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Amar Mehta
- Denmark Statistics, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tom Cole-Hunter
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Centre for Air Pollution, Energy, and Health Research, University of New South Wales, Sydney, New South Wales, Australia
- International Laboratory for Air Quality and Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Laust H. Mortensen
- Denmark Statistics, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rudi Westendorp
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Rina So
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Shuo Li
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine; Centre for Health and Society, Medical Faculty, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany
| | - Steffen Loft
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elvira V. Bräuner
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Global Centre for Clean Air Research (GCARE), University of Surrey, United Kingdom
| | - Ole Hertel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- iClimate, Aarhus University, Roskilde, Denmark
| | | | | | - Camilla Geels
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Lise M. Frohn
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | | | - Mette K. Simonsen
- Diakonissestiftelsen, Frederiksberg, Denmark
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Youn-Hee Lim
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Madla CM, Gavins FKH, Merchant HA, Orlu M, Murdan S, Basit AW. Let's talk about sex: Differences in drug therapy in males and females. Adv Drug Deliv Rev 2021; 175:113804. [PMID: 34015416 DOI: 10.1016/j.addr.2021.05.014] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/04/2021] [Accepted: 05/15/2021] [Indexed: 12/13/2022]
Abstract
Professor Henry Higgins in My Fair Lady said, 'Why can't a woman be more like a man?' Perhaps unintended, such narration extends to the reality of current drug development. A clear sex-gap exists in pharmaceutical research spanning from preclinical studies, clinical trials to post-marketing surveillance with a bias towards males. Consequently, women experience adverse drug reactions from approved drug products more often than men. Distinct differences in pharmaceutical response across drug classes and the lack of understanding of disease pathophysiology also exists between the sexes, often leading to suboptimal drug therapy in women. This review explores the influence of sex as a biological variable in drug delivery, pharmacokinetic response and overall efficacy in the context of pharmaceutical research and practice in the clinic. Prospective recommendations are provided to guide researchers towards the consideration of sex differences in methodologies and analyses. The promotion of disaggregating data according to sex to strengthen scientific rigour, encouraging innovation through the personalisation of medicines and adopting machine learning algorithms is vital for optimised drug development in the sexes and population health equity.
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Affiliation(s)
- Christine M Madla
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29 - 39 Brunswick Square, London WC1N 1AX, United Kingdom
| | - Francesca K H Gavins
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29 - 39 Brunswick Square, London WC1N 1AX, United Kingdom
| | - Hamid A Merchant
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, United Kingdom
| | - Mine Orlu
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29 - 39 Brunswick Square, London WC1N 1AX, United Kingdom
| | - Sudaxshina Murdan
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29 - 39 Brunswick Square, London WC1N 1AX, United Kingdom
| | - Abdul W Basit
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29 - 39 Brunswick Square, London WC1N 1AX, United Kingdom.
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38
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Sanjoy SS, Choi YH, Sparrow RT, Baron SJ, Abbott JD, Azzalini L, Holmes DR, Alraies MC, Tzemos N, Ayan D, Mamas MA, Bagur R. Sex Differences in Outcomes Following Left Atrial Appendage Closure. Mayo Clin Proc 2021; 96:1845-1860. [PMID: 34218859 DOI: 10.1016/j.mayocp.2020.11.