1
|
Kikuko IH, Julario R, Puspitasari AN, Intan RE, Azmi Y, Nisa’i Fatimah F, Savitri CG, Firmanda DR, Suhandoko LP, Fildzah Dini AS. ECG abnormality and predictor of new-onset atrial fibrillation in hypertension and diabetes mellitus population: An observational analytic study from cardiovascular outpatient clinic at a National Cardiovascular Center in Indonesia. J Arrhythm 2023; 39:860-867. [PMID: 38045447 PMCID: PMC10692857 DOI: 10.1002/joa3.12938] [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: 01/10/2023] [Revised: 08/16/2023] [Accepted: 09/14/2023] [Indexed: 12/05/2023] Open
Abstract
Background Population-based studies have also found that diabetes mellitus (DM) and hypertension (HT) are independent risk factors for atrial fibrillation (AF). However, less is known about new-onset atrial fibrillation (NOAF) risk factors and its correlation with DM and HT. The aim of this study was to determine the prevalence and pattern of ECG abnormalities, and the predictor of NOAF in patients with HT and DM. Methods This cross-sectional study was conducted at a tertiary hospital from May until December 2021. All medical record data from outpatients who had both diagnoses HT and DM were included in this study. Data from patients with unstable hemodynamics and lack of complete medical record data were excluded. Then, patient history, medical records, ECG, and laboratory information were reviewed. Results There were 162 patients included in this study. Arrhythmia was found in 14.2% of the population, with new-onset AF (NOAF) as the most common finding with 8.6% incidence, followed by PVC (3.1%) and PAC (2.5%). Bivariate analysis showed that valvular heart disease, random blood glucose, LVEF, and infection status were associated with a higher incidence of NOA. Model from multivariate logistic regression showed that valvular heart disease and random blood glucose level were independently correlated with NOAF (p = .009). Conclusion It can be concluded that random blood glucose level at a certain point and valvular heart disease can be used as a risk predictor of NOAF in the hypertension population with concomitant DM.
Collapse
Affiliation(s)
- Irawati Hajar Kikuko
- Department of Cardiology and Vascular Medicine, Faculty of MedicineAirlangga University, Dr. Soetomo General HospitalSurabayaIndonesia
| | - Rerdin Julario
- Department of Cardiology and Vascular Medicine, Faculty of MedicineAirlangga University, Dr. Soetomo General HospitalSurabayaIndonesia
| | - A’rofah Nurlina Puspitasari
- Department of Cardiology and Vascular Medicine, Faculty of MedicineAirlangga University, Dr. Soetomo General HospitalSurabayaIndonesia
| | - Ryan Enast Intan
- Department of Cardiology and Vascular Medicine, Faculty of MedicineAirlangga University, Dr. Soetomo General HospitalSurabayaIndonesia
| | - Yusuf Azmi
- Department of Cardiology and Vascular Medicine, Faculty of MedicineAirlangga University, Dr. Soetomo General HospitalSurabayaIndonesia
| | - Fahrun Nisa’i Fatimah
- Department of Cardiology and Vascular Medicine, Faculty of MedicineAirlangga University, Dr. Soetomo General HospitalSurabayaIndonesia
| | - Cornelia Ghea Savitri
- Department of Cardiology and Vascular Medicine, Faculty of MedicineAirlangga University, Dr. Soetomo General HospitalSurabayaIndonesia
| | - Dwika Rasyid Firmanda
- Department of Cardiology and Vascular Medicine, Faculty of MedicineAirlangga University, Dr. Soetomo General HospitalSurabayaIndonesia
| | - Lidya Pertiwi Suhandoko
- Department of Cardiology and Vascular Medicine, Faculty of MedicineAirlangga University, Dr. Soetomo General HospitalSurabayaIndonesia
| | - Atikah S. Fildzah Dini
- Department of Cardiology and Vascular Medicine, Faculty of MedicineAirlangga University, Dr. Soetomo General HospitalSurabayaIndonesia
| |
Collapse
|
2
|
Gumprecht J, Lip GYH, Sokal A, Średniawa B, Stokwiszewski J, Zdrojewski T, Rutkowski M, Grodzicki T, Kaźmierczak J, Opolski G, Kalarus Z. Impact of diabetes mellitus severity, treatment regimen and glycaemic control on atrial fibrillation prevalence in the Polish population aged ≥ 65. Sci Rep 2023; 13:17252. [PMID: 37828071 PMCID: PMC10570325 DOI: 10.1038/s41598-023-43939-5] [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: 03/06/2023] [Accepted: 09/30/2023] [Indexed: 10/14/2023] Open
Abstract
