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Achkasov E, Bondarev S, Smirnov V, Waśkiewicz Z, Rosemann T, Nikolaidis PT, Knechtle B. Atrial Fibrillation in Athletes-Features of Development, Current Approaches to the Treatment, and Prevention of Complications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4890. [PMID: 31817190 PMCID: PMC6950061 DOI: 10.3390/ijerph16244890] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/04/2019] [Accepted: 11/25/2019] [Indexed: 12/31/2022]
Abstract
Atrial fibrillation (AF) is one of the most common types of cardiac arrhythmias. This review article highlights the problem of the development of atrial fibrillation in individuals engaged in physical activity and sports. Predisposing factors, causes, and development mechanisms of atrial fibrillation in athletes from the perspective of the authors are described. Methods of treatment, as well as prevention of thromboembolic complications, are discussed. Directions for further studies of this problem and prevention of complications are proposed.
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Affiliation(s)
- Evgeny Achkasov
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Russia; (E.A.); (S.B.); (Z.W.)
| | - Sergey Bondarev
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Russia; (E.A.); (S.B.); (Z.W.)
| | - Victor Smirnov
- Department of Hospital Therapy, Saint-Petersburg State Pediatric Medical University Ministry of Health of Russia, Saint Petersburg 194100, Russia;
| | - Zbigniew Waśkiewicz
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Russia; (E.A.); (S.B.); (Z.W.)
- Institute of Sport Science, Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland;
| | | | - Beat Knechtle
- Exercise Physiology Laboratory, 18450 Nikaia, Greece;
- Medbase St. Gallen Am Vadianplatz, 9001 St. Gallen, Switzerland
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Physical Activity and Risk of Atrial Fibrillation: A Nationwide Cohort Study in General Population. Sci Rep 2019; 9:13270. [PMID: 31519947 PMCID: PMC6744571 DOI: 10.1038/s41598-019-49686-w] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/23/2019] [Indexed: 11/15/2022] Open
Abstract
Although exercise prevents cardiovascular disease and mortality, vigorous exercise and endurance athletics can cause atrial fibrillation (AF). However, no large cohort study has assessed the relationship between physical activity and AF in the general population. We assessed the effect of physical activity at different energy expenditures on the incidence of AF. We studied 501,690 individuals without pre-existing AF (mean age, 47.6 ± 14.3 years; 250,664 women [50.0%]) included in the Korean National Health Insurance Service database. The physical activity level was assessed using a standardized self-reported questionnaire at baseline. During a median follow-up of 4 years, 3,443 participants (1,432 women [41.6%]) developed AF. The overall incidence of AF at follow-up was 1.79 per 1,000 person-years. The subjects who met the recommended physical activity level (500–1,000 metabolic equivalent task [MET] minutes/week) had a 12% decreased AF risk (adjusted hazard ratio [HR]: 0.88, 95% confidence interval [CI]: 0.80–0.97), but not the insufficiently (1–500 MET-minutes/week; HR: 0.94, 95% CI: 0.86–1.03) and highly active subjects (≥1,000 MET-minutes/week; HR: 0.93, 95% CI: 0.85–1.03). The recommended minimum key target range of physical activity level was associated with the maximum benefit for reduced AF risk in the general population. The dose-response relationship between physical activity level and AF risk showed a U-shaped pattern. Although exceeding the key target range attenuated this benefit, it did not increase the AF risk beyond that during inactivity.