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/13/2020] [Accepted: 11/23/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the effects of female sex on in-hospital outcomes and to provide estimates for sex-specific prediction models of adverse outcomes following left atrial appendage closure (LAAC). PATIENTS AND METHODS Cohort-based observational study querying the National Inpatient Sample database between October 1, 2015, and December 31, 2017. Demographics, baseline characteristics, and comorbidities were assessed with the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Index score (ECS), and CHA2DS2-VASc score. The primary outcome was in-hospital major adverse events (MAEs) defined as the composite of bleeding, vascular, cardiac complications, post-procedural stroke, and acute kidney injury. The associations of the CCI, ECS, and CHA2DS2-VASc score with in-hospital MAE were examined using logistic regression models for women and men, respectively. RESULTS A total of 3294 hospitalizations were identified, of which 1313 (40%) involved women and 1981 (60%) involved men. Women were older (76.3±7.7 vs 75.2±8.4 years, P<.001), had a higher CHA2DS2-VASc score (4.9±1.4 vs 3.9±1.4, P<.001) but showed lower CCI and ECS compared with men (2.1±1.9 vs 2.3±1.9, P=.01; and 9.3±5.9 vs 9.9±5.7, P=.002, respectively). The primary composite outcome occurred in 4.6% of patients and was higher in women compared with men (women 5.6% vs men 4.0%, P=.04), and this was mainly driven by the occurrence of cardiac complications (2.4% vs 1.2%, P=.01). In women, older age, higher median income, and higher CCI (adjusted odds ratio [aOR], 1.32; 95% confidence interval [CI], 1.21 to 1.44; P<.001), ECS (aOR, 1.04; 95% CI, 1.02 to 1.07; P=.002), and CHA2DS2-VASc score (aOR, 1.24; 95% CI, 1.10 to 1.39; P<.001) were associated with increased risk of in-hospital MAE. In men, non-White race/ethnicity, lower median income, and higher ECS (aOR, 1.06; 95% CI, 1.04 to 1.09; P<.001) were associated with increased risk of in-hospital MAE. CONCLUSION Women had higher rates of in-hospital adverse events following LAAC than men did. Women with older age and higher median income, CCI, ECS, and CHA2DS2-VASc scores were associated with in-hospital adverse events, whereas men with non-White race/ethnicity, lower median income, and higher ECS were more likely to experience adverse events. Further research is warranted to identify sex-specific, racial/ethnic, and socioeconomic pathways during the patient selection process to minimize complications in patients undergoing LAAC.
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Affiliation(s)
- Shubrandu S Sanjoy
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Yun-Hee Choi
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | | | | | - J Dawn Abbott
- Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Lorenzo Azzalini
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - M Chadi Alraies
- Wayne State University, Detroit Medical Center, Detroit, MI, USA
| | | | - Diana Ayan
- London Health Science Centre, London, ON, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
| | - Rodrigo Bagur
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; London Health Science Centre, London, ON, Canada; Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom.
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39
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Eriksson M, Åsberg S, Sunnerhagen KS, von Euler M. Sex Differences in Stroke Care and Outcome 2005-2018: Observations From the Swedish Stroke Register. Stroke 2021; 52:3233-3242. [PMID: 34187179 DOI: 10.1161/strokeaha.120.033893] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies of stroke management and outcome in Sweden have revealed differences between men and women. We aimed to analyze if differences in stroke incidence, care, and outcome have altered over time. METHODS All stroke events registered in the Swedish Stroke Register 2005 to 2018 were included. Background variables and treatment were collected during the acute hospital stay. Survival data were obtained from the national cause of death register by individual linkage. We used unadjusted proportions and estimated age-adjusted marginal means, using a generalized linear model, to present outcome. RESULTS We identified 335 183 stroke events and a decreasing incidence in men and women 2005 to 2018. Men were on average younger than women (73.3 versus 78.1 years) at stroke onset. The age-adjusted proportion of reperfusion therapy 2005 to 2018 increased more rapidly in women than in men (2.3%-15.1% in men versus 1.4%-16.9% in women), but in 2018, women still had a lower probability of receiving thrombolysis within 30 minutes. Among patients with atrial fibrillation, oral anticoagulants at discharge increased more rapidly in women (31.2%-78.6% in men versus 26.7%-81.9% in women). Statins remained higher in men (36.9%-83.7% in men versus 32.3%-81.2% in women). Men had better functional outcome and survival after stroke. After adjustment for women's higher age, more severe strokes, and background characteristics, the absolute difference in functional outcome was <1% and survival did not differ. CONCLUSIONS Stroke incidence, care, and outcome show continuous improvements in Sweden, and previously reported differences between men and women become less evident. More severe strokes and older age in women at stroke onset are explanations to persisting differences.
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Affiliation(s)
- Marie Eriksson
- Department of Statistics, USBE, Umeå University, Sweden (M.E.)
| | - Signild Åsberg
- Department of Neuroscience, Uppsala University, Sweden (S.A.)
| | | | - Mia von Euler
- School of Medicine, Örebro University, Sweden (M.v.E.)
