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Niu H, Li J, Teng C, Lu X, Jin C, Cai P, Shi A, Shen X, Chen Q, Chen M, Yuan Y, Li P. The incidence and impact of atrial fibrillation on hospitalized Coronavirus disease-2019 patients. Clin Cardiol 2024; 47:e24240. [PMID: 38402574 PMCID: PMC10894524 DOI: 10.1002/clc.24240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/04/2024] [Accepted: 02/09/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Since 2019, Coronavirus disease-2019 (COVID-19) has raised unprecedented global health crisis. The incidence and impact of atrial fibrillation (AF) on patients with COVID-19 remain unclearly defined. METHODS We conducted a retrospective cohort study using ICD-10 codes to identify patients with a primary diagnosis of COVID-19 with or without AF in National Inpatient Sample Database 2020. We compared the outcome of COVID-19 patients with a concurrent diagnosis of AF with those without. HYPOTHESIS AF will adversely affect the prognosis of hospitalized COVID-19 patients. RESULTS A total of 211 619 patients with a primary diagnosis of COVID-19 were identified. Among these patients, 31 923 (15.08%) had a secondary diagnosis of AF. Before propensity score matching, COVID-AF cohort was older (75.8 vs. 62.2-year-old, p < .001) and had more men (57.5% vs. 52.0%, p < .001). It is associated with more comorbidities, mainly including diabetes mellitus (43.7% vs. 39.9%, p < .001), hyperlipidemia (54.6% vs. 39.8%, p < .001), chronic kidney disease (34.5% vs. 17.0%, p < .001), coronary artery disease (35.3% vs. 14.4%, p < .001), anemia (27.8% vs. 18.6%, p < .001), and cancer (4.8% vs. 3.4%, p < .001). After performing propensity score match, a total of 31 862 patients were matched within each group. COVID-AF cohort had higher inpatient mortality (22.2% vs. 15.3%, p < .001) and more complications, mainly including cardiac arrest (3.9% vs. 2.3%, p < .001), cardiogenic shock (0.9% vs. 0.3%, p < .001), hemorrhagic stroke (0.4% vs. 0.3%, p = .025), and ischemic stroke (1.3% vs. 0.7%, p < .001). COVID-AF cohort was more costly, with a longer length of stay, and a higher total charge. CONCLUSION AF is common in patients hospitalized for COVID-19, and is associated with poorer in-hospital mortality, immediate complications and increased healthcare resource utilization.
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Affiliation(s)
- Haiming Niu
- Department of Critical Care MedicineZhongshan People's HospitalZhongshanP.R. China
| | - Jianwei Li
- Department of Critical Care MedicineZhongshan People's HospitalZhongshanP.R. China
| | - Catherine Teng
- Division of Cardiology, Department of MedicineUniversity of Texas Health Science CenterSan AntonioTexasUSA
| | - Xiaojia Lu
- Department of Cardiology, Mount Sinai Beth IsraelIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Chengyue Jin
- Department of Cardiologythe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Peng Cai
- Department of Mathematical SciencesWorcester Polytechnic InstituteWorcesterMassachusettsUSA
| | - Ao Shi
- Faculty of MedicineSt. George University of LondonLondonUK
| | - Xiaoqing Shen
- Department of Critical Care MedicineZhongshan People's HospitalZhongshanP.R. China
| | - Qiqi Chen
- Department of Critical Care MedicineZhongshan People's HospitalZhongshanP.R. China
| | - Miaolian Chen
- Department of Critical Care MedicineZhongshan People's HospitalZhongshanP.R. China
| | - Yong Yuan
- Department of CardiovasculogyZhongshan People's HospitalZhongshanP.R. China
| | - Pengyang Li
- Division of Cardiology, Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
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2
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Liao KM, Chen PJ, Chen CY. Prescribing patterns in patients with chronic obstructive pulmonary disease and atrial fibrillation. Open Med (Wars) 2023; 18:20230864. [PMID: 38045860 PMCID: PMC10693011 DOI: 10.1515/med-2023-0864] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 10/28/2023] [Accepted: 11/04/2023] [Indexed: 12/05/2023] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) had higher risk of atrial fibrillation (AF). The treatment of AF includes medicines to control heart rate and reduce the risk of stroke, and procedures such as cardioversion to restore normal heart rhythm. To reduce the stroke, patients with AF may prescribe some type of antithrombotic medication (such as warfarin, one of the new non-vitamin K antagonist oral anticoagulants [NOACs] - dabigitran, apixaban, rivoraxaban, or edoxaban) or maybe aspirin. The aim of our study was to exam the prescription pattern in patients with COPD and AF. We selected COPD population in Taiwan older than 40 years and less than 90 years old with an COPD diagnosis at least two outpatient claims or at least one inpatient claim coded and also need at least one prescription of bronchodilators. We followed this COPD cohort until they have AF and their prescription pattern. We included 267,740 patients with COPD who meet the inclusion and exclusion criteria and 6,582 patients concomitant with COPD and AF. The mean age was 75 years, and about 77% of the patients were older than 70 years. Three-fourths of patients with COPD were male. The common comorbidities were hypertension (17.58%), diabetes (7.47%), ischemic heart disease (4.66%), and dyslipidemia (3.68%). we found that most patients received aspirin which accounting for 31%, followed by coumadin (8.22%) and clopidogrel. Prescribing NOAC within 30 days after AF diagnosis was low in patients with COPD and the percentage of NOAC usage was also lower than warfarin.
