Exploring the temporal relationship between atrial fibrillation and heart failure development. Analysis from nationwide database

Background

Atrial fibrillation (AF) and heart failure (HF) often coexist and are closely intertwined, each condition worsening the other. The temporal relationships between these two disorders have not yet been fully explored. We assessed, on a nationwide scale, the prognosis of patients hospitalized with HF and AF, based on the timing of AF and HF development.

Methods

From the administrative database covering hospital care for the whole French population, we identified 1,349,638 patients diagnosed with both AF and HF between 2010 and 2018: 956,086 of these AF patients developed HF first (prevalent HF) and 393,552 developed HF after AF (incident HF). The outcome analysis (all-cause death, cardiovascular [CV] death, ischemic stroke or hospitalization for HF) was performed with follow-up starting at the time of last event between AF or HF in the whole cohort and in 427,848 propensity-score-matched patients (213,924 with incident HF and 213,924 with prevalent HF).

Results

During follow-up (mean follow-up 1.6±1.9 year), matched patients with prevalent HF had a higher risk of all-cause death (21.6 vs 19.2%/year), CV death (7.6 vs 6.5%/year) as well as non-cardiovascular death (13.9 vs 12.7%/year) than those with incident HF. The risk for ischemic stroke was lower in the prevalent HF group (1.2 vs 2.4%/year).

Conclusion

In patients hospitalized with both AF and HF, we identified two distinct clinical entities based on the chronological sequence of the two disorders. Patients in whom HF preceded AF (prevalent HF) had higher mortality and higher risk of rehospitalization for HF.

Funding Acknowledgement

Type of funding sources: None.

Atrial fibrillation with or without structural abnormalities. Analysis from a nationwide database

Background

Atrial Fibrillation (AF) is often associated with underlying heart failure, valvular disease, ischemic heart disease, as well as other structural heart diseases, but can also occur as an independent entity which may be named pure AF or lone AF. Small cohort studies have suggested that lone AF patients may have a favorable prognosis in terms of mortality and ischemic stroke rates. We aimed to assess, at a nationwide scale, the prognosis of patients hospitalized with lone AF and AF associated with cardiac disease.

Methods

From the French administrative hospital-discharge PMSI database (Programme de Médicalisation des Systèmes d'Information) covering hospital care and representative of the whole French population, all consecutive patients with AF diagnosis hospitalized between 2010 and 2018 were included. From this huge database, 2,793,234 patients were included: group lone FA: 665,431, group AF and cardiac disease: 2,727,803. Incidence rates (%/year) for the outcomes (all-cause death, cardiovascular [CV] death, or ischemic stroke) during follow-up were compared between groups using incidence rate ratios (RR) for the whole cohort and also for a subgroup of 539,654 propensity score matched patients for non-cardiovascular conditions (269,827 with AF alone and 269,827 with AF and CD).

Results

The majority of this population had AF associated with a cardiac disease (n=2,127,803; 76.2%). At follow-up (median [IQR] 1.1 [0.1–3.4] years), patients with AF and CD were at higher risk of all-cause mortality (yearly incidence 13.6% vs 9.0%, RR [95% CI] 1.51 [1.50–1.52], p<0.00001) and CV death (4.4% vs 1.9%, RR 2.33 [2.30–2.36], p<0.00001) than those with lone AF. In the propensity score matched population (median follow-up [IQR] 1.9 [0.3–4.4] years), patients with AF and CD also had worse outcomes than patients with lone AF (yearly incidence rates for all-cause mortality: 10.6% vs 7.4%, RR 1.43 [1.42–1.45], p<0.00001; and for CV death: 3.3% vs 2.0%, RR 1.64 [1.61–1.68], p<0.00001). However, lone AF patients were at higher risk of ischemic stroke: yearly incidence rates 2.75% in those with lone AF vs 1.69% in patients with AF and CD (RR 0.62 [0.60–0.63], p<0.00001).

Conclusion

In our large study from a nationwide database about patients hospitalized with AF, two distinct clinical entities were identified, that could explain the results highlighted: 1) the consistently higher mortality in the group associating AF and underlying heart disease (AF may bea marker for poor outcome when there is a structural heart disease; 2) Lone AF group which prognosis may be related to a higher incidence of thromboembolic events. These results could have important implications in terms of thromboembolic prevention but further studies are still needed to investigate the underlying mechanisms of embolic pathophysiology and its specific management.

Funding Acknowledgement

Type of funding source: None

Clinical and demographic characteristics of treatment seeking online video game players

Background and aim

Within Switzerland, video game players seeking specialised treatment are usually referred to gambling addiction services. The Centre for Excessive Gambling (CJE) is a specialised gambling addiction unit in Lausanne University Hospital. Between 2003 and 2015 the service offered also support to 64 adults seeking treatment for videogaming-related disorders.

According to international literature, Internet disorder treatment programmes have been developed. However, little is known about clinical profile of users seeking treatment. Studies into Internet or gaming disorders typically employ Internet survey methods or use student samples. The current presentation will outline demographic and clinical features of video gamers receiving treatment at the CJE.

Method

Data were collected from the medical records of 57 video gamers seeking treatment at the CJE between 2003 and 2015.

Results

The sample includes 93% men, mostly single (91%), with an average age of 25 years ± 7. On average the sample spent 9 hours ± 5 per day playing video games. A disorder had emerged an average of 3 years ago ± 3. The crisis preceding the first consultation was familial (50%), emotional (29%) or professional (16%). Sixty-five percent of the sample had a mood disorder and 20% reported suicidal ideations.

Discussion

Treatments should address comorbidities and family problems associated with video game disorders. Offering consultations for parents could be useful, even in absence of the young player.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Optimisation of a sol–gel synthesis route for the preparation of MgF2 particles for a large scale coating process

Preparation of transparent and low viscous MgF₂ sols via sol–gel technique which can be applied for antireflective coatings on glass substrates is described.

Off-axis prism resonator for improved beam quality of slab lasers

An off-axis prism resonator that was especially designed for slab lasers is investigated. It consists of an output coupling mirror and two 90-deg prisms, one of which is placed off axis. This arrangement permits a fill factor of one and reduces the mode order of the extracted beam compared with that of a conventional stable mirror resonator. Thus a high extraction efficiency and high beam quality are achieved.