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40
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Kim MH, You SC, Sung JH, Jang E, Yu HT, Kim TH, Pak HN, Lee MH, Yang PS, Joung B. Safety and long-term outcomes of catheter ablation according to sex in patients with atrial fibrillation: A nationwide cohort study. Int J Cardiol 2021; 338:95-101. [PMID: 34147556 DOI: 10.1016/j.ijcard.2021.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/10/2021] [Accepted: 06/12/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Catheter ablation is more effective than antiarrhythmic drug therapy alone in patients with atrial fibrillation (AF). However, there are limited data on the outcomes of AF ablation according to sex. The purpose of this study was to evaluate gender differences in the actual outcomes after catheter ablation for atrial fibrillation. METHODS Of 801,710 patients with AF in the Korean National Health Insurance Service database, we identified 9175 patients without valvular heart disease who underwent AF ablation between 2006 and 2015 and assessed 30-day safety and one-year effectiveness outcomes according to sex. RESULTS Of the 9175 patients who underwent AF ablation, 2206 (24%) were female. Women, compared to men, were older (60.8 ± 10.2 vs. 56.0 ± 10.5 years), had higher CHA2DS2-VASc (3.5 ± 1.7 vs. 2.0 ± 1.6), higher HAS-BLED (2.6 ± 1.3 vs. 2.4 ± 1.2), and higher Charlson comorbidity index scores (3.8 ± 2.6 vs. 3.1 ± 2.5) (p < 0.001 for all). Following ablation, there was no significant difference in the risk of 30-day complications, including hemorrhage and tamponade, between women and men. In multivariable analyses, there were no significant differences in all-cause hospitalization (adjusted hazard ratio [HR] 1.05, 95% confidence interval [CI] 0.91-1.22, p = 0.489) and AF rehospitalization (adjusted HR 1.16, 95% CI 0.96-1.40, p = 0.135). Women were less likely to undergo cardioversion (adjusted HR 0.72, 95% CI 0.62-0.84, p < 0.001) but were more likely to be re-hospitalized for heart failure (adjusted HR 1.86, 95% CI 1.11-3.11, p = 0.019). CONCLUSION Women who underwent AF ablation did not differ from men in terms of the risk of complications and all-cause hospitalization in this study. The small increased risk in women reported in previous studies may be related to residual confounding, particularly from insufficient control for age and comorbidities.
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Affiliation(s)
- Moon-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seng Chan You
- Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Hoon Sung
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Eunsun Jang
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Pil-Sung Yang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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41
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Costa Viana C, da Silva Praxedes MF, Freitas Nunes de Sousa WJ, Bartolazzi F, Sousa Vianna M, Padilha da Silva JL, Parreiras Martins MA. Sex-influence on the time in therapeutic range (TTR) during oral anticoagulation with coumarin derivatives: Systematic review and meta-analysis. Br J Clin Pharmacol 2021; 87:4488-4503. [PMID: 33973668 DOI: 10.1111/bcp.14892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/23/2021] [Accepted: 05/01/2021] [Indexed: 12/17/2022] Open
Abstract
AIMS We sought to investigate the association between sex and oral anticoagulation control employing coumarin derivatives. METHODS Electronic sources were MEDLINE, Biblioteca Virtual em Saúde (BVS), The Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Cochrane Central and Web of Science. Inclusion criteria were: observational and experimental studies; age ≥18 years; both sexes; treatment with any coumarin derivative for ≥3 months; any indication of long-term use; quality of oral anticoagulation measured by time in therapeutic range (TTR). The meta-analysis was developed with odds ratios (OR) for binary variables and mean differences (MD) for continuous variables, using random-effects models (DerSimonian and Laird) with 95% confidence intervals (CI). RESULTS Overall, 22 articles were selected, comprising 16 cohort studies, four cross-sectional studies and two clinical trials. The number of participants ranged from 110 to 104 505 (183 612; women: 45%). The main indication of oral anticoagulation was atrial fibrillation. Most studies reported the use of warfarin. In the meta-analysis, 15 studies were analysed using TTR as a binary variable (OR = 0.87; 95% CI = 0.78, 0.96; z = -2.75; P = .006.; I2 = 67%) and seven studies as a continuous variable (MD = -2.97; 95% CI = -4.80, -1.14; z = -3.19; P = .0014; I2 = 75%). The pooled estimates indicated that women were associated with lower TTR than men. CONCLUSIONS Our findings revealed an association between female sex and worse oral anticoagulation control. Further studies are needed with primary design to investigate sex-related factors influencing oral anticoagulation control with coumarin derivatives. Innovative strategies focused on women's health may be useful to improve patient-centred care.
