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Tas A, Fosboel E, Butt J, Weeke P, Kristensen S, Burcharth J, Vinding N, Petersen J, Koeber L, Vester-Andersen M, Gundlund A. Perioperative atrial fibrillation in major emergency abdominal surgery: does it affect postoperative outcome? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) in relation to surgery remains a clinical challenge. Major emergency abdominal surgery (e.g. ileus, perforation) is associated with postoperative complications and mortality. However, the prevalence and impact of perioperative AF in this setting is not well examined.
Purpose
We compared 30-days and 1-year outcomes (i.e. hospitalization of any causes, AF-related hospitalization, thromboembolic events and all-cause mortality) in patients who did and did not develop perioperative AF (POAF) in relation to their major emergency abdominal surgery.
Methods
We crosslinked data from Danish nationwide registries and identified all patients who underwent major emergency abdominal surgery (2000–2018) and discharged alive. Patients who developed POAF during hospitalization were matched in a 1:3 ratio on age, sex, year of surgery and category of surgery with those without POAF. Starting follow up at discharge, we examined the rates of outcomes at 30-days and 1-year post-discharge. The cumulative incidences and ratios of outcomes were assessed with the Aalen Johanson estimator together with Kaplan-Meier estimator and multivariable Cox regression analysis, respectively.
Results
We identified 891 patients with POAF and 64,914 patients without POAF. The matched cohort were composed of 889 patients with POAF and 2667 patients without POAF with a median age of 79 years [25th-75th percentile; 72–84 years] and 45.2% males. In general, patients with POAF had higher comorbid burden compared with patients without POAF. The cumulative incidences of a hospitalization of any cause after 30-days post-discharge were 31.2% and 22.3% in patients with and without POAF, respectively. The corresponding numbers for AF-related hospitalization were 20.8% and 1.2%, respectively. In adjusted analyses, POAF was associated with a significantly higher risk of hospitalization of any causes together with AF-related hospitalization (Figure 1 and 2).
The cumulative incidences of a thromboembolic event after 30-days post-discharge were 2.2% and 0.9% in patients with and without POAF, respectively. The corresponding numbers for all-cause mortality were 9.7% and 3.2%, respectively. In adjusted analyses, POAF was associated with a significantly higher risk of a thromboembolic event together with all-cause mortality within 30-days of follow up as well as 1-year of follow up. However, the results regarding thromboembolic events did not reach statistical significance after 1-year of follow up (Figure 1 and 2).
Conclusions
Perioperative atrial fibrillation in relation to major emergency abdominal surgery was associated with higher 30-days and 1-year rates of hospitalizations of any causes, atrial fibrillation related hospitalization, a thromboembolic event and all-cause mortality. These findings suggest that perioperative atrial fibrillation is a strong prognostic marker of increased morbidity following major emergency abdominal surgery.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Tas
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - E Fosboel
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J Butt
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - P Weeke
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - S Kristensen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J Burcharth
- Herlev-Gentofte University Hospital, Department of Surgucal Gastroenterology , Gentofte , Denmark
| | - N Vinding
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J Petersen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - M Vester-Andersen
- Herlev-Gentofte University Hospital, Department of Anesthesiology , Gentofte , Denmark
| | - A Gundlund
- Herlev-Gentofte University Hospital, Department of Cardiology , Gentofte , Denmark