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Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan
| | - Pei-Jun Chen
- Department of Nursing, Chi Mei Medical Center, Chiali, Taiwan
| | - Chung-Yu Chen
- Master Program in Clinical Pharmacy, School of Pharmacy, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Sanmin District, Kaohsiung80708, Taiwan
- Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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3
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Nielsen AB, Skaarup KG, Djernæs K, Duus LS, Espersen C, Sørensen SK, Ruwald MH, Hansen ML, Worck RH, Johannessen A, Hansen J, Nardelli P, San José Estépar R, San José Estépar R, Biering-Sørensen T. Association Between Pulmonary Vascular Volume and Cardiac Structure and Function in Patients With Atrial Fibrillation. Am J Cardiol 2023; 205:182-189. [PMID: 37604065 DOI: 10.1016/j.amjcard.2023.07.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 08/23/2023]
Abstract
Pulmonary vascular abnormalities, quantified from computed tomography scans, have frequently been observed in patients with pulmonary diseases. However, little is known about pulmonary vascular changes in patients with cardiac disease. Thus, we aimed to examine the cardiopulmonary relation in patients with atrial fibrillation (AF) by comparing pulmonary vascular volume (PVV) to echocardiographic measures and AF severity. A total of 742 patients (median age 63 years, 70% men) who underwent ablation for AF were included. Preprocedural cardiac computed tomography was used to measure the total and small-vessel PVV, along with the pulmonary artery to aorta ratio and the degree of emphysema. The association between PVV and echocardiographic parameters was evaluated using a multivariable linear regression analysis. Lower total and small-vessel PVV were associated with more impaired measures of cardiac structure and function, including but not limited to left ventricular ejection fraction and peak atrial longitudinal strain. Patients with reduced total and small-vessel PVV had higher odds of having persistent AF than paroxysmal AF in the unadjusted logistic regression analyses. However, after clinical and echocardiographic adjustments, only reduced small-vessel PVV remained independently associated with persistent AF (odds ratio 1.90, 95% confidence interval 1.26 to 2.87, p = 0.002). In conclusion, pulmonary vascular remodeling is associated with persistent AF and with more impaired measures of cardiac structure and function, providing further insights into heart-lung interactions in this patient group.