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Affiliation(s)
- Catiane Costa Viana
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Marcus Fernando da Silva Praxedes
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil.,Centro de Ciências da Saúde, Universidade Federal do Recôncavo da Bahia, Av. do Cajueiro 1015, Cajueiro, Santo Antonio de Jesus, Bahia, 44574-490, Brazil
| | - Waleska Jaclyn Freitas Nunes de Sousa
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Bairro Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil.,Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110, Bairro Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Frederico Bartolazzi
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Bairro Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Mayara Sousa Vianna
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - José Luiz Padilha da Silva
- Departamento de Estatística da Universidade Federal do Paraná, R. Evaristo F. Ferreira da Costa, 408, Jardim das Américas, Curitiba, Paraná, 81530-015, Brazil
| | - Maria Auxiliadora Parreiras Martins
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil.,Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Bairro Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil.,Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110, Bairro Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil
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42
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Gender differences in physician decisions to adopt new prescription drugs. Soc Sci Med 2021; 277:113886. [PMID: 33882439 DOI: 10.1016/j.socscimed.2021.113886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/19/2021] [Accepted: 03/26/2021] [Indexed: 11/20/2022]
Abstract
Physician adoption of new technologies is a key issue for population health and the sustainability of the healthcare system. This paper explores gender differences in general practitioners' (GPs) adoption of new oral anticoagulants. We combine detailed individual data on physician and practice style characteristics from the Medicine in Australia: Balancing Employment and Life (MABEL) panel survey of Australian physicians with administrative prescribing data from the Australian Pharmaceutical Benefits Scheme (PBS) and the Medicare Benefits Schedule (MBS) for the period January 1, 2012 and December 31, 2015. After adjusting for various factors proposed in the literature as drivers of this gender gap, in addition to risk preferences and personality traits, we find a large statistical gender difference in the speed of adoption with men being faster than women in uptake. However, conditional on having prescribed for the first time, female and male GPs differ only slightly in the intensity of use of these new drugs. We show that the gender gap depends on the measure of uptake and discuss possible channels that could be driving the relatively large gender difference that remains in the speed of adoption.
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43
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Herraiz-Martínez A, Tarifa C, Jiménez-Sábado V, Llach A, Godoy-Marín H, Colino H, Nolla-Colomer C, Casabella S, Izquierdo-Castro P, Benítez I, Benítez R, Roselló-Díez E, Rodríguez-Font E, Viñolas X, Ciruela F, Cinca J, Hove-Madsen L. Influence of sex on intracellular calcium homeostasis in patients with atrial fibrillation. Cardiovasc Res 2021; 118:1033-1045. [PMID: 33788918 PMCID: PMC8930070 DOI: 10.1093/cvr/cvab127] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/30/2021] [Indexed: 11/22/2022] Open
Abstract
Aims Atrial fibrillation (AF) has been associated with intracellular calcium disturbances in human atrial myocytes, but little is known about the potential influence of sex and we here aimed to address this issue. Methods and results Alterations in calcium regulatory mechanisms were assessed in human atrial myocytes from patients without AF or with long-standing persistent or permanent AF. Patch-clamp measurements revealed that L-type calcium current (ICa) density was significantly smaller in males with than without AF (−1.15 ± 0.37 vs. −2.06 ± 0.29 pA/pF) but not in females with AF (−1.88 ± 0.40 vs. −2.21 ± 0.0.30 pA/pF). In contrast, transient inward currents (ITi) were more frequent in females with than without AF (1.92 ± 0.36 vs. 1.10 ± 0.19 events/min) but not in males with AF. Moreover, confocal calcium imaging showed that females with AF had more calcium spark sites than those without AF (9.8 ± 1.8 vs. 2.2 ± 1.9 sites/µm2) and sparks were wider (3.0 ± 0.3 vs. 2.2 ± 0.3 µm) and lasted longer (79 ± 6 vs. 55 ± 8 ms), favouring their fusion into calcium waves that triggers ITIs and afterdepolarizations. This was linked to higher ryanodine receptor phosphorylation at s2808 in women with AF, and inhibition of adenosine A2A or beta-adrenergic receptors that modulate s2808 phosphorylation was able to reduce the higher incidence of ITI in women with AF. Conclusion Perturbations of the calcium homoeostasis in AF is sex-dependent, concurring with increased spontaneous SR calcium release-induced electrical activity in women but not in men, and with diminished ICa density in men only.