Diabetes mellitus (DM) is a well-known risk factor for atrial fibrillation (AF), but the mechanism(s) by which DM affects AF prevalence remains unclear. This study aims to evaluate the impact of diabetes mellitus severity (expressed as its known duration), antihyperglycemic treatment regimen and glycaemic control on AF prevalence. From the representative sample of 3014 participants (mean age 77.5, 49.1% female) from the cross-sectional NOMED-AF study, 881 participants (mean age 77.6 ± 0.25, 46.4% female) with concomitant DM were involved in the analysis. AF was screened using a telemonitoring vest for a mean of 21.9 ± 9.1 days. The mean DM duration was 12 ± 0.35 years, but no significant impact of DM timespan on AF prevalence was observed. No differences in the treatment pattern (oral medication vs insulin vs both oral + insulin) among the study population with and without AF were shown (p = 0.106). Metabolic control reflected by HbA1c levels showed no significant association with AF and silent AF prevalence (p = 0.635; p = 0.094). On multivariate analyses, age (Odds Ratio (OR) 1.35, 95%CI: 1.18-1.53, p < 0.001), p = 0.042), body mass index (BMI; OR 1.043, 95%CI: 1.01-1.08, p = 0.027) and LDL < 100 mg/dl (OR 0.64, 95%CI: 0.42-0.97, p = 0.037) were independent risk factors for AF prevalence, while age (OR 1.45, 95%CI: 1.20-1.75, p < 0.001), LDL < 100 mg/dl (OR 0.43, 95%CI 0.23-0.82, p = 0.011), use of statins (OR 0.51, 95%CI: 0.28-0.94, p = 0.031) and HbA1c ≤ 6.5 (OR 0.46, 95%CI: 0.25-0.85, p = 0.013) were associated with silent AF prevalence. Diabetes duration, diabetic treatment pattern or metabolic control per se did not significantly impact the prevalence of AF, including silent AF detected by prospective continuous monitoring. Independent predictors of AF were age, BMI and low LDL levels, with statins and HbA1c ≤ 6.5 being additional independent predictors for silent AF.Trial registration: NCT03243474.
Collapse
Affiliation(s)
- Jakub Gumprecht
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
- Department of Cardiology, Silesian Centre for Heart Diseases, Zabrze, Poland.
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Cardiology, DMS in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Adam Sokal
- Department of Cardiology, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Beata Średniawa
- Department of Cardiology, DMS in Zabrze, Medical University of Silesia, Katowice, Poland
- Department of Cardiology, Silesian Centre for Heart Diseases, Zabrze, Poland
- Silesian Park of Medical Technology Kardio-Med Silesia in Zabrze, Zabrze, Poland
| | | | - Tomasz Zdrojewski
- Department of Preventive Medicine and Education, Medical University of Gdańsk, Gdańsk, Poland
| | - Marcin Rutkowski
- Department of Preventive Medicine and Education, Medical University of Gdańsk, Gdańsk, Poland
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | | | - Grzegorz Opolski
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Zbigniew Kalarus
- Department of Cardiology, DMS in Zabrze, Medical University of Silesia, Katowice, Poland
- Department of Cardiology, Silesian Centre for Heart Diseases, Zabrze, Poland
- Silesian Park of Medical Technology Kardio-Med Silesia in Zabrze, Zabrze, Poland
| |
Collapse
|
3
|
Bouchlarhem A, Haddar L, Nasri S, Onci-Es-Saad, Kallel O, Bkiyar H, Ismaili N, Skiker I, Housni B. Brainstem stroke: A fatal thromboembolic event after new onset atrial fibrillation during covid-19 infection: A case report and literature review. Radiol Case Rep 2021; 16:3244-3249. [PMID: 34377221 PMCID: PMC8343382 DOI: 10.1016/j.radcr.2021.07.090] [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] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 12/23/2022] Open
Abstract
Coronavirus disease (COVID-19) disease is a serious pandemic that put the world on an exceptional sanitary alert. It is a multifaceted disease, since it can affect the lung, the cardiovascular system and the central nervous system at the same time. A 66-year-old man, diabetic, hypertensive, admitted to the emergency room for medical management of acute dyspnea, diagnosed with COVID-19 infection. The evolution is marked by respiratory distress as well as new onset atrial fibrillation and a severe ischemic stroke of the brainstem. COVID-19 disease is associated with very serious thromboembolic complications of high incidence, and this is explained by the coagulopathy secondary to the alteration of the microcirculation after the hyper-inflammatory state. Ischemic stroke is one of these complications. The occurrence of new onset atrial fibrillation during COVID-19 infection makes the incidence of ischemic stroke very high and the prognosis more severe. The treatment is mainly based on antithrombotic therapy. Thromboembolic complications remain a real problem to manage in COVID-19 patients given the several mechanisms that promote this situation.