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Kjeldsen S, Mohr G, Moeller S, Kragholm K, Wissenberg M, Hansen S, Koeber L, Lippert F, Folke F, Andersson C, Gislason G, Torp-Pedersen C, Weeke P. P3808Proarrhythmic pharmacotherapy and out-of-hospital cardiac arrest - a nationwide Danish study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Kjeldsen
- Gentofte University Hospital, Cardiology, Gentofte, Denmark
| | - G Mohr
- Gentofte University Hospital, Cardiology, Gentofte, Denmark
| | - S Moeller
- Gentofte University Hospital, Cardiology, Gentofte, Denmark
| | - K Kragholm
- Aalborg University Hospital, Unit of Epidemiology and Biostatistics, Aalborg, Denmark
| | - M Wissenberg
- University of Copenhagen, Emergency Medical Services Copenhagen, Copenhagen, Denmark
| | - S Hansen
- Aalborg University Hospital, Unit of Epidemiology and Biostatistics, Aalborg, Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, The Heart Center, Copenhagen, Denmark
| | - F Lippert
- University of Copenhagen, Emergency Medical Services Copenhagen, Copenhagen, Denmark
| | - F Folke
- University of Copenhagen, Emergency Medical Services Copenhagen, Copenhagen, Denmark
| | - C Andersson
- Gentofte University Hospital, Cardiology, Gentofte, Denmark
| | - G Gislason
- University of Copenhagen, Department of Clinical Medicine, Copenhagen, Denmark
| | - C Torp-Pedersen
- Aalborg University, Department of Health Science and Technology, Aalborg, Denmark
| | - P Weeke
- Gentofte University Hospital, Cardiology, Gentofte, Denmark
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Mohr G, Sondergaard K, Pallisgaard J, Weeke P, Jensen A, Rajan S, Lippert F, Torp-Pedersen C, Vilsboell T, Gislason G. P2087Use of insulin providers versus insulin sensitizers and risk of out-of-hospital cardiac arrest - a nationwide case-time-control study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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de Knegt MC, Fuchs A, Weeke P, Møgelvang R, Hassager C, Kofoed KF. Optimisation of coronary vascular territorial 3D echocardiographic strain imaging using computed tomography: a feasibility study using image fusion. Int J Cardiovasc Imaging 2016; 32:1715-1723. [PMID: 27539731 DOI: 10.1007/s10554-016-0964-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/17/2016] [Indexed: 10/21/2022]
Abstract
Current echocardiographic assessments of coronary vascular territories use the 17-segment model and are based on general assumptions of coronary vascular distribution. Fusion of 3D echocardiography (3DE) with multidetector computed tomography (MDCT) derived coronary anatomy may provide a more accurate assessment of left ventricular (LV) territorial function. We aimed to test the feasibility of MDCT and 3DE fusion and to compare territorial longitudinal strain (LS) using the 17-segment model and a MDCT-guided vascular model. 28 patients underwent 320-slice MDCT and transthoracic 3DE on the same day followed by invasive coronary angiography. MDCT (Aquilion ONE, ViSION Edition, Toshiba Medical Systems) and 3DE apical full-volume images (Artida, Toshiba Medical Systems) were fused offline using a dedicated workstation (prototype fusion software, Toshiba Medical Systems). 3DE/MDCT image alignment was assessed by 3 readers using a 4-point scale. Territorial LS was assessed using the 17-segment model and the MDCT-guided vascular model in territories supplied by significantly stenotic and non-significantly stenotic vessels. Successful 3DE/MDCT image alignment was obtained in 86 and 93 % of cases for reader one, and reader two and three, respectively. Fair agreement on the quality of automatic image alignment (intra-class correlation = 0.40) and the success of manual image alignment (Fleiss' Kappa = 0.40) among the readers was found. In territories supplied by non-significantly stenotic left circumflex arteries, LS was significantly higher in the MDCT-guided vascular model compared to the 17-segment model: -15.00 ± 7.17 (mean ± standard deviation) versus -11.87 ± 4.09 (p < 0.05). Fusion of MDCT and 3DE is feasible and provides physiologically meaningful displays of myocardial function.