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Affiliation(s)
| | - Carmen Tarifa
- Biomedical Research Institute Barcelona Centre IIBB-CSIC.,IIB Sant Pau
| | | | | | - Hector Godoy-Marín
- Dept. Pathology and Experimental Therapeutics, IDIBELL, Univ. Barcelona, L'Hospitalet de Llobregat, Spain.,Neuroscience Institute, Univ. Barcelona, Spain
| | - Hildegard Colino
- Biomedical Research Institute Barcelona Centre IIBB-CSIC.,IIB Sant Pau
| | | | - Sergi Casabella
- Biomedical Research Institute Barcelona Centre IIBB-CSIC.,IIB Sant Pau
| | | | - Iván Benítez
- Biostatistic Unit, Biomedical Research Institute, IRBLleida, Spain
| | - Raul Benítez
- Dept. Automatic Control, Univ. Politècnica de Catalunya, Barcelona
| | - Elena Roselló-Díez
- Dept. Cardiac Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Univ. Autònoma de Barcelona, Spain
| | | | - Xavier Viñolas
- Dept. Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona
| | - Francisco Ciruela
- Dept. Pathology and Experimental Therapeutics, IDIBELL, Univ. Barcelona, L'Hospitalet de Llobregat, Spain.,Neuroscience Institute, Univ. Barcelona, Spain
| | - Juan Cinca
- Dept. Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona.,CIBERCV.,Univ. Autònoma de Barcelona, Spain
| | - Leif Hove-Madsen
- Biomedical Research Institute Barcelona Centre IIBB-CSIC.,IIB Sant Pau.,CIBERCV
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Nomoto F, Suzuki S, Hashizume N, Kanzaki Y, Maruyama T, Kozuka A, Saigusa T, Ebisawa S, Okada A, Motoki H, Yahikozawa K, Kuwahara K. A case of Dressler's syndrome successfully treated with colchicine and acetaminophen. J Cardiol Cases 2021; 23:131-135. [PMID: 33717379 PMCID: PMC7917394 DOI: 10.1016/j.jccase.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/18/2020] [Accepted: 10/03/2020] [Indexed: 11/05/2022] Open
Abstract
The incidence of Dressler’s syndrome after myocardial infarction (MI) has decreased in the reperfusion therapy era. Although guidelines recommend high-dose aspirin for treatment based on evidence from the pre-percutaneous coronary intervention (pre-PCI) era, bleeding and thrombotic concerns occurred upon aspirin administration after coronary stenting. A 69-year-old man with recent MI was admitted to our hospital. The patient presented with chest pain 1 week before admission. Electrocardiography revealed newly detected atrial fibrillation with no ST segment change. Urgent coronary angiography demonstrated a left circumflex artery occlusion. He underwent PCI, and a sirolimus-eluting stent was deployed. Aspirin, prasugrel, and apixaban were administered. However, hospital discharge was delayed because he developed heart failure during hospitalization. Twenty-three days after admission, he developed a fever of >39 °C. Electrocardiography showed anterior ST segment elevation, and echocardiography revealed a 6-mm pericardial effusion. We diagnosed the patient with Dressler’s syndrome, and colchicine 0.5 mg/day + acetaminophen 2000 mg/day were administered. His condition clinically improved after treatment and he was discharged 32 days after admission. There was hesitation about administration of high-dose aspirin in a patient who has undergone recent coronary stenting. Combination therapy of colchicine and acetaminophen could be a treatment option for Dressler’s syndrome. <Learning objective: Guidelines recommend high-dose aspirin for the treatment of Dressler’s syndrome based on evidence from the pre-percutaneous coronary intervention (pre-PCI) era. However, bleeding and thrombotic concerns are present upon high-dose aspirin administration in patients who have undergone PCI. Therefore, a combination therapy of low-dose colchicine and acetaminophen could be a treatment option for patients with Dressler’s syndrome who have undergone recent coronary stenting.>
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Affiliation(s)
- Fumika Nomoto
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Sho Suzuki
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Naoto Hashizume
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Yusuke Kanzaki
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Takuya Maruyama
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Ayako Kozuka
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kumiko Yahikozawa
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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45