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Liu X, Guo N, Zhu W, Zhou Q, Liu M, Chen C, Yuan P, Wan R, Hong K. Resting Heart Rate and the Risk of Atrial Fibrillation. Int Heart J 2019; 60:805-811. [PMID: 31204373 DOI: 10.1536/ihj.18-470] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
In a previous meta-analysis, it was demonstrated that the resting heart rate (RHR) is a potential risk factor for atrial fibrillation (AF). However, the results of that meta-analysis were conflicting, and the relationship between the RHR and AF is still not well established. In the current meta-analysis, our aim is to update evidence with a better statistical model. We searched the Cochrane Library, PubMed, and Embase databases for relevant studies and used a "one-stage approach" with a restricted cubic spline model to summarize the dose-specific relationships between the RHR and AF. Relative risk (RR) was used to measure the effects. In total, 10 studies were included, with a total of 18,630 cases of AF among 431,432 participants. In the dose-response analysis, there was evidence of a nonlinear association between the RHR and the risk of AF (nonlinearity, P < 0.0001), which exhibited a significant J-shaped association between the two factors. An RHR between 68 and 80 bpm had the lowest risk of AF. Among people who had RHR < 70 bpm, the summary RR was 1.09 per 10-RHR decrease (95% confidence interval [CI] = 1.06-1.12; P < 0.001). The results were similar for participants with RHR > 70 bpm (per 10 bpm increase) (RR = 1.06, 95% CI = 1.03-1.08; P < 0.001). Our dose-response meta-analysis revealed a significant J-shaped association between the RHR and AF. Both low RHR and high RHR were associated with an increased risk of AF compared with a modest RHR of 68-80 bpm.
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Affiliation(s)
- Xiao Liu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
| | - Ninghong Guo
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
| | - Wengen Zhu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
| | - Quan Zhou
- Department of Science and Education, First People's Hospital of Changde City
| | - Menglu Liu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
| | - Chen Chen
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
| | - Ping Yuan
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
| | - Rong Wan
- Jiangxi Key Laboratory of Molecular Medicine
| | - Kui Hong
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University
- Jiangxi Key Laboratory of Molecular Medicine
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Vazquez-Arce MI, Marques-Sule E. [Descriptive and comparative study of cardiovascular risk factors and physical activity in patients with acute coronary syndrome]. Aten Primaria 2017; 50:576-582. [PMID: 28844478 PMCID: PMC6837138 DOI: 10.1016/j.aprim.2017.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 04/03/2017] [Accepted: 06/05/2017] [Indexed: 11/07/2022] Open
Abstract
Objetivo Analizar diversos factores de riesgo cardiovascular en función de la actividad física realizada en pacientes con síndrome coronario agudo (SCA). Diseño Estudio observacional transversal. Emplazamiento Servicio de prevención cardiovascular hospitalario (Departamento Salud, Valencia, España). Participantes Un total de 401 sujetos con SCA y alta hospitalaria entre 2 y 3 meses previos a la medición, entre 30 y 80 años; ausencia de contraindicación para realizar actividad física; sin participación previa en programas de rehabilitación cardiaca. Mediciones principales Se estimó el equivalente metabólico MET (kcal/kg) según el tipo de actividad, frecuencia, duración e intensidad. La muestra se dividió en 2 grupos: grupo sedentario (consumo < 10 MET/semana) y grupo físicamente activo (≥ 10 MET/semana). Se analizaron diversas variables relacionadas con los factores de riesgo cardiovascular: índice de masa corporal (IMC), perímetro abdominal, perfil lipídico, glucemia y presión arterial. Resultados La actividad física general registró un consumo medio de 8,24 ± 12,5 MET/semana. Los factores prevalentes fueron sobrepeso (77,05%) y dislipemia (64,3%). El 64,8% refirió sedentarismo. El grupo físicamente activo mostró diferencias significativas en relación al grupo no activo en los niveles de triglicéridos (146,53 ± 72,8 vs. 166,94 ± 104,78 mg/dl; IC 95%; p = 0,031) y el IMC (27,65 ± 3,86 vs. 28,50 ± 4,38 kg/m2; IC 95%; p = 0,045). Conclusión Los pacientes con SCA realizaron escasa actividad física, con prevalencia de sobrepeso y dislipemia. Los sujetos físicamente activos mejoraron los niveles de triglicéridos y el índice de masa corporal. Desde atención primaria es necesaria la promoción de la salud mediante el fomento de ejercicio en pacientes con SCA.
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Affiliation(s)
- Maria Isabel Vazquez-Arce
- Servicio de Rehabilitación y Medicina Física, Hospital Universitario y Politécnico La Fe, Universidad San Vicente Mártir, Valencia, España
| | - Elena Marques-Sule
- Departamento de Fisioterapia, Universitat de València, Valencia, España.