Collapse
Key Words
- ACE, Angiotensin Converting Enzyme
- BMI, Body Mass Index
- BP, Blood Pressure
- Brainstem
- CRP, C-Reactive Protein
- CT, Computed Tomography
- Coagulopathy
- Coronavirus
- Covid-19
- GCS, Glasgow Coma Scale
- HR, Heart Rate
- MRI, Magnetic Resonance Imaging
- Mechanical Thrombectomy
- NIHSS, National Institutes Of Health Stroke Scale
- New onset atrial fibrillation
- RF, Respiratory Frequency
- RT-PCR, Reverse Transcription Polymerase Chain Reaction
- Stroke
Collapse
Affiliation(s)
- Amine Bouchlarhem
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Anesthesiology and Intensive Care Unit, Mohammed VI University Hospital Mohammed I University Oujda, Morocco
| | - Leila Haddar
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Anesthesiology and Intensive Care Unit, Mohammed VI University Hospital Mohammed I University Oujda, Morocco
| | - Siham Nasri
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Radiology, Mohammed VI University Hospital Mohammed I University Oujda, Morocco
| | - Onci-Es-Saad
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Anesthesiology and Intensive Care Unit, Mohammed VI University Hospital Mohammed I University Oujda, Morocco
| | - Ossema Kallel
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Cardiology, Mohammed VI University Hospital Mohammed I University Oujda, Morocco
| | - Houssam Bkiyar
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Anesthesiology and Intensive Care Unit, Mohammed VI University Hospital Mohammed I University Oujda, Morocco
| | - Nabila Ismaili
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Cardiology, Mohammed VI University Hospital Mohammed I University Oujda, Morocco
| | - Imane Skiker
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Radiology, Mohammed VI University Hospital Mohammed I University Oujda, Morocco
| | - Brahim Housni
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Anesthesiology and Intensive Care Unit, Mohammed VI University Hospital Mohammed I University Oujda, Morocco
| |
Collapse
|
4
|
Homan EA, Reyes MV, Hickey KT, Morrow JP. Clinical Overview of Obesity and Diabetes Mellitus as Risk Factors for Atrial Fibrillation and Sudden Cardiac Death. Front Physiol 2019; 9:1847. [PMID: 30666210 PMCID: PMC6330323 DOI: 10.3389/fphys.2018.01847] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 12/07/2018] [Indexed: 12/22/2022] Open
Abstract
The epidemics of obesity and diabetes mellitus are associated with an increased incidence of both atrial fibrillation (AF), the most common sustained arrhythmia in adults, and sudden cardiac death (SCD). Obesity and DM are known to have adverse effects on cardiac structure and function. The pathologic mechanisms are thought to involve cardiac tissue remodeling, metabolic dysregulation, inflammation, and oxidative stress. Clinical data suggest that left atrial size, epicardial fat pad thickness, and other modifiable risk factors such as hypertension, glycemic control, and obstructive sleep apnea may mediate the association with AF. Data from human atrial tissue biopsies demonstrate alterations in atrial lipid content and evidence of mitochondrial dysfunction. With respect to ventricular arrhythmias, abnormalities such as long QT syndrome, frequent premature ventricular contractions, and left ventricular hypertrophy with diastolic dysfunction are commonly observed in obese and diabetic humans. The increased risk of SCD in this population may also be related to excessive cardiac lipid deposition and insulin resistance. While nutritional interventions have had limited success, perhaps due to poor long-term compliance, weight loss and improved cardiorespiratory fitness may reduce the frequency and severity of AF.