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Suehiro H, Kiuchi K, Fukuzawa K, Yoshida N, Takami M, Watanabe Y, Izawa Y, Akita T, Takemoto M, Sakai J, Nakamura T, Yatomi A, Takahara H, Sonoda Y, Nakasone K, Yamamoto K, Yamashita T, Hirata KI. Circulating intermediate monocytes and atrial structural remodeling associated with atrial fibrillation recurrence after catheter ablation. J Cardiovasc Electrophysiol 2021; 32:1035-1043. [PMID: 33533109 DOI: 10.1111/jce.14929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/22/2021] [Accepted: 01/27/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Inflammation, such as that associated with intermediate CD14++ CD16+ monocytes and atrial structural remodeling (SRM), may be important in the recurrence of atrial fibrillation (AF) after catheter ablation. However, the relationship between the intermediate CD14++ CD16+ monocytes, SRM, and AF recurrence is unclear. METHODS Twenty-four patients with AF were enrolled. The proportion of intermediate monocytes (PIM) was assessed before ablation by flow cytometry. As a surrogate marker of SRM, the volume ratio (VR) of signal intensity greater than 1 standard deviation on late-gadolinium enhancement magnetic resonance imaging (LGE-MRI) was calculated. We investigated whether PIM correlated with SRM on LGE-MRI and determined the optimal cutoff value for predicting AF recurrence. RESULTS Univariate analysis revealed positive correlations between PIM and BNP with SRM (PIM: r = .593, p = .002; BNP: r = .567, p = .004). Multivariable analysis revealed that PIM was independently associated with VR on LGE-MRI (β = .522; p = .033). The finding of an area under the receiver operating characteristic curve of 0.750 revealed that a VR ≥ 13.3% on LGE-MRI as the optimal cutoff value to predict AF recurrence with 80% sensitivity and 71% specificity, which was associated with PIM ≥ 10.0%. CONCLUSION Intermediate monocytes were significantly positively correlated with SRM. PIM ≥ 10% was associated with a VR ≥ 13.3% on LGE-MRI, which predicted AF recurrence after catheter ablation.
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Affiliation(s)
- Hideya Suehiro
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kunihiko Kiuchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Fukuzawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naofumi Yoshida
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mitsuru Takami
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshiaki Watanabe
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yu Izawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomomi Akita
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Makoto Takemoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jun Sakai
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshihiro Nakamura
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsusuke Yatomi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroyuki Takahara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yusuke Sonoda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazutaka Nakasone
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kyoko Yamamoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoya Yamashita
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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46
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Abbas SS, Majeed T, Weaver N, Nair BR, Forder PM, Byles JE. Utility estimations of health states of older Australian women with atrial fibrillation using SF-6D. Qual Life Res 2021; 30:1457-1466. [PMID: 33550542 DOI: 10.1007/s11136-020-02748-3] [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] [Accepted: 12/23/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To estimate SF-6D utility scores for older women with atrial fibrillation (AF); calculate and compare mean utility scores for women with AF with various demographic, health behaviours, and clinical characteristics; and develop a multivariable regression model to determine factors associated with SF-6D utility scores. METHODS This study evaluated N = 1432 women diagnosed with AF from 2000 to 2015 of the old cohort (born 1921-26) of the Australian Longitudinal Study on Women's Health (ALSWH) who remained alive for at least 12 months post first recorded AF diagnosis. Self-reported data on demographics, health behaviours, health conditions, and SF-36 were obtained from the ALSWH surveys, corresponding to within three years of the date of the first record of AF diagnosis. Linked Pharmaceutical Benefits Scheme (PBS) data determined the use of oral anticoagulants and comorbid conditions, included in CHA2DS2-VA (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes, Stroke or TIA, Vascular disease and Age 65-74 years) score calculation, were assessed using state-based hospital admissions data. Utility scores were calculated for every woman from their SF-36 responses using the SF-6D algorithm with Australian population norms. Mean utility scores were then calculated for women with various demographic, health behaviours, and clinical characteristics. Ordinary Least Square (OLS) regression modelling was performed to determine factors associated with these utility scores. Two different scenarios were used for the analysis: (1) complete-case, for women with complete data on all the SF-36 items required to estimate SF-6D (N = 584 women), and (2) Multiple Imputation (MI) for missing data, applied to missing values on SF-36 items (N = 1432 women). MI scenario was included to gauge the potential