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Skielboe AK, Marott JL, Dixen U, Friberg JB, Jensen GB. Occupational physical activity, but not leisure-time physical activity increases the risk of atrial fibrillation: The Copenhagen City Heart Study. Eur J Prev Cardiol 2016; 23:1883-1893. [DOI: 10.1177/2047487316655464] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/30/2016] [Indexed: 11/16/2022]
Affiliation(s)
| | - Jacob L Marott
- Copenhagen City Heart Study, Frederiksberg Hospital, Denmark
| | - Ulrik Dixen
- Department of Cardiology, Hvidovre Hospital, Denmark
| | | | - Gorm B Jensen
- Copenhagen City Heart Study, Frederiksberg Hospital, Denmark
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Zhu WG, Wan R, Din Y, Xu Z, Yang X, Hong K. Sex Differences in the Association Between Regular Physical Activity and Incident Atrial Fibrillation: A Meta-analysis of 13 Prospective Studies. Clin Cardiol 2016; 39:360-7. [PMID: 26997209 DOI: 10.1002/clc.22531] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/29/2016] [Indexed: 01/11/2023] Open
Abstract
Several studies investigated the role of physical activity in atrial fibrillation (AF), but the results remain controversial. We aimed to estimate the association between physical activity and incident AF, as well as to determine whether a sex difference existed. We systematically retrieved relevant studies from Cochrane Library, PubMed, and ScienceDirect through December 1, 2015. Data were abstracted from eligible studies and effect estimates pooled using a random-effects model. Thirteen prospective studies fulfilled inclusion criteria. For primary analysis, neither total physical activity exposure (relative risk [RR]: 0.98, 95% confidence interval [CI]: 0.90-1.06, P = 0.62) nor intensive physical activity (RR: 1.07, 95% CI: 0.93-1.25, P = 0.41) was associated with a significant increased risk of AF. In the country-stratified analysis, the pooled results were not significantly changed. However, in the sex-stratified analysis, total physical activity exposure was associated with an increased risk of AF in men (RR: 1.18, 95% CI: 1.02-1.37), especially at age <50 years (RR: 1.58, 95% CI: 1.28-1.95), with a significantly reduced risk of AF in women (RR: 0.92, 95% CI: 0.87-0.97). Additionally, male individuals with intensive physical activity had a slightly higher (although statistically nonsignificant) risk of developing AF (RR: 1.12, 95% CI: 0.99-1.28), but there was a significantly reduced risk of incident AF in women (RR: 0.92, 95% CI: 0.86-0.98). Published literature supports a sex difference in the association between physical activity and incident AF. Increasing physical activity is probably associated with an increased risk of AF in men and a decreased risk in women.
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Affiliation(s)
- Wen-Gen Zhu
- Cardiovascular Department, Second Affiliated Hospital to Nanchang University, Jiangxi, China
| | - Rong Wan
- Jiangxi Key Laboratory of Molecular Medicine, Jiangxi, China
| | - Ying Din
- Cardiovascular Department, Second Affiliated Hospital to Nanchang University, Jiangxi, China
| | - Zhenyan Xu
- Cardiovascular Department, Second Affiliated Hospital to Nanchang University, Jiangxi, China
| | - Xiaohui Yang
- Cardiovascular Department, Second Affiliated Hospital to Nanchang University, Jiangxi, China
| | - Kui Hong
- Cardiovascular Department, Second Affiliated Hospital to Nanchang University, Jiangxi, China.,Jiangxi Key Laboratory of Molecular Medicine, Jiangxi, China
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Morseth B, Graff-Iversen S, Jacobsen BK, Jørgensen L, Nyrnes A, Thelle DS, Vestergaard P, Løchen ML. Physical activity, resting heart rate, and atrial fibrillation: the Tromsø Study. Eur Heart J 2016; 37:2307-13. [PMID: 26966149 DOI: 10.1093/eurheartj/ehw059] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 01/28/2016] [Indexed: 11/14/2022] Open
Abstract
AIMS The objective was to examine the association of physical activity and resting heart rate (RHR) with hospital-diagnosed atrial fibrillation (AF) in a Norwegian cohort. METHODS AND RESULTS This prospective study included 20 484 adults (50.3% men) who participated in the third Tromsø Study survey in 1986-87. At baseline, physical activity was assessed by a validated questionnaire, and RHR was objectively measured. Participants were followed from baseline through 2010 with respect to incident cases of hospital-diagnosed AF documented on an electrocardiogram. During a mean follow-up period of 20 years (409 045 person-years), 750 participants (70.5% men) were diagnosed with AF. Compared with the low physical activity group, moderately active individuals had a 19% lower risk of any AF [adjusted hazard ratio (HR) 0.81, 95% confidence interval (CI) 0.68-0.97], whereas highly active had similar risk of AF. Vigorously active individuals showed a non-significantly higher risk of AF (adjusted HR 1.37, 95% CI 0.77-2.43). Risk of AF increased with decreasing RHR (adjusted HR 0.92, 95% CI 0.86-0.98 for each 10 b.p.m. increase in RHR), and RHR < 50 b.p.m. was a risk factor for AF (P < 0.05). CONCLUSION In this prospective cohort study, leisure time physical activity was associated with AF in a J-shaped pattern. Moderate physical activity was associated with a reduced risk of AF, whereas higher activity levels attenuated the benefits of moderate activity. Low RHR was a risk factor for AF. Our results support the hypothesis that moderate and vigorous physical activity may affect AF risk via different pathophysiological mechanisms.
