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Zhang HW, Chang GD, Liu XM, Gao H, Xu XD, Lv SY. Analysis of epidemiological characteristics and psychopsychological factors of arrhythmia in the elderly. World J Psychiatry 2025; 15:100281. [DOI: 10.5498/wjp.v15.i4.100281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Revised: 01/16/2025] [Accepted: 02/21/2025] [Indexed: 03/25/2025] Open
Abstract
BACKGROUND Irregular heart rhythms are a primary manifestation of cardiovascular disease, considerably contributing to global morbidity and mortality rates. Moreover, patients with cardiac arrhythmias often experience a higher prevalence of sleep disorders, anxiety, and depression owing to various factors.
AIM To investigate the epidemiological characteristics and psychological factors associated with arrhythmia in the elderly and to establish a theoretical foundation for its prevention and treatment in older adults.
METHODS A retrospective analysis was performed on 169 elderly patients admitted to the Shangqiu First People’s Hospital from December 2022 to December 2023. All subjects underwent 24-hour electrocardiogram monitoring to record heart rate, heart rate variability, and 24-hour ambulatory electrocardiogram data. Additionally, patients’ medical records were reviewed to gather information on their general condition, including age, gender, underlying diseases, and other relevant factors. Patients were divided into four groups based on their Hamilton Anxiety (HAMA) and Hamilton Depression Rating Scale (HAMD) scores: Group A (HAMA scores ≥ 7), Group B (HAMD scores ≥ 7), Group C (both HAMA and HAMD scores ≥ 7), and Group D (HAMA and HAMD scores < 7). Psychological factors such as depression, anxiety, sleep status, and quality of life were analyzed. Pearson correlation was used to examine the relationship between scores from the Pittsburgh Sleep Quality Index (PSQI), HAMA/HAMD scales, and the Short Form 36-item Health Survey (SF-36) with the presence of arrhythmia.
RESULTS Among the 169 patients, 87 (51.5%) had concurrent arrhythmia. Atrial arrhythmias constituted the largest proportion at 34.8% (30 out of 87), followed by sinus tachycardia at 24.1% (21 out of 87), and ventricular arrhythmias at 9.2% (8 out of 87). Factors such as advanced age, coronary heart disease, hypertension, smoking, exposure to secondhand smoke, and residing in rural areas significantly increased the risk of developing arrhythmia. There was a statistically significant difference between the two groups regarding PSQI, HAMA-14, HAMD-17, and SF-36 scores. Pearson correlation analysis revealed that PSQI, HAMA-14, and HAMD-17 scores were positively correlated with arrhythmia in the elderly, while the SF-36 score was negatively correlated. The anxiety, depression, and combined anxiety–depression groups exhibited significantly higher PSQI, HAMA-14, and HAMD-17 scores compared to the nonanxiety and non-depression group.
CONCLUSION Arrhythmia among the elderly is primarily found in individuals with advanced age and existing health conditions. It is also linked to psychological factors such as depression, anxiety, reduced quality of life, and sleep disturbances.