bias when using complete data only. RESULTS The mean health utility was estimated to be 0.638 ± 0.119 for the complete dataset and 0.642 ± 0.120 for the dataset where missing values were handled using MI. Using the MI technique, living in regional and remote areas ([Formula: see text]) and the use of oral anticoagulants ([Formula: see text] were positively associated with health utility compared to living in major cities and no use of anticoagulants, respectively. Difficulty to manage on available income [Formula: see text], no/low physical activity [Formula: see text], disability [Formula: see text], history of stroke ([Formula: see text] and history of arthritis [Formula: see text] were negatively associated with health utility. CONCLUSION This study presents health utility estimates for older women with AF. These estimates can be used in future clinical and economic research. The study also highlights better health utilities for women living in regional and remote areas, which requires further exploration.
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Affiliation(s)
- Shazia S Abbas
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.
| | - Tazeen Majeed
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Natasha Weaver
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Balakrishnan R Nair
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Peta M Forder
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Julie E Byles
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
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47
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Lei N, Kareem M, Moon SK, Ciaccio EJ, Acharya UR, Faust O. Hybrid Decision Support to Monitor Atrial Fibrillation for Stroke Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:813. [PMID: 33477887 PMCID: PMC7833442 DOI: 10.3390/ijerph18020813] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 11/16/2022]
Abstract
In this paper, we discuss hybrid decision support to monitor atrial fibrillation for stroke prevention. Hybrid decision support takes the form of human experts and machine algorithms working cooperatively on a diagnosis. The link to stroke prevention comes from the fact that patients with Atrial Fibrillation (AF) have a fivefold increased stroke risk. Early diagnosis, which leads to adequate AF treatment, can decrease the stroke risk by 66% and thereby prevent stroke. The monitoring service is based on Heart Rate (HR) measurements. The resulting signals are communicated and stored with Internet of Things (IoT) technology. A Deep Learning (DL) algorithm automatically estimates the AF probability. Based on this technology, we can offer four distinct services to healthcare providers: (1) universal access to patient data; (2) automated AF detection and alarm; (3) physician support; and (4) feedback channels. These four services create an environment where physicians can work symbiotically with machine algorithms to establish and communicate a high quality AF diagnosis.
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Affiliation(s)
- Ningrong Lei
- College of Business, Technology and Engineering, Sheffield Hallam University, Sheffield S1 1WB, UK;
| | - Murtadha Kareem
- Materials & Engineering Research Institute, Sheffield Hallam University, Sheffield S1 1WB, UK;
| | - Seung Ki Moon
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798, Singapore;
| | - Edward J. Ciaccio
- Department of Medicine-Cardiology, Columbia University, New York, NY 10027, USA;
| | - U Rajendra Acharya
- Ngee Ann Polytechnic, Singapore 598269, Singapore;
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung 41354, Taiwan
- School of Management and Enterprise, University of Southern Queensland, Toowoomba 4350, Australia
| | - Oliver Faust
- College of Business, Technology and Engineering, Sheffield Hallam University, Sheffield S1 1WB, UK;
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48
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Zhang J, Johnsen SP, Guo Y, Lip GYH. Epidemiology of Atrial Fibrillation: Geographic/Ecological Risk Factors, Age, Sex, Genetics. Card Electrophysiol Clin 2021; 13:1-23. [PMID: 33516388 DOI: 10.1016/j.ccep.2020.10.010] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Atrial fibrillation is the most common arrhythmia globally. The global prevalence of atrial fibrillation is positively correlated with the sociodemographic index of different regions. Advancing age, male sex, and Caucasian race are risk factors; female sex is correlated with higher atrial fibrillation mortality worldwide likely owing to thromboembolic risk. African American ethnicity is associated with lower atrial fibrillation risk, same as Asian and Hispanic/Latino ethnicities compared with Caucasians. Atrial fibrillation may be heritable, and more than 100 genetic loci have been identified. A polygenic risk score and clinical risk factors are feasible and effective in risk stratification of incident disease.