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Affiliation(s)
- Anne Bjerg Nielsen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark; Applied Chest Imaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | | | - Kasper Djernæs
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Lisa Steen Duus
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark; Applied Chest Imaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Caroline Espersen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Samuel Kiil Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Martin Huth Ruwald
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Morten Lock Hansen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - René Husted Worck
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Arne Johannessen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Jim Hansen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Pietro Nardelli
- Applied Chest Imaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rubén San José Estépar
- Applied Chest Imaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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4
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Sidhu GD, Ayoub T, El Hajjar AH, Dhorepatil A, Nedunchezian S, Dagher L, Ferdinand K, Marrouche N. Atrial Fibrillation and Acute Ischemic Stroke: Evaluation of the Contemporary 2018 National Inpatient Sample Database. CJC Open 2022; 4:513-519. [PMID: 35734515 PMCID: PMC9207776 DOI: 10.1016/j.cjco.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background Atrial fibrillation (AF) in acute ischemic stroke (AIS) is considered a binary entity regardless of AF type. We aim to investigate in-hospital morbidity and mortality among patients with nonparoxysmal AF–related AIS. Methods Patients hospitalized for AIS with associated paroxysmal or persistent AF were identified from the 2018 national inpatient sample database. We compared in-hospital mortality, stroke-related morbidity, hospital cost, length of stay, and discharge disposition in patients hospitalized with paroxysmal or persistent AF. Results A total of 26,470 patients were hospitalized for AIS with paroxysmal or persistent AF. Patient with AIS with persistent AF had a longer hospital length of stay (paroxysmal AF, mean [M] 5.7 days, standard deviation [SD] ±6.8 days; persistent AF, M 7.4 days, SD ±11.9 days, P < 0.001) and in-hospital costs (paroxysmal AF, M $15,449, SD ±$18,320; persistent AF, M $19,834 SD ±$23,312, P < 0.001). Patients with AIS with permanent AF had higher in-hospital mortality (paroxysmal AF, 4.6%, vs permanent AF, 6.2%, P < 0.001). Indirect markers of stroke-related disability, like intracranial hemorrhage (odds ratio [OR]: 1.9, 95% confidence interval (CI): 1.6-2.2), need for gastrostomy (OR: 2.1, 95% CI: 1.8-2.4), and tracheostomy (OR: 3.1, 95% CI: 2.1-4.4) were more associated with AIS from persistent AF. Conclusions Persistent AF is associated with poor in-hospital stroke-related outcome, possibly due to a worse thrombo-embolic phenomenon. AF pattern may be a harbinger of worse stroke-related morbidity.
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Affiliation(s)
| | | | | | | | | | | | | | - Nassir Marrouche
- Corresponding author: Dr Nassir F. Marrouche, Tulane University School of Medicine- Tulane University Heart and Vascular Institute, 1430 Tulane Ave, Box 8548, New Orleans, Louisiana 70112, USA.
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5
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Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia and associated with increased morbidity and mortality resulting from thromboembolism and heart failure. AF often presents initially as paroxysmal and may progress to a sustained form over time. Sustained forms of AF may be associated with increased symptoms and cardiovascular morbidity, and AF progression may be associated with increased risk of clinically adverse events and outcomes. The present review discusses the clinical factors of arrhythmia progression and risk stratification available to assess the probability of AF progression. Furthermore, currently available treatment options for preventing AF progression are explored and evaluated.
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Affiliation(s)
- Hisashi Ogawa
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
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6
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Ye J, Yao P, Shi X, Yu X. A systematic literature review and meta-analysis on the impact of COPD on atrial fibrillation patient outcome. Heart Lung 2021; 51:67-74. [PMID: 34740082 DOI: 10.1016/j.hrtlng.2021.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND COPD is often accompanied by extra-pulmonary manifestations such as thrombo-embolic and hemorrhagic events, the disease is linked with atrial fibrillation (AF). OBJECTIVE The objective of the current review was to assess the impact of chronic obstructive pulmonary disease (COPD) on outcomes of atrial fibrillation (AF). METHODS PubMed, Scopus, Embase, and Web of Science databases were searched for studies comparing overall mortality, cardiovascular death, and other outcomes for AF patients with and without COPD. The data retrieved were subjected to both qualitative and quantitative analyses. The hazard ratios (HR) obtained for mortality in presence of COPD were pooled to meta-analyze using generic inverse variance function of RevMan 5.3 software. The association of various risk factors and HRs were pooled with 95% confidence interval (CI). The quality of the included studies was assessed using Newcastle Ottawa scale (NOS). RESULTS The hazard ratios (HR) were calculated with 95% confidence intervals (CIs). A total of seven studies were included. The pooled HR for the impact of COPD on overall mortality and cardiovascular mortality in AF patients was found to be 1.70 (95% CI: 1.47, 1.97; p<0.0001) and 1.80 (95% CI: 1.29, 2.52; p = 0.0005), respectively. Hemorrhagic events were significantly higher in AF patients with COPD (Odds ratio (OR): 1.84; 95% CI: 1.58, 2.14; p<0.00001). CONCLUSION COPD has a deleterious impact on AF progression in terms of overall mortality, cardiovascular death, stroke and hemorrhagic complications.