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Affiliation(s)
- Hong-Wei Zhang
- Department of Arrhythmia, Shangqiu First People’s Hospital, Shangqiu 476100, Henan Province, China
| | - Guo-Dong Chang
- Department of Arrhythmia, Shangqiu First People’s Hospital, Shangqiu 476100, Henan Province, China
| | - Xue-Meng Liu
- Department of Arrhythmia, Shangqiu First People’s Hospital, Shangqiu 476100, Henan Province, China
| | - Hui Gao
- Department of Arrhythmia, Shangqiu First People’s Hospital, Shangqiu 476100, Henan Province, China
| | - Xiu-Dan Xu
- Department of Arrhythmia, Shangqiu First People’s Hospital, Shangqiu 476100, Henan Province, China
| | - Su-Ying Lv
- Department of Arrhythmia, Shangqiu First People’s Hospital, Shangqiu 476100, Henan Province, China
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Ghasemi H, Bastan MM, Najafi M, Nejadghaderi SA. Three decades of atrial fibrillation and flutter epidemiology and risk factors in Iran with a focus on the impact of COVID-19. Sci Rep 2025; 15:9697. [PMID: 40113914 PMCID: PMC11926214 DOI: 10.1038/s41598-025-91737-y] [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: 10/17/2024] [Accepted: 02/24/2025] [Indexed: 03/22/2025] Open
Abstract
Atrial fibrillation/flutter (AF/AFL) is one of the most common sustained heart rhythm disorders in clinical practice and a major public health concern. This study aimed to evaluate the disease burden of AF/AFL in Iran and analyze trends using the Global Burden of Disease (GBD) 2021 data, by age, sex, location, risk factor, and socio-demographic index (SDI), considering the impacts of COVID-19. Data on the prevalence, incidence, disability-adjusted life years (DALYs), deaths, and six attributable risk factors related to AF/AFL in Iran and its 31 provinces from 1990 to 2021 was collected from the GBD 2021 study. The International Classification of Disease (ICD) codes used were I48-48.9 for ICD-10 and 427.3 for ICD-9. The data was sourced from surveys, censuses, vital statistics, and other health-related records. In Iran, in 2021, the AF/AFL age-standardized incidence rate (ASIR) was 40.6 (30.0 to 54.4), the age-standardized prevalence rate (ASPR) was 425.4 (327.2 to 559.2), the age-standardized DALY rate was 72.4 (57.4 to 88.3), and the age-standardized death rate (ASDR) was 3.3 (2.5 to 3.8) per 100,000 population. Following COVID-19, there were significant decreases in age-standardized DALY and death rates over 2019-2021. By province, Fars had the highest AF/AFL ASIR and ASPR in 2021. In addition, East and West Azarbayejan had the highest age-standardized DALY rate and ASDR, respectively. The national incidence, prevalence, DALYs, and death rates of AF/AFL showed an overall increasing trend with age. Males experienced higher rates of incidence and prevalence compared to females. In contrast, females had higher rates of DALYs and deaths compared to males. The burden of AF/AFL increased with advancing age. The risk factor with the highest DALYs and deaths attributable to AF/AFL was high systolic blood pressure. Notably, no remarkable association was found between SDI and the burden of AF/AFL in Iran. The incidence and prevalence of AF/AFL in Iran have significantly increased, highlighting the critical need for cost-effective and nationwide interventions.
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Affiliation(s)
- Hoomaan Ghasemi
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Mahdi Bastan
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Morvarid Najafi
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Aria Nejadghaderi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Sellal JM, Hammache N, Echivard M. [Atrial fibrillation in 2025: Diagnosis and treatment]. Rev Med Interne 2025:S0248-8663(25)00078-5. [PMID: 40082169 DOI: 10.1016/j.revmed.2025.02.010] [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: 02/20/2025] [Accepted: 02/23/2025] [Indexed: 03/16/2025]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia. It increases the risk of hospitalization, heart failure, cognitive decline and mortality. It is the first cause of ischemic stroke. These are largely preventable if AF is diagnosed. It is essential to estimate the patient's embolic risk using the CHA2DS2-VA score, which now replaces the CHADS-Vasc score. Patients who require it must receive adequate anticoagulant treatment. New technologies (in particular, smart-watch) have led to advances in the detection and diagnosis of this arrhythmia. Patients suffering from AF may be treated with a heart rate control strategy (to limit tachycardia) or a rhythm control strategy (to maintain sinus rhythm). Catheter ablation is increasingly being offered to patients as an alternative to antiarrhythmic therapy. Controlling risk factors is essential to prevent the onset of AF, and to try to maintain sinus rhythm over the long term.