Collapse
Affiliation(s)
- Edwin A Homan
- Columbia University Medical Center, New York, NY, United States
| | - Michael V Reyes
- Columbia University Medical Center, New York, NY, United States
| | | | - John P Morrow
- Columbia University Medical Center, New York, NY, United States
| |
Collapse
|
5
|
Feng L, Naheed A, de Silva HA, Jehan I, Raqib R, Islam MT, Luke N, Kasturiratne A, Farazdaq H, Senan S, Jafar TH. Regional Variation in Comorbid Prediabetes and Diabetes and Associated Factors among Hypertensive Individuals in Rural Bangladesh, Pakistan, and Sri Lanka. J Obes 2019; 2019:4914158. [PMID: 31183214 PMCID: PMC6515018 DOI: 10.1155/2019/4914158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/16/2019] [Indexed: 11/17/2022] Open
Abstract
We aimed to explore the cross-country variation in the prevalence of comorbid prediabetes or diabetes and determine the sociodemographic, lifestyle, and clinical factors, especially body mass index (BMI) and waist circumference, associated with comorbid diabetes in individuals with hypertension in rural South Asia. We analyzed cross-sectional data of 2426 hypertensive individuals of ≥40 years from 30 randomly selected rural communities in Bangladesh, Pakistan, and Sri Lanka. Prediabetes was defined as fasting plasma glucose (FPG) between 100 and 125 mg/dL without use of antidiabetic treatment and diabetes as FPG ≥126 mg/dL or use of antidiabetic medication. The prevalence (95% CI) of prediabetes or diabetes (53.5% (51.5%, 55.5%)) and diabetes (27.7% (25.9%, 29.5%)) was high in the overall hypertensive study population in rural communities in 3 countries. Rural communities in Sri Lanka had the highest crude prevalence of prediabetes or diabetes and diabetes (73.1% and 39.3%) with hypertension, followed by those in Bangladesh (47.4% and 23.1%) and Pakistan (39.2% and 20.5%). The factors independently associated with comorbid diabetes and hypertension were residing in rural communities in Sri Lanka, higher education, international wealth index, waist circumference, pulse pressure, triglyceride, and lower high-density lipoprotein. The association of diabetes with waist circumference was stronger than with BMI in hypertensive individuals. Prediabetes or diabetes are alarmingly common among adults with hypertension and vary among countries in rural South Asia. The high prevalence of comorbid diabetes in Sri Lanka among hypertensives is not fully explained by conventional risk factors and needs further etiological research. Urgent public health efforts are needed to integrate diabetes control within hypertension management programs in rural South Asia, including screening waist circumference.
Collapse
Affiliation(s)
- Liang Feng
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Aliya Naheed
- Initiative for Non-Communicable Diseases, Health Systems and Population Studies Division, icddr, b, Dhaka, Bangladesh
| | - H. Asita de Silva
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Imtiaz Jehan
- Department of Community Health Science, Aga Khan University, Karachi, Pakistan
| | - Rubhana Raqib
- Immunobiology, Nutrition and Toxicology Laboratory, Infectious Diseases Division, icddr, b, Dhaka, Bangladesh
| | - Md Tauhidul Islam
- Initiative for Non-Communicable Diseases, Health Systems and Population Studies Division, icddr, b, Dhaka, Bangladesh
| | - Nathasha Luke
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Anuradhani Kasturiratne
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Hamida Farazdaq
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan
| | - Sahar Senan
- Department of Community Health Science, Aga Khan University, Karachi, Pakistan
| | - Tazeen H. Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Renal Medicine, Singapore General Hospital, Singapore
- Duke Global Health Institute, Duke University, Durham, NC, USA
| |
Collapse
|
6
|
Antihyperglycemic drugs use and new-onset atrial fibrillation: A population-based nested case control study. PLoS One 2018; 13:e0197245. [PMID: 30161122 PMCID: PMC6116917 DOI: 10.1371/journal.pone.0197245] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 04/30/2018] [Indexed: 12/19/2022] Open
Abstract