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Affiliation(s)
- Juqian Zhang
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, L14 3PE, UK
| | - Søren Paaske Johnsen
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, Aalborg, Aalborg 9000, Denmark
| | - Yutao Guo
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, L14 3PE, UK; Department of Cardiology, Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, L14 3PE, UK; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, Aalborg, Aalborg 9000, Denmark; Department of Cardiology, Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, China.
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49
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Crijns HJGM, Wijtvliet EPJ, Pluymaekers NAHA, Van Gelder IC. Newly discovered atrial fibrillation: who(se) care(s)? Europace 2020; 22:677-678. [PMID: 32282897 PMCID: PMC7203630 DOI: 10.1093/europace/euz359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Harry J G M Crijns
- Department of Cardiology and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - E Petra J Wijtvliet
- Department of Cardiology and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nikki A H A Pluymaekers
- Department of Cardiology and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
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50
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Lévy S, Hartikainen J, Ritz B, Juhlin T, Carbajosa-Dalmau J, Domanovits H. Vernakalant for Rapid Cardioversion of Recent-Onset Atrial Fibrillation: Results from the SPECTRUM Study. Cardiovasc Drugs Ther 2020; 35:283-292. [PMID: 33206300 PMCID: PMC7994211 DOI: 10.1007/s10557-020-07103-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 01/10/2023]
Abstract
Aims Rapid restoration of sinus rhythm using pharmacological cardioversion is commonly indicated in patients with symptomatic recent-onset atrial fibrillation (AF). The objectives of this large, international, multicenter observational study were to determine the safety and effectiveness of intravenous (IV) vernakalant for conversion of AF to sinus rhythm in daily practice. Methods and Results Consenting patients with symptomatic recent-onset AF (< 7 days) treated with IV vernakalant were enrolled and followed up to 24 h after the last infusion or until discharge, in order to determine the incidence of predefined serious adverse events (SAEs) and other observed SAEs and evaluate the conversion rate within the first 90 min. Overall, 2009 treatment episodes in 1778 patients were analyzed. The age of patients was 62.3 ± 13.0 years (mean ± standard deviation). Median AF duration before treatment was 11.1 h (IQR 5.4–27.0 h). A total of 28 SAEs occurred in 26 patients including 19 predefined SAEs, i.e., sinus arrest (n = 4, 0.2%), significant bradycardia (n = 11, 0.5%), significant hypotension (n = 2, 0.1%), and atrial flutter with 1:1 conduction (n = 2, 0.1%). There were no cases of sustained ventricular arrhythmias or deaths. All patients who experienced SAEs recovered fully (n = 25) or with sequelae (n = 1). Conversion rate to sinus rhythm was 70.2%, within a median of 12 min (IQR 8.0–28.0 min). Conclusions This large multicenter, international observational study confirms the good safety profile and the high effectiveness of vernakalant for the rapid cardioversion of recent-onset AF in daily hospital practice.
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Affiliation(s)
- Samuel Lévy
- Marseille School of Medicine, Aix-Marseille University, bd Charles Livon, Marseille Cedex 07, 13284, Marseille, France.
| | | | - Beate Ritz
- Correvio International Sàrl, Geneva, Switzerland
| | | | - José Carbajosa-Dalmau
- ISABIAL-Fundación FISABIO, Hospital General Universitario de Alicante, Alicante, Spain
| | - Hans Domanovits
- Vienna General Hospital, Medical University of Vienna, Vienna, Austria
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