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Affiliation(s)
- Jean-Marc Sellal
- Département de cardiologie, CHRU de Nancy, 1, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France; IADI, Inserm U1254, Université de Lorraine, Nancy, 1, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | - Néfissa Hammache
- Département de cardiologie, CHRU de Nancy, 1, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France; IADI, Inserm U1254, Université de Lorraine, Nancy, 1, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - Mathieu Echivard
- Département de cardiologie, CHRU de Nancy, 1, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France; IADI, Inserm U1254, Université de Lorraine, Nancy, 1, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
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Jay M, Huan P, Cliffe N, Rakoff J, Morris E, Kavsak P, Luthra M, Punthakee Z. Treatment of Subclinical Hyperthyroidism and Incident Atrial Fibrillation. Clin Endocrinol (Oxf) 2025; 102:315-323. [PMID: 39400387 PMCID: PMC11788941 DOI: 10.1111/cen.15150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 09/17/2024] [Accepted: 09/26/2024] [Indexed: 10/15/2024]
Abstract
CONTEXT Treating overt hyperthyroidism prevents atrial fibrillation (AF). Though subclinical hyperthyroidism (SH) has been associated with AF, it is unknown whether treating SH prevents AF. OBJECTIVE We aimed to identify the association between treating SH and incident AF. DESIGN In a pharmacoepidemiologic retrospective cohort study, patients diagnosed with SH between 2000 and 2021 were followed. PATIENTS Outpatients ≥ 18 years with biochemical SH and without prior AF, hypothyroidism, thyroid cancer, pituitary disease, or pregnancy were included. MAIN OUTCOMES The primary outcome was incident AF. Secondary outcomes were ECG and echocardiographic features associated with AF. RESULTS Of 2169 patients screened, 360 (131 treated and 229 untreated) were followed up for a mean of 4.27 years. In the treated and untreated groups, AF occurred in 4 (3.1%) and 15 (6.6%) patients (p = 0.15), and AF incidence was 0.8% and 1.4%/year (p = 0.31), respectively. The hazard ratio (HR) for treatment as a time-dependent variable was 0.60 (95% CI 0.19-1.92; p = 0.39). As some cases of AF were documented nearly simultaneously with SH treatment, a sensitivity analysis was performed reassigning two patients diagnosed with AF < 30 days after starting SH treatment to the untreated group. Here, in the treated and untreated groups, AF occurred in 1.6% and 7.4% (p = 0.02), and AF incidence was 0.4% and 1.8%/year (p = 0.02), respectively. The HR was 0.25 (0.06-1.13; p = 0.07). There were no differences in ECG or echocardiographic features. CONCLUSION There was an overall trend towards lower incidence and prevalence of AF following treatment of SH, supporting the need for larger scale studies.
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Affiliation(s)
- Mohammad Jay
- Department of Medicine, Division of EndocrinologyUniversity of TorontoTorontoOntarioCanada
| | - Peter Huan
- Faculty of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Nikki Cliffe
- Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Jonah Rakoff
- Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Emily Morris
- Faculty of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Peter Kavsak
- Department of Pathology and Molecular MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Meera Luthra
- Department of Medicine, Division of EndocrinologyMcMaster UniversityHamiltonOntarioCanada
| | - Zubin Punthakee
- Department of Medicine, Division of EndocrinologyMcMaster UniversityHamiltonOntarioCanada
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Wattanasukchai L, Bubphan T, Thavorncharoensap M, Youngkong S, Chaikledkaew U, Thakkinstian A. Cost Effectiveness of Catheter Ablation Versus Antiarrhythmic Drugs for Atrial Fibrillation: A Systematic Review and Meta-analysis. Am J Cardiovasc Drugs 2025; 25:169-189. [PMID: 39570492 PMCID: PMC11811442 DOI: 10.1007/s40256-024-00693-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2024] [Indexed: 11/22/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and is associated with substantial morbidity and mortality. Current international guidelines recommend antiarrhythmic drugs or catheter ablation (CA) as rhythm-control strategies for AF. This study aimed to comprehensively assess economic evaluations (EEs) of the treatment of AF by country income level. METHODS Seven electronic databases were