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Affiliation(s)
- Martina Chantal de Knegt
- Department of Cardiology 2014, Faculty of Health Sciences, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,Department of Cardiology, Faculty of Health Sciences, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - A Fuchs
- Department of Cardiology 2014, Faculty of Health Sciences, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - P Weeke
- Department of Cardiology 2014, Faculty of Health Sciences, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - R Møgelvang
- Department of Cardiology 2014, Faculty of Health Sciences, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - C Hassager
- Department of Cardiology 2014, Faculty of Health Sciences, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - K F Kofoed
- Department of Cardiology 2014, Faculty of Health Sciences, The Heart Center, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Department of Radiology, Faculty of Health Sciences, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Naidoo D, Wu AC, Brilliant MH, Denny J, Ingram C, Kitchner TE, Linneman JG, McGeachie MJ, Roden DM, Shaffer CM, Shah A, Weeke P, Weiss ST, Xu H, Medina MW. A polymorphism in HLA-G modifies statin benefit in asthma. Pharmacogenomics J 2014; 15:272-7. [PMID: 25266681 PMCID: PMC4379135 DOI: 10.1038/tpj.2014.55] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/04/2014] [Accepted: 08/13/2014] [Indexed: 11/16/2022]
Abstract
Several reports have shown that statin treatment benefits patients with asthma, however inconsistent effects have been observed. The mir-152 family (148a, 148b and 152) has been implicated in asthma. These microRNAs suppress HLA-G expression, and rs1063320, a common SNP in the HLA-G 3’UTR which is associated with asthma risk, modulates miRNA binding. We report that statins up-regulate mir-148b and 152, and affect HLA-G expression in an rs1063320 dependent fashion. In addition, we found that individuals who carried the G minor allele of rs1063320 had reduced asthma related exacerbations (emergency department visits, hospitalizations or oral steroid use) compared to non-carriers (p=0.03) in statin users ascertained in the Personalized Medicine Research Project at the Marshfield Clinic (n=421). These findings support the hypothesis that rs1063320 modifies the effect of statin benefit in asthma, and thus may contribute to variation in statin efficacy for the management of this disease.
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Affiliation(s)
- D Naidoo
- Atherosclerosis Research, Children's Hospital Oakland Research Institute, Oakland, CA, USA
| | - A C Wu
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - M H Brilliant
- Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, WI, USA
| | - J Denny
- 1] Department of Medical Bioinformatics, Vanderbilt University School of Medicine, Nashville, TN, USA [2] Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - C Ingram
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - T E Kitchner
- Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, WI, USA
| | - J G Linneman
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, WI, USA
| | - M J McGeachie
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - D M Roden
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - C M Shaffer
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - A Shah
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - P Weeke
- 1] Department of Medicine, Vanderbilt University, Nashville, TN, USA [2] Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark
| | - S T Weiss
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - H Xu
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - M W Medina
- Atherosclerosis Research, Children's Hospital Oakland Research Institute, Oakland, CA, USA
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Weeke P, Jensen A, Folke F, Gislason GH, Olesen JB, Fosbøl EL, Wissenberg M, Lippert FK, Christensen EF, Nielsen SL, Holm E, Kanters JK, Poulsen HE, Køber L, Torp-Pedersen C. Antipsychotics and associated risk of out-of-hospital cardiac arrest. Clin Pharmacol Ther 2014; 96:490-7. [PMID: 24960522 DOI: 10.1038/clpt.2014.139] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 06/17/2014] [Indexed: 11/09/2022]
Abstract
Antipsychotic drugs have been associated with sudden cardiac death, but differences in the risk of out-of-hospital cardiac arrest (OHCA) associated with different antipsychotic drug classes are not clear. We identified all OHCAs in Denmark (2001-2010). The risk of OHCA associated with antipsychotic drug use was evaluated by conditional logistic regression analysis in case-time-control models. In total, 2,205 (7.6%) of 28,947 OHCA patients received treatment with an antipsychotic drug at the time of the event. Overall, treatment with any antipsychotic drug was associated with OHCA (odds ratio (OR) = 1.53, 95% confidence interval (CI): 1.23-1.89), as was use with typical antipsychotics (OR = 1.66, CI: 1.27-2.17). By contrast, overall, atypical antipsychotic drug use was not (OR = 1.29, CI: 0.90-1.85). Two individual typical antipsychotic drugs, haloperidol (OR = 2.43, CI: 1.20-4.93) and levomepromazine (OR = 2.05, CI: 1.18-3.56), were associated with OHCA, as was one atypical antipsychotic drug, quetiapine (OR = 3.64, CI: 1.59-8.30).