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Affiliation(s)
- Bente Morseth
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway School of Sport Sciences, UiT The Arctic University of Norway, 9037 Tromsø, Norway Centre for Clinical Research and Education, University Hospital of North Norway Trust, Tromsø, Norway
| | - Sidsel Graff-Iversen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Bjarne K Jacobsen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Lone Jørgensen
- Department of Health and Care Sciences, University of Tromsø, Tromsø, Norway Department of Clinical Therapeutic Services, University Hospital of Northern Norway, Tromsø, Norway
| | - Audhild Nyrnes
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Dag S Thelle
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway Department of Community Medicine and Public Health, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Peter Vestergaard
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
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8
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[Atrial fibrillation and physical activity. An overview]. Herz 2015; 41:131-7. [PMID: 26407697 DOI: 10.1007/s00059-015-4352-x] [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: 06/16/2015] [Revised: 07/31/2015] [Accepted: 08/09/2015] [Indexed: 10/23/2022]
Abstract
A training-induced increase in vagal tone, left atrial enlargement and high atrial volume load due to exercise can theoretically favor induction and continuation of atrial fibrillation (AF) in (endurance) athletes. However, there is currently no evidence for a higher occurrence of AF in young endurance athletes in comparison to an age-matched normal population. The correlate of long-term endurance training results in proarrhythmogenic atrial remodeling in a rat model. The results of some studies also suggest that there may be atrial remodeling in humans, which might be an explanation for the comparatively higher incidence of AF in veteran athletes, whereby the relative risk might have been overestimated due to methodological problems, e.g. due to insufficient consideration of "new" AF risk factors. To date, there are no indications for an increased risk of AF due to normal physical activity: on the contrary, moderate physical activity seems to decrease the risk for AF. For an individual evaluation of sports participation of patients with AF, the overall cardiac situation, atrioventricular conduction during exercise, a possible oral anticoagulation as well as the sport and training intensity practiced are important. Well-adapted training for patients with AF has to be considered as safe and effective in terms of the overall positive effects of physical activity in patients with cardiovascular problems, for example due to a positive influence on cardiovascular risk factors.