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Affiliation(s)
- Jiale Ye
- Department of respiratory and critical care medicine, Huzhou Central Hospital, Affiliated Central Hospital HuZhou University, Huzhou City, Zhejiang Province 313000, P.R China
| | - Pingli Yao
- Department of respiratory and critical care medicine, Huzhou Central Hospital, Affiliated Central Hospital HuZhou University, Huzhou City, Zhejiang Province 313000, P.R China
| | - Xuefei Shi
- Department of respiratory and critical care medicine, Huzhou Central Hospital, Affiliated Central Hospital HuZhou University, Huzhou City, Zhejiang Province 313000, P.R China
| | - Xiaojun Yu
- Department of critical care medicine, Huzhou Central Hospital, Affiliated Central Hospital HuZhou University, Huzhou City, Zhejiang Province 313000, PR China.
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7
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Heijman J, Luermans JGLM, Linz D, van Gelder IC, Crijns HJGM. Risk Factors for Atrial Fibrillation Progression. Card Electrophysiol Clin 2021; 13:201-209. [PMID: 33516398 DOI: 10.1016/j.ccep.2020.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Atrial fibrillation is a chronic, progressive condition that presents a major health burden. This review summarizes recent studies assessing atrial fibrillation progression and its associated risk factors, describes the mechanisms underlying atrial fibrillation progression, and discusses the clinical implications of the progressive nature of atrial fibrillation. Progression of atrial fibrillation burden, and clinical progression from paroxysmal to more advanced (persistent/permanent) forms is common, but progression rates are variable. Atrial fibrillation progression parallels progressive atrial remodeling induced by atrial fibrillation risk factors and atrial fibrillation itself, and is associated with worse clinical outcomes.
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Affiliation(s)
- Jordi Heijman
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center+, PO Box 5800, Maastricht 6202 AZ, The Netherlands. https://twitter.com/JordiHeijman
| | - Justin G L M Luermans
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center+, PO Box 5800, Maastricht 6202 AZ, The Netherlands. https://twitter.com/JLuermans
| | - Dominik Linz
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center+, PO Box 5800, Maastricht 6202 AZ, The Netherlands. https://twitter.com/Dominik_Linz
| | - Isabelle C van Gelder
- Department of Cardiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, Groningen 9700 RB, The Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center+, PO Box 5800, Maastricht 6202 AZ, The Netherlands.
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8
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Yeh JJ, Yang YC, Hsu CY, Kao CH. Effect of Bronchodilator and Steroid Use on Heart Disease and Stroke Risks in a Bronchiectasis-Chronic Obstructive Pulmonary Disease Overlap Cohort: A Propensity Score Matching Study. Front Pharmacol 2019; 10:1409. [PMID: 31849665 PMCID: PMC6895570 DOI: 10.3389/fphar.2019.01409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 11/05/2019] [Indexed: 01/14/2023] Open
Abstract
Background: To determine the effects of bronchodilator, steroid, and anti-arrhythmia drug use on the risk of heart disease/stroke (HDS) in patients with bronchiectasis–chronic obstructive pulmonary disease overlap syndrome (BCOS). Methods: We retrospectively enrolled patients with BCOS (BCOS cohort, n = 1,493) and patients without bronchiectasis and chronic obstructive pulmonary disease (COPD) (non-BCOS cohort, n = 5,972). The cumulative incidence of HDS was analyzed through Cox proportional regression. We calculated adjusted hazard ratios (aHRs) and their 95% confidence intervals (CIs) for HDS after adjustments for sex, age, comorbidities, long-acting β2-agonist or long-acting muscarinic antagonist (LABAs/LAMAs) use, short-acting β2-agonist or short-acting muscarinic antagonist (SABAs/SAMAs) use, oral steroid (OSs) or inhaled corticosteroid steroid (ICSs) use, and anti-arrhythmia drugs use. Results: The aHR (95% CI) for HDS was 1.08 (0.28–4.06) for patients using LAMAs compared with those not using drugs. Regarding drug use days, the aHRs (95% CIs) were 32.2 (1.79–773.0), 1.85 (1.01–3.39), and 31.1 (3.25–297.80) for those with recent SABAs use, past ICSs use, and past anti-arrythmia drugs use, respectively. Regarding cumulative drug dose, the aHRs (95% CIs) were 2.12 (1.46–3.10), 3.48 (1.13–10.6), 3.19 (2.04–4.99), 28.1 (1.42–555.7), 2.09 (1.32–3.29), 2.28 (1.53–3.40), and 1.93 (1.36–2.74) for those with a low dose of SABAs, medium dose of SABAs, low dose of SAMAs, low dose of ICSs, medium dose of ICSs, low dose of OSs, and medium dose of OSs, respectively. Conclusions: Compared with patients without bronchiectasis and COPD, BCOS patients with recent SABAs, past ICSs, and past anti-arrhythmia drugs use; a low or medium SABAs ICSs, and OSs dose; and a low SAMAs dose had a higher risk of HDS. LAMAs were not associated with HDS.