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Affiliation(s)
- P Weeke
- Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark
| | - A Jensen
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - F Folke
- Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark
| | - G H Gislason
- 1] Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark [2] National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - J B Olesen
- Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark
| | - E L Fosbøl
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - M Wissenberg
- Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark
| | - F K Lippert
- Prehospital Emergency Medical Services, On behalf of the Capital, Central Denmark, Northern, South Denmark and Zealand Regions, Denmark
| | - E F Christensen
- Prehospital Emergency Medical Services, On behalf of the Capital, Central Denmark, Northern, South Denmark and Zealand Regions, Denmark
| | - S L Nielsen
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - E Holm
- Geriatric Department, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | - J K Kanters
- Laboratory of Experimental Cardiology, University of Copenhagen, Copenhagen, Denmark
| | - H E Poulsen
- Laboratory of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg, Denmark
| | - L Køber
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - C Torp-Pedersen
- Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark
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7
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Karlsson LIM, Wissenberg M, Malta Hansen C, Weeke P, Lippert FK, Nielsen SL, Frischknecht Christensen E, Kober L, Folke F, Torp-Pedersen C. Low survival in patients with out-of-hospital cardiac arrest during nighttime: a nationwide study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Weeke P, Torp-Pedersen C. Response to "SSRIs: a premature burial". Clin Pharmacol Ther 2013; 93:235. [PMID: 23299645 DOI: 10.1038/clpt.2012.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Andersson C, van Gaal L, Caterson ID, Weeke P, James WPT, Coutinho W, Finer N, Sharma AM, Maggioni AP, Torp-Pedersen C. Relationship between HbA1c levels and risk of cardiovascular adverse outcomes and all-cause mortality in overweight and obese cardiovascular high-risk women and men with type 2 diabetes. Diabetologia 2012; 55:2348-55. [PMID: 22638548 DOI: 10.1007/s00125-012-2584-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 04/11/2012] [Indexed: 12/25/2022]
Abstract
AIMS/HYPOTHESIS The optimal HbA(1c) concentration for prevention of macrovascular complications and deaths in obese cardiovascular high-risk patients with type 2 diabetes remains to be established and was therefore studied in this post hoc analysis of the Sibutramine Cardiovascular OUTcomes (SCOUT) trial, which enrolled overweight and obese patients with type 2 diabetes and/or cardiovascular disease. METHODS HRs for meeting the primary endpoint (nonfatal myocardial infarction, nonfatal stroke, resuscitated cardiac arrest or cardiovascular death) and all-cause mortality were analysed using Cox regression models. RESULTS Of 8,252 patients with type 2 diabetes included in SCOUT, 7,479 had measurements of HbA(1c) available at baseline (i.e. study randomisation). Median age was 62 years (range 51-86 years), median BMI was 34.0 kg/m(2) (24.8-65.1 kg/m(2)) and 44% were women. The median HbA(1c) concentration was 7.2% (3.8-15.9%) (55 mmol/l [18-150 mmol/l]) and median diabetes duration was 7 years (0-57 years). For each 1 percentage point HbA(1c) increase, the adjusted HR for the primary endpoint was 1.17 (95% CI 1.11, 1.23); no differential sex effect was observed (p = 0.12 for interaction). In contrast, the risk of all-cause mortality was found to be greater in women than in men: HR 1.22 (1.10, 1.34) vs 1.12 (1.04, 1.20) for each 1 percentage point HbA(1c) increase (p = 0.02 for interaction). There was no evidence of increased risk associated with HbA(1c) ≤ 6.4% (≤ 46 mmol/l). Glucose-lowering treatment regimens, diabetes duration or a history of cardiovascular disease did not modify the associations. CONCLUSIONS/INTERPRETATION In overweight, cardiovascular high-risk patients with type 2 diabetes, increasing HbA(1c) concentrations were associated with increasing risks of cardiovascular adverse outcomes and all-cause mortality.
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Affiliation(s)
- C Andersson
- Department of Cardiology, Gentofte University Hospital of Copenhagen, Niels Andersens vej 65, 2900 Hellerup, Denmark.