systematically searched for EE literature until March 30, 2024, with no constraints on time or language. Two independent reviewers selected the studies, extracted the data, and assessed the quality of the data. Full EEs comparing CA with antiarrhythmic drugs for rhythm-control treatment were included; surgical or rate-control treatments were excluded. The quality of the included articles was assessed using the ECOBIAS checklist. Costs were converted to purchasing power parity US dollars for 2023. A random-effects meta-analysis was applied to pool incremental net benefit (INB) based on a heterogeneity test and its degree (I2 > 25% or Cochran's Q test < 0.1). We also explored heterogeneity and potential publication bias and conducted sensitivity and subgroup analyses. RESULTS In total, 27 studies across nine countries were eligible, predominantly from high-income countries (n = 25), with a smaller subset from upper-middle-income countries (n = 2). Because of the heterogeneity among the studies, a random-effects model was selected over a fixed-effects model to pool INBs. Most studies (n = 21) favored CA as the cost-effective intervention, yielding an INB of $US23,796 (95% confidence interval [CI] 15,341-32,251) in high-income countries. However, heterogeneity was substantial (I2 = 99.67%). In upper-middle-income countries, the estimated INB was $US18,330 (95% CI - 11,900-48,526). The publication bias results showed no evidence of asymmetrical funnel plots. CONCLUSION In this meta-analysis, CA emerged as a cost-effective rhythm-control treatment for AF when compared with antiarrhythmic drugs, particularly in high-income countries. However, economic evidence for upper-middle-income countries is lacking, and no primary evaluations were found for low-middle-income and low-income countries. Further EEs are necessary to expand the understanding of AF treatment globally.
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Affiliation(s)
- Luxzup Wattanasukchai
- Clinical Epidemiology Unit, Faculty of Medicine, Khon Kean University, Khon Kaen, Thailand
| | - Tunlaphat Bubphan
- Cardiology Unit, Department of Internal Medicine, Udon Thani Hospital, Udon Thani, Thailand
| | - Montarat Thavorncharoensap
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Sitaporn Youngkong
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Usa Chaikledkaew
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand.
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Ripoll JG, Chang MG, Bittner EA, Ortoleva J, Khromava M, Bradley DT, Griffin EK, Diaz Soto JC, Wieruszewski PM, Chang K, Nabzdyk CS, Ramakrishna H. Analysis of The 2024 ESC/EACTS Guidelines For The Management Of Atrial Fibrillation. J Cardiothorac Vasc Anesth 2025; 39:818-835. [PMID: 39674741 DOI: 10.1053/j.jvca.2024.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 11/15/2024] [Indexed: 12/16/2024]
Abstract
The 2024 European Society of Cardiology guidelines for atrial fibrillation (AF) emphasize a patient-centered approach to management, structured around the AF-CARE pathway: Comorbidity and risk factor management (C), Avoiding stroke and thromboembolism (A), Reducing symptoms through rate and rhythm control (R), and Evaluation and dynamic reassessment (E). This framework ensures that comorbidities such as hypertension, heart failure, diabetes, and obesity are effectively managed to prevent disease progression and improve outcomes. A key principle of the guidelines is shared decision making involving patients, families, caregivers, and healthcare teams to ensure individualized care that reflects patient preferences. The guidelines also stress healthcare equity, advocating for the elimination of disparities related to sex, ethnicity, disability, and socioeconomic status. For diagnosis, electrocardiographic confirmation of clinical AF is essential, followed by risk stratification using the CHA₂DS₂-VASc score to guide anticoagulation therapy. Direct oral anticoagulants are preferred for most patients because of their good safety profile. Stroke prevention is prioritized, with rhythm control as first-line treatment for suitable patients. For those with persistent symptoms despite medications, catheter ablation is recommended. Rate control strategies, including beta-blockers, digoxin, and calcium channel blockers, are used to manage heart rate and symptoms. Ongoing education for patients, families, and providers supports informed decision making and dynamic reassessment, optimizing patient outcomes and quality of life.