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9
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Physical activity, symptoms, medication and subjective health among veteran endurance athletes with atrial fibrillation. Clin Res Cardiol 2015. [DOI: 10.1007/s00392-015-0898-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Myrstad M, Nystad W, Graff-Iversen S, Thelle DS, Stigum H, Aarønæs M, Ranhoff AH. Effect of years of endurance exercise on risk of atrial fibrillation and atrial flutter. Am J Cardiol 2014; 114:1229-33. [PMID: 25169984 DOI: 10.1016/j.amjcard.2014.07.047] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 07/05/2014] [Accepted: 07/05/2014] [Indexed: 11/28/2022]
Abstract
Emerging evidence suggests that endurance exercise increases the risk for atrial fibrillation (AF) in men, but few studies have investigated the dose-response relation between exercise and risk for atrial arrhythmias. Both exposure to exercise and reference points vary among studies, and previous studies have not differentiated between AF and atrial flutter. The aim of this study was to assess the risk for atrial arrhythmias by cumulative years of regular endurance exercise in men. To cover the range from physical inactivity to long-term endurance exercise, the study sample in this retrospective cohort study was based on 2 distinct cohorts: male participants in a long-distance cross-country ski race and men from the general population, in total 3,545 men aged ≥ 53 years. Arrhythmia diagnoses were validated by electrocardiograms during review of medical records. Regular endurance exercise was self-reported by questionnaire. A broad range of confounding factors was available for adjustment. The adjusted odds ratios per 10 years of regular endurance exercise were 1.16 (95% confidence interval 1.06 to 1.29) for AF and 1.42 (95% confidence interval 1.20 to 1.69) for atrial flutter. In stratified analyses, the associations were significant in cross-country skiers and in men from the general population. In conclusion, cumulative years of regular endurance exercise were associated with a gradually increased risk for AF and atrial flutter.
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Affiliation(s)
- Marius Myrstad
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway; Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
| | - Wenche Nystad
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Dag S Thelle
- Department of Biostatistics, Institute of Basal Medical Sciences, University of Oslo, Oslo, Norway; Department of Public Health and Community Medicine, Gothenburg University, Gothenburg, Sweden
| | - Hein Stigum
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway; Department of Preventive Medicine and Epidemiology, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Marit Aarønæs
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Anette H Ranhoff
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway; Department of Clinical Science, Kavli Research Center for Geriatrics and Dementia, University of Bergen, Bergen, Norway
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Myrstad M, Løchen ML, Graff-Iversen S, Gulsvik AK, Thelle DS, Stigum H, Ranhoff AH. Increased risk of atrial fibrillation among elderly Norwegian men with a history of long-term endurance sport practice. Scand J Med Sci Sports 2014; 24:e238-44. [PMID: 24256074 PMCID: PMC4282367 DOI: 10.1111/sms.12150] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2013] [Indexed: 12/23/2022]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia. The prevalence increases with increasing age. In middle-aged men, endurance sport practice is associated with increased risk of AF but there are few studies among elderly people. The aim of this study was to investigate the role of long-term endurance sport practice as a risk factor for AF in elderly men. A cross-sectional study compared 509 men aged 65-90 years who participated in a long-distance cross-country ski race with 1768 men aged 65-87 years from the general population. Long-term endurance sport practice was the main exposure. Self-reported AF and covariates were assessed by questionnaires. Risk differences (RDs) for AF were estimated by using a linear regression model. After multivariable adjustment, a history of endurance sport practice gave an added risk for AF of 6.0 percent points (pp) (95% confidence interval 0.8-11.1). Light and moderate leisure-time physical activity during the last 12 months reduced the risk with 3.7 and 4.3 pp, respectively, but the RDs were not statistically significant. This study suggests that elderly men with a history of long-term endurance sport practice have an increased risk of AF compared with elderly men in the general population.