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Olesen JB, Lip GYH, Hansen PR, Lindhardsen J, Ahlehoff O, Andersson C, Weeke P, Hansen ML, Gislason GH, Torp-Pedersen C. Bleeding risk in 'real world' patients with atrial fibrillation: comparison of two established bleeding prediction schemes in a nationwide cohort. J Thromb Haemost 2011; 9:1460-7. [PMID: 21624047 DOI: 10.1111/j.1538-7836.2011.04378.x] [Citation(s) in RCA: 158] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Oral anticoagulation (OAC) in patients with atrial fibrillation (AF) is a double-edged sword, because it decreases the risk of stroke at the cost of an increased risk of bleeding. We compared the performance of a new bleeding prediction scheme, HAS-BLED, with an older bleeding prediction scheme, HEMORR(2)HAGES, in a cohort of 'real-world' AF patients. METHODS By individual-level-linkage of nationwide registers, we identified all patients (n = 118,584) discharged with non-valvular AF in Denmark during the period 1997-2006, with and without OAC. Major bleeding rates during 1 year of follow-up were determined, and the predictive capabilities of the two schemes were compared by c-statistics. The risk of bleeding associated with individual risk factors composing HAS-BLED was estimated using Cox proportional-hazard analyses. RESULTS Of AF patients receiving OAC (n = 44,771), 34.8% and 47.3% were categorized as 'low bleeding risk' by HAS-BLED and HEMORR(2)HAGES, respectively, and the bleeding rates per 100 person-years were 2.66 (95% confidence interval [CI], 2.40-2.94) and 3.06 (2.83-3.32), respectively. C-statistics for the two schemes were 0.795 (0.759-0.829) and 0.771 (0.733-0.806), respectively. The risk factors composing HAS-BLED were associated with varying risks, with a history of bleeding (hazard ratio [HR] 2.98; 95% CI 2.68-3.31) and being elderly (HR 1.93; 95% CI 1.71-2.18) being associated with the highest risks. Comparable results were found in AF patients not receiving OAC (n = 77,813). CONCLUSIONS In an unselected nationwide cohort of hospitalized patients with atrial fibrillation, the HAS-BLED score performs similarly to HEMORR(2)HAGES in predicting bleeding risk but HAS-BLED is much simpler and easier to use in everyday clinical practise.
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Affiliation(s)
- J B Olesen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
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Andersson C, Olesen JB, Hansen PR, Weeke P, Norgaard ML, Jørgensen CH, Lange T, Abildstrøm SZ, Schramm TK, Vaag A, Køber L, Torp-Pedersen C, Gislason GH. Metformin treatment is associated with a low risk of mortality in diabetic patients with heart failure: a retrospective nationwide cohort study. Diabetologia 2010; 53:2546-53. [PMID: 20838985 DOI: 10.1007/s00125-010-1906-6] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Accepted: 08/17/2010] [Indexed: 12/24/2022]
Abstract
AIMS/HYPOTHESIS The safety of metformin in heart failure has been questioned because of a perceived risk of life-threatening lactic acidosis, though recent studies have not supported this concern. We investigated the risk of all-cause mortality associated with individual glucose-lowering treatment regimens used in current clinical practice in Denmark. METHODS All patients aged ≥ 30 years hospitalised for the first time for heart failure in 1997-2006 were identified and followed until the end of 2006. Patients who received treatment with metformin, a sulfonylurea and/or insulin were included and assigned to mono-, bi- or triple therapy groups. Multivariable Cox proportional hazard regression models were used to assess the risk of all-cause mortality. RESULTS A total of 10,920 patients were included. The median observational time was 844 days (interquartile range 365-1,395 days). In total, 6,187 (57%) patients died. With sulfonylurea monotherapy used as the reference, adjusted hazard ratios for all-cause mortality associated with the different treatment groups were as follows: metformin 0.85 (95% CI 0.75-0.98, p = 0.02), metformin + sulfonylurea 0.89 (95% CI 0.82-0.96, p = 0.003), metformin + insulin 0.96 (95% CI 0.82-1.13, p = 0.6), metformin + insulin + sulfonylurea 0.94 (95% CI 0.77-1.15, p = 0.5), sulfonylurea + insulin 0.97 (95% CI 0.86-1.08, p = 0.5) and insulin 1.14 (95% CI 1.06-1.20, p = 0.0001). CONCLUSIONS/INTERPRETATION Treatment with metformin is associated with a low risk of mortality in diabetic patients with heart failure compared with treatment with a sulfonylurea or insulin.
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Affiliation(s)
- C Andersson
- Department of Cardiology, Gentofte University Hospital, Niels Andersens Vej 65, 2900 Hellerup, Denmark.
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