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Affiliation(s)
- Jun-Jun Yeh
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.,Department of Early Childhood Education and Nursery, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Yu-Cih Yang
- College of Medicine, China Medical University, Taichung, Taiwan.,Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chung Y Hsu
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Nuclear Medicine, China Medical University Hospital, Taichung, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.,Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan
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9
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Abdullah AS, Eigbire G, Ali M, Awadalla M, Wahab A, Ibrahim H, Salama A, Alweis R. Relationship of Atrial Fibrillation to Outcomes in Patients Hospitalized for Chronic Obstructive Pulmonary Disease Exacerbation. J Atr Fibrillation 2019; 12:2117. [PMID: 32002109 DOI: 10.4022/jafib.2117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/14/2019] [Accepted: 02/26/2019] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Chronic Obstructive Pulmonary Disease (COPD) is a major cause of hospitalization and is associated with an increased incidence of atrial fibrillation (AF). The impact of AF on in-hospital outcomes, including mortality, in patients hospitalized for COPD exacerbation is not well elucidated. METHODS We used the National Inpatient Sample database to examine discharges with the primary diagnosis of COPD exacerbation and compared mortality, length of stay and costs in patients with AF compared to those without AF. The study adjusted the outcomes for known cardiovascular risk factors and confounders using logistic regression and propensity score matching analysis. RESULTS Among 1,377,795 discharges with COPD exacerbation, 16.6% had AF. Patients with AF were older and had more comorbidities. Mortality was higher (2.4%) in the AF group than in the no AF group (1%), p <0.001. After adjustment to age, sex and confounders, AF remained an independent predictor for mortality, OR:1.44 (95% CI 133 - 1.56, p <0.001), prolonged length of stay, OR:1.63 (95% CI 1.57 - 1.69, p <0.001) and increased cost, OR: 1.45 (95% CI: 1.40 - 1.49, p <0.001). CONCLUSIONS among patients with COPD exacerbation, AF was associated with increased mortality and higher resource utilization.
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Affiliation(s)
| | - George Eigbire
- Department of Cardiology - Louisiana State University, New Orleans, LA
| | - Mohamed Ali
- Department of Cardiology - Royal Victoria Hospital, Blackpool, UK
| | - Mohanad Awadalla
- Department of Medicine - University of Massachusetts Memorial Medical Center, Worcester, MA
| | - Abdul Wahab
- Department of Medicine - Unity Hospital - Rochester Regional Health, Rochester, NY
| | - Hisham Ibrahim
- Department of Cardiology - University of Iowa, Iowa City, IA
| | - Amr Salama
- Department of Medicine - Unity Hospital - Rochester Regional Health, Rochester, NY
| | - Richard Alweis
- Department of Medicine - Unity Hospital - Rochester Regional Health, Rochester, NY.,Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY.,School of Health Sciences, Rochester Institute of Technology, Rochester, NY
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10
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Angeli F, Reboldi G, Trapasso M, Aita A, Ambrosio G, Verdecchia P. Detrimental Impact of Chronic Obstructive Pulmonary Disease in Atrial Fibrillation: New Insights from Umbria Atrial Fibrillation Registry. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E358. [PMID: 31324041 PMCID: PMC6681215 DOI: 10.3390/medicina55070358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/25/2019] [Accepted: 07/03/2019] [Indexed: 11/16/2022]
Abstract