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Affiliation(s)
- M Myrstad
- Medical Department, Diakonhjemmet HospitalOslo, Norway
- Division of Epidemiology, Norwegian Institute of Public HealthOslo, Norway
| | - M-L Løchen
- Department of Community Health, UiT The Arctic University of NorwayTromsø, Norway
| | - S Graff-Iversen
- Department of Community Health, UiT The Arctic University of NorwayTromsø, Norway
- Division of Epidemiology, Norwegian Institute of Public HealthOslo, Norway
| | - A K Gulsvik
- Department of General Internal Medicine, Oslo University HospitalOslo, Norway
| | - D S Thelle
- Department of Biostatistics, Institute of Basal Medical Sciences, University of OsloOslo, Norway
- Department of Public Health and Community Medicine, Gothenburg UniversityGothenburg, Sweden
| | - H Stigum
- Division of Epidemiology, Norwegian Institute of Public HealthOslo, Norway
- Department of Biostatistics, Institute of Basal Medical Sciences, University of OsloOslo, Norway
| | - A H Ranhoff
- Medical Department, Diakonhjemmet HospitalOslo, Norway
- Kavli Research Centre for Ageing and Dementia, Department of Clinical Science, University of BergenBergen, Norway
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Wisløff T, Hagen G, Klemp M. Economic evaluation of warfarin, dabigatran, rivaroxaban, and apixaban for stroke prevention in atrial fibrillation. PHARMACOECONOMICS 2014; 32:601-612. [PMID: 24715603 PMCID: PMC4031399 DOI: 10.1007/s40273-014-0152-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Atrial fibrillation is a major risk factor for stroke, which causes thousands of deaths and sequelae. It is recommended that atrial fibrillation patients at medium or high risk of stroke use an oral anticoagulant to reduce the risk of stroke. In the past few years, three new oral anticoagulants (NOACs), dabigatran, rivaroxaban, and apixaban, have been introduced in competition to the older oral anticoagulant warfarin. OBJECTIVE The objective of this study was to evaluate the relative cost effectiveness of warfarin, dabigatran, rivaroxaban, and apixaban in a Norwegian setting. METHODS We created a probabilistic decision-analytic Markov model to simulate the life of patients with atrial fibrillation. We performed several scenario analyses, including changing the switching age for dabigatran from 80 to 75 years old. RESULTS Assuming the European Society of Cardiology guidance, sequential dabigatran (2 × 150 mg daily until 80 years old, 2 × 110 mg thereafter) seems to be the most cost-effective alternative for high-risk AF patients. For medium-risk patients, apixaban (2 × 5 mg daily) seems to be somewhat more effective than dabigatran, but dabigatran is still marginally the most cost-effective alternative. In scenario analyses reducing dabigatran from 2 × 150 mg to 2 × 110 mg at the age of 75 years (instead of at age 80), apixaban (2 × 5 mg daily) becomes the most cost-effective alternative for both risk groups. CONCLUSION We have found apixaban or sequential dabigatran to be the alternatives most likely to be considered cost effective, depending on the switching age for dabigatran. These conclusions are highly sensitive to assumptions made in the analysis.
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Affiliation(s)
- Torbjørn Wisløff
- Norwegian Knowledge Centre for the Health Services, Postboks 7004, St. Olavs Plass, 0130, Oslo, Norway,
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Grundvold I, Skretteberg PT, Liestøl K, Erikssen G, Engeseth K, Gjesdal K, Kjeldsen SE, Arnesen H, Erikssen J, Bodegard J. Low Heart Rates Predict Incident Atrial Fibrillation in Healthy Middle-Aged Men. Circ Arrhythm Electrophysiol 2013; 6:726-31. [DOI: 10.1161/circep.113.000267] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Irene Grundvold
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (I.G., P.T.S., K.E., K.G., S.E.K., H.A., J.B.); Center for Clinical Heart Research, Oslo University Hospital, Norway (I.G., H.A.); Faculty of Medicine (I.G., P.T.S., K.G., S.E.K., H.A., J.E.), Department of Informatics, University of Oslo, Norway (K.L.); and Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E.)
| | - Per Torger Skretteberg
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (I.G., P.T.S., K.E., K.G., S.E.K., H.A., J.B.); Center for Clinical Heart Research, Oslo University Hospital, Norway (I.G., H.A.); Faculty of Medicine (I.G., P.T.S., K.G., S.E.K., H.A., J.E.), Department of Informatics, University of Oslo, Norway (K.L.); and Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E.)
| | - Knut Liestøl
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (I.G., P.T.S., K.E., K.G., S.E.K., H.A., J.B.); Center for Clinical Heart Research, Oslo University Hospital, Norway (I.G., H.A.); Faculty of Medicine (I.G., P.T.S., K.G., S.E.K., H.A., J.E.), Department of Informatics, University of Oslo, Norway (K.L.); and Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E.)
| | - Gunnar Erikssen
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (I.G., P.T.S., K.E., K.G., S.E.K., H.A., J.B.); Center for Clinical Heart Research, Oslo University Hospital, Norway (I.G., H.A.); Faculty of Medicine (I.G., P.T.S., K.G., S.E.K., H.A., J.E.), Department of Informatics, University of Oslo, Norway (K.L.); and Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E.)
| | - Kristian Engeseth
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (I.G., P.T.S., K.E., K.G., S.E.K., H.A., J.B.); Center for Clinical Heart Research, Oslo University Hospital, Norway (I.G., H.A.); Faculty of Medicine (I.G., P.T.S., K.G., S.E.K., H.A., J.E.), Department of Informatics, University of Oslo, Norway (K.L.); and Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E.)
| | - Knut Gjesdal
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (I.G., P.T.S., K.E., K.G., S.E.K., H.A., J.B.); Center for Clinical Heart Research, Oslo University Hospital, Norway (I.G., H.A.); Faculty of Medicine (I.G., P.T.S., K.G., S.E.K., H.A., J.E.), Department of Informatics, University of Oslo, Norway (K.L.); and Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E.)
| | - Sverre E. Kjeldsen
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (I.G., P.T.S., K.E., K.G., S.E.K., H.A., J.B.); Center for Clinical Heart Research, Oslo University Hospital, Norway (I.G., H.A.); Faculty of Medicine (I.G., P.T.S., K.G., S.E.K., H.A., J.E.), Department of Informatics, University of Oslo, Norway (K.L.); and Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E.)
| | - Harald Arnesen
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (I.G., P.T.S., K.E., K.G., S.E.K., H.A., J.B.); Center for Clinical Heart Research, Oslo University Hospital, Norway (I.G., H.A.); Faculty of Medicine (I.G., P.T.S., K.G., S.E.K., H.A., J.E.), Department of Informatics, University of Oslo, Norway (K.L.); and Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E.)
| | - Jan Erikssen
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (I.G., P.T.S., K.E., K.G., S.E.K., H.A., J.B.); Center for Clinical Heart Research, Oslo University Hospital, Norway (I.G., H.A.); Faculty of Medicine (I.G., P.T.S., K.G., S.E.K., H.A., J.E.), Department of Informatics, University of Oslo, Norway (K.L.); and Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E.)
| | - Johan Bodegard
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (I.G., P.T.S., K.E., K.G., S.E.K., H.A., J.B.); Center for Clinical Heart Research, Oslo University Hospital, Norway (I.G., H.A.); Faculty of Medicine (I.G., P.T.S., K.G., S.E.K., H.A., J.E.), Department of Informatics, University of Oslo, Norway (K.L.); and Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway (G.E.)
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14
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Thelle DS, Selmer R, Gjesdal K, Sakshaug S, Jugessur A, Graff-Iversen S, Tverdal A, Nystad W. Resting heart rate and physical activity as risk factors for lone atrial fibrillation: a prospective study of 309 540 men and women. Heart 2013; 99:1755-60. [DOI: 10.1136/heartjnl-2013-303825] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Apor P. [Atrial fibrillation and physical activity]. Orv Hetil 2013; 154:503-9. [PMID: 23524234 DOI: 10.1556/oh.2013.29554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Atrial fibrillation is the most frequent arrhythmia. Its "lone" form (when underlying pathology is not discovered) can be detected in a small percentage of endurance sports participants, and in growing numbers among veterans, probably as a result of some cardiac or other irregularities. Enhanced vagal tone and sudden sympathetic impulse, repetitive oxidative stress, inflammatory processes, enlarged atria, electric instabilization can explain the higher occurrence. Treatment of atrial fibrillation enables the affected persons to participate in regular medium-intensity exercise, 3-5 hours a week, which offers a protective role against cardiovascular, metabolic and mental illnesses.
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Affiliation(s)
- Péter Apor
- Semmelweis Egyetem, Testnevelési és Sporttudományi Kar Budapest Oxygén Wellness Budapest Apor-Med Bt. Budapest.
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16
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Stirbys P. How Much Exercise Is Too Much. J Atr Fibrillation 2013; 5:819. [PMID: 28496819 PMCID: PMC5153114 DOI: 10.4022/jafib.819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 02/03/2013] [Accepted: 02/03/2013] [Indexed: 01/21/2023]
Affiliation(s)
- Petras Stirbys
- Department of Cardiology, Hospital of Lithuanian University of Health Sciences , Kaunas Clinics, Kaunas, Lithuania
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17
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Grimsmo J. Er det farlig å trene hardt? TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:263. [DOI: 10.4045/tidsskr.11.1465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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