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Affiliation(s)
- Juan G Ripoll
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Marvin G Chang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Edward A Bittner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Jamel Ortoleva
- Department of Anesthesiology, Boston Medical Center, Boston, MA
| | - Maryna Khromava
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Derek T Bradley
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Emily K Griffin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Juan C Diaz Soto
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | | | - Kitae Chang
- Department of Anesthesiology, Pain and Perioperative Medicine, Brigham and Women's Hospital, Boston, MA
| | - Christoph S Nabzdyk
- Department of Anesthesiology, Pain and Perioperative Medicine, Brigham and Women's Hospital, Boston, MA
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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7
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Shi M, Ning Z. In vivo and in vitro investigations of schisandrin B against angiotensin II induced ferroptosis and atrial fibrosis by regulation of the SIRT1 pathway. Sci Rep 2025; 15:6200. [PMID: 39979353 PMCID: PMC11842858 DOI: 10.1038/s41598-025-89895-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Accepted: 02/10/2025] [Indexed: 02/22/2025] Open
Abstract
Schisandrin B (Sch B) derived from Schisandra chinensis, is known for its anti-inflammatory and anti-microbial properties. The study aimed to explore Sch B's protective roles and underlying mechanisms in angiotensin II (Ang II) - induced ferroptosis, atrial fibrosis, and AF using both in vivo and in vitro models. AF mice model generated induced by Ang II and established an in vitro model using the HL-1 cell line induced by Ang II. We assessed atrial fibrosis through histological analysis and oxidative stress analysis. We employed RT-qPCR and Western blot techniques to evaluate mRNA and protein expression. Sch B significantly attenuated Ang II-induced AF development, atrial apoptosis, and myocardial injury-related molecules, including CK-MB and LDH. Relative DHE intensity, MDA, NOX2, and NOX4 increased significantly, and SOD and CAT levels decreased markedly in Ang II-induced mice. Sch B treatment could inhibit atrial ROS production and oxidative stress in Ang II-infused mice. In addition, Sch B showed cardioprotective effects in Ang II-infused HL-1 cells. Sch B significantly reduced pro-inflammatory cytokines, including IL-1β, TNF-α, and IL-6, restored by EX527 (SIRT1 inhibitor). Sch B inhibited intracellular ROS generation and oxidative stress in HL-1 cells, which were restored by Ex-527. Furthermore, Sch B decreased the increase in Fe2 + concentration caused by Ang II infusion, which was recovered by Ex-527. Sch B markedly increased the expression of SIRT1, SLC7A11, GPX4 and FTH1 while reducing the expression patterns by Ex-527 treatment. Our experimental data suggest that Sch B protects against Ang II-induced ferroptosis, atrial fibrosis, and AF by activating SIRT1 in vivo and in vitro.
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Affiliation(s)
- Mengqing Shi
- Graduate School, Shanghai University of Traditional Chinese Medicine (SHUTCM), Shanghai, 201203, China
| | - Zhongping Ning
- Shanghai University of Traditional Chinese Medicine (SHUTCM), Shanghai, 201203, China.
- Department of Cardiology, Shanghai Pudong New Area Zhoupu Hospital (Shanghai Health Medical College Affiliated Zhoupu Hospital), No.1500 Zhou Yuan Road, Pudong New District, Shanghai, 201318, China.
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Chen Y, Zhuang J, Li X, Zhang C, Cao X, Xu Z, Feng X. The relationship between the 3D electroanatomical mapping parameters of the left atrial posterior wall and the recurrence of paroxysmal atrial fibrillation. Front Cardiovasc Med 2025; 12:1522807. [PMID: 40027