Currently, the potential risk of atrial fibrillation associated with antihyperglycemic drug use has been a topic of considerable interest. However, it remains uncertain whether different classes of antihyperglycemic drug therapy are associated with the risk of atrial fibrillation risk. Here, we investigated the association between different classes of antihyperglycemic drugs and new-onset atrial fibrillation (NAF). A case-matched study was performed based on the National Health Insurance Program in Taiwan. Patients who had NAF were considered the NAF group and were matched in a 1:4 ratio with patients without NAF, who were assigned to the non-NAF group. Patients were matched according to sex, age, diabetes mellitus duration, index date, and Charlson Comorbidity Index score. We used multivariate logistic regression controlling for potential confounders to examine the association between different classes of antihyperglycemic drug use and the risk of NAF. Overall, we identified 2,882 cases and 11,528 matched controls for the study. After adjusting for sex, age, comorbidities, and concurrent medications, users of biguanides or thiazolidinediones were at a lower risk of developing NAF when compared with non-users (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.71–0.95 and OR 0.72, 95% CI 0.63–0.83, respectively). In contrast, users of insulin were at a higher risk of developing NAF than were non-users (OR 1.19, 95% CI 1.06–1.35). Sulfonylureas, glinides, α-glucosidase inhibitors, and dipeptidyl peptidase-4 inhibitors were not associated with developing the risk of NAF. In conclusion, the use of biguanides or thiazolidinediones may be associated with a low risk of NAF, whereas insulin may be associated with a significant increase in the risk of NAF in patients with type 2 diabetes mellitus during long-term follow-up. Further prospective randomized studies should investigate which specific class of antihyperglycemic drug treatment for diabetes mellitus can prevent or postpone NAF.
Collapse
|
7
|
Xiong Z, Liu T, Tse G, Gong M, Gladding PA, Smaill BH, Stiles MK, Gillis AM, Zhao J. A Machine Learning Aided Systematic Review and Meta-Analysis of the Relative Risk of Atrial Fibrillation in Patients With Diabetes Mellitus. Front Physiol 2018; 9:835. [PMID: 30018571 PMCID: PMC6037848 DOI: 10.3389/fphys.2018.00835] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/13/2018] [Indexed: 01/19/2023] Open
Abstract
Background: Meta-analysis is a widely used tool in which weighted information from multiple similar studies is aggregated to increase statistical power. However, the exponential growth of publications in key areas of medical science has rendered manual identification of relevant studies increasingly time-consuming. The aim of this work was to develop a machine learning technique capable of robust automatic study selection for meta-analysis. We have validated this approach with an up-to-date meta-analysis to investigate the association between diabetes mellitus (DM) and new-onset atrial fibrillation (AF). Methods: The PubMed online database was searched from 1960 to September 2017 where 4,177 publications that mentioned both DM and AF were identified. Relevant studies were selected as follows. First, publications were clustered based on common text features using an unsupervised K-means algorithm. Clusters that best matched the selected set of potentially relevant studies (a "training" set of 139 articles) were then identified by using maximum entropy classification. The 139 articles selected automatically on this basis were screened manually to identify potentially relevant studies. To determine the validity of the automated process, a parallel set of studies was also assembled by manually screening all initially searched publications. Finally, detailed manual selection was performed on the full texts of the studies in both sets using standard criteria. Quality assessment, meta-regression random-effects models, sensitivity analysis and publication bias assessment were then conducted. Results: Machine learning-assisted screening identified the same 29 studies for meta-analysis as those identified by using manual screening alone. Machine learning enabled more robust and efficient study selection, reducing the number of studies needed for manual screening from 4,177 to 556 articles. A pooled analysis using the most conservative estimates indicated that patients with DM had ~49% greater risk of developing AF compared with individuals without DM. After adjusting for three additional risk factors i.e., hypertension, obesity and heart disease, the relative risk was 23%. Using multivariate adjusted models, the risk for developing AF in patients with DM was similar for all DM subtypes. Women with DM were 24% more likely to develop AF than men with DM. The risk for new-onset AF in patients with DM has also increased over the years. Conclusions: We have developed a novel machine learning method to identify publications suitable for inclusion in meta-analysis.This approach has the capacity to provide for a more efficient and more objective study selection process for future such studies. We have used it to demonstrate that DM is a strong, independent risk factor for AF, particularly for women.