Background and objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Among extra-pulmonary manifestations of COPD, atrial fibrillation (AF) is commonly observed in clinical practice. The coexistence of COPD and AF significantly affects the risk of cardiovascular morbidity and mortality. Nonetheless, the mechanisms explaining the increased risk of vascular events and death associated to the presence of COPD in AF are complex and not completely understood. We analyzed data from an Italian network database to identify markers and mediators of increased vascular risk among subjects with AF and COPD. Materials and Methods: Cross-sectional analysis of the Umbria Atrial Fibrillation (Umbria-FA) Registry, a multicenter, observational, prospective on-going registry of patients with non-valvular AF. Of the 2205 patients actually recruited, 2159 had complete clinical data and were included in the analysis. Results: the proportion of patients with COPD was 15.6%. COPD patients had a larger proportion of permanent AF when compared to the control group (49.1% vs. 34.6%, p < 0.0001) and were more likely to be obese and current smokers. Other cardiovascular risk factors including chronic kidney disease (CKD), peripheral artery disease and subclinical atherosclerosis were more prevalent in COPD patients (all p < 0.0001). COPD was also significantly associated with higher prevalence of previous vascular events and a history of anemia (all p < 0.0001). The thromboembolic and bleeding risk, as reflected by the CHA2DS2VASc and HAS-BLED scores, were higher in patients with COPD. Patients with COPD were also more likely to have left ventricular (LV) hypertrophy at standard ECG than individuals forming the cohort without COPD (p = 0.018). Conclusions: AF patients with COPD have a higher risk of vascular complications than AF patients without this lung disease. Our analysis identified markers and mediators of increased risk that can be easily measured in clinical practice, including LV hypertrophy, CKD, anemia, and atherosclerosis of large arteries.
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Affiliation(s)
- Fabio Angeli
- Division of Cardiology and Cardiovascular Pathophysiology, Hospital S. Maria della Misericordia, 06156 Perugia, Italy.
| | | | - Monica Trapasso
- Department of Medicine, University of Perugia, 06156 Perugia, Italy
| | - Adolfo Aita
- Fondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria Della Misericordia, 06156 Perugia, Italy
| | - Giuseppe Ambrosio
- Division of Cardiology and Cardiovascular Pathophysiology, Hospital S. Maria della Misericordia, 06156 Perugia, Italy
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria Della Misericordia, 06156 Perugia, Italy
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11
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Tomioka T, Fukui K, Tanaka S, Ito Y, Shioiri H, Koyama J, Inoue K. Influence of atrial fibrillation on cardiac prognosis in chronic obstructive pulmonary disease. Indian Heart J 2019; 71:7-11. [PMID: 31000186 PMCID: PMC6477134 DOI: 10.1016/j.ihj.2018.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/15/2018] [Accepted: 11/04/2018] [Indexed: 01/22/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD), a known risk factor for the development of congestive heart failure (CHF), was recently shown to predict the prevalence of atrial fibrillation (AF). Here, we explore the influence of AF on cardiac prognosis in COPD patients. Methods A total of 339 consecutive patients who underwent spirometry from 2010 to 2013 for various reasons were retrospectively examined. Based on the diagnostic criteria, patients were stratified into COPD and non-COPD groups, which were both further divided into those with AF (chronic AF or paroxysmal AF) or sinus rhythm (SR) based on previous electrocardiography results. Significances of differences in cardiac events were assessed by the chi-square test. Multivariate logistic regression analyses and Cox proportional hazard models were applied to evaluate the influence of AF on cardiac events. Results Of the 339 patients, 190 were diagnosed with COPD, with 42 of these were having AF. During the mean follow-up period of 7.4 ± 0.8 years, CHF developed more frequently in COPD patients with AF than in COPD patients without AF [50% vs 7%; odds ratio (OR) 12.4, 95% confidence interval (CI): 5.25–29.49, p < 0.05]. AF was an independent predictor of CHF development (OR 20.4, 95% CI: 6.55–79.80, p < 0.05) and cardiac mortality (OR 2.8, 95% CI: 1.79–4.72, p < 0.05). Moreover, positive correlations were found between the severity of pulmonary obstruction with AF and CHF development (R = 0.69, p < 0.05), as well as cardiac mortality (R = 0.78.p < 0.05). Conclusions These results suggest that AF may be strongly associated with cardiac mortality and CHF in COPD patients.
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Affiliation(s)
- Tomoko Tomioka
- Department of Cardiology, South-Miyagi Medical Center, Japan.
| | - Kento Fukui
- Department of Cardiology, South-Miyagi Medical Center, Japan
| | - Shuhei Tanaka
- Department of Cardiology, South-Miyagi Medical Center, Japan
| | - Yoshitaka Ito
- Department of Cardiology, South-Miyagi Medical Center, Japan
| | - Hiroki Shioiri
- Department of Cardiology, South-Miyagi Medical Center, Japan
| | - Jiro Koyama
- Department of Cardiology, South-Miyagi Medical Center, Japan
| | - Kanichi Inoue
- Department of Cardiology, South-Miyagi Medical Center, Japan
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Ultimo S, Zauli G, Martelli AM, Vitale M, McCubrey JA, Capitani S, Neri LM. Cardiovascular disease-related miRNAs expression: potential role as biomarkers and effects of training exercise. Oncotarget 2018; 9:17238-17254. [PMID: 29682219 PMCID: PMC5908320 DOI: 10.18632/oncotarget.24428] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 01/20/2018] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular diseases (CVDs) are one of the most important causes of mortality worldwide, therefore the need of effective preventive strategies is imperative. Aging is associated with significant changes in both cardiovascular structure and function that lower the threshold for clinical signs and symptoms, making older people more susceptible to CVDs morbidity and mortality. microRNAs (miRNAs) modulate gene expression at post-transcriptional level and increasing evidence has shown that miRNAs are involved in cardiovascular physiology and in the pathogenesis of CVDs. Physical activity is recommended by the medical community and the cardiovascular benefits of exercise are multifactorial and include important systemic effects on skeletal muscle, the peripheral vasculature, metabolism, and neuroendocrine systems, as well as beneficial modifications within the myocardium itself. In this review we describe the role of miRNAs and their dysregulation in several types of CVDs. We provide an overview of miRNAs in CVDs and of the effects of physical activity on miRNA regulation involved in both cardiovascular pathologies and age-related cardiovascular changes and diseases. Circulating miRNAs in response to acute and chronic sport exercise appear to be modulated following training exercise, and may furthermore serve as potential biomarkers for CVDs and different age-related CVDs.
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Affiliation(s)
- Simona Ultimo
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Giorgio Zauli
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Alberto M Martelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marco Vitale
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,CoreLab, Azienda Ospedaliero, Universitaria di Parma, Parma, Italy
| | - James A McCubrey
- Department of Microbiology and Immunology, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Silvano Capitani
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Luca M Neri
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
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RISK FACTORS AND COMORBIDITY IN PATIENTS WITH ATRIAL FIBRILLATION AND ISCHEMIC HEART DISEASE. EUREKA: HEALTH SCIENCES 2018. [DOI: 10.21303/2504-5679.2018.00553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of the study was to evaluate the risk factors and the incidence of comorbidity in patients with coronary heart disease, depending on the presence of atrial fibrillation.
Materials and methods of research: a retrospective analysis of 222 stories of illnesses of patients with coronary heart disease who undergo inpatient treatment, aged from 39 to 88 years, has been conducted. Depending on the presence of atrial fibrillation, all patients were divided into 2 groups: group 1 (main) - patients with ischemic heart disease with atrial fibrillation (n = 105), group 2 (comparison) - patients with ischemic heart disease without atrial fibrillation (n = 117).
Results. In the group of patients without AF, the proportion of persons with inherited exacerbations of IHD was 64.29 %, while in the main group - 25.0 %, the differences did not reach the statistically significant level, but this relationship is confirmed by the results of the rank correlation analysis - between the presence AP and heredity revealed a significant weak feedback - c=-0.21 (p<0.05). The diseases that were observed in the examined patients with coronary artery disease present acute violation of cerebral circulation, angina pectoris, acute myocardial infarction, hypertension, diabetes, pathology of the kidneys and the thyroid gland, diastolic dysfunction and obesity. The groups differed in the proportion of patients with stroke - in the group with AF, it was significantly (p=0.002) higher - 23.81 %, in compare to 8.55 % in the comparison group.
Conclusions: The presence of atrial fibrillation in patients with coronary heart disease is associated with a high degree of comorbidity. First of all, with the combination of IHD and atrial fibrillation, a high incidence of hypertension, diabetes mellitus, obesity, acute cerebrovascular disorder, kidney disease and thyroid gland is established.
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