Collapse
Affiliation(s)
- Zhaohan Xiong
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Tong Liu
- Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.,Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Tianjin, China
| | - Gary Tse
- Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Mengqi Gong
- Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.,Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Tianjin, China
| | - Patrick A Gladding
- Department of Cardiology, Waitemata District Health Board, Auckland, New Zealand
| | - Bruce H Smaill
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | | | - Anne M Gillis
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Jichao Zhao
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
8
|
Shaikh F, Pasch LB, Newton PJ, Bajorek BV, Ferguson C. Addressing Multimorbidity and Polypharmacy in Individuals With Atrial Fibrillation. Curr Cardiol Rep 2018; 20:32. [PMID: 29574524 DOI: 10.1007/s11886-018-0975-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The objectives of this review were to (1) discuss how multimorbidity and polypharmacy contributes to the complexity of management among individuals with AF and (2) identify any interventions to manage polypharmacy in relation to AF. RECENT FINDINGS Based on the four landmark clinical trials of novel anticoagulants, the most common comorbidities with AF are hypertension, heart failure, diabetes, stroke and myocardial infarction. Polypharmacy was also found prevalent in 76.5% of patients with AF, with a median of six drugs per patient. Despite the consequences of polypharmacy in AF, there is very little evidence-based intervention designed to manage it. Hence, there is a need for further research to examine interventions to manage polypharmacy in relation to AF. Atrial fibrillation (AF) is the most common type of cardiac arrhythmia requiring treatment in adults. Due to the structural and/or electrophysiological abnormalities that occur in AF, patients are managed through the use of prophylactic anticoagulant and rate and/or rhythm control medications. However, these medications are considered high risk and can increase the chances of medication misadventure. Additionally, AF rarely occurs in isolation and is known to coexist with multiple other medical comorbidities, i.e. multimorbidity. This also increases the number of medications, i.e. polypharmacy and pill burden which results in treatment non-compliance to prescribed therapy.
Collapse
Affiliation(s)
- Fahad Shaikh
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, 67 Thomas St, Broadway, Ultimo, 2007, NSW, Australia
| | - Lachlan B Pasch
- Western Sydney Nursing and Midwifery Research Centre, Western Sydney Local Health District and Western Sydney University, Blacktown Clinical and Research School, Blacktown Hospital, Marcel Crescent, Blacktown, NSW, 2148, Australia
| | - Phillip J Newton
- Western Sydney Nursing and Midwifery Research Centre, Western Sydney Local Health District and Western Sydney University, Blacktown Clinical and Research School, Blacktown Hospital, Marcel Crescent, Blacktown, NSW, 2148, Australia
| | - Beata V Bajorek
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, 67 Thomas St, Broadway, Ultimo, 2007, NSW, Australia
| | - Caleb Ferguson
- Western Sydney Nursing and Midwifery Research Centre, Western Sydney Local Health District and Western Sydney University, Blacktown Clinical and Research School, Blacktown Hospital, Marcel Crescent, Blacktown, NSW, 2148, Australia.
| |
Collapse
|
9
|
Clinical significance of nutritional status in patients with atrial fibrillation: An overview of current evidence. J Cardiol 2016; 69:719-730. [PMID: 27520756 DOI: 10.1016/j.jjcc.2016.06.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/26/2016] [Accepted: 06/30/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obesity is a well-known atherosclerosis risk factor; however, its role and the importance of undernutrition in atrial fibrillation (AF) pathogenesis are still not well understood. The aim of this study was to present the current state of knowledge on this issue in different groups of patients. METHODS Systematic review of papers published between 1980 and 2016. RESULTS The literature shows contradicting views regarding the impact of nutritional status on the risk, course, and complications of AF. On the one hand, it has been revealed that overweight, obesity, and high birth mass increase the risk of AF, and that their reduction is linked to an improved course of AF and reduced all-cause and cardiovascular mortality. On the other hand, a so-called obesity paradox has been found, which shows lower all-cause mortality in overweight patients with AF compared to those of normal weight or who are underweight. It has also been shown, although based on a small number of studies, that the relationship between nutritional status and risk of AF and its complication may be U-shaped, which means that not only patients with obesity, but also individuals with underweight, cachexia, and low birth weight may have an increased risk and poor outcome of AF. CONCLUSIONS The relationship between patients' nutritional status and the course of AF has become clearer but it requires further studies examining the importance of weight reduction on AF course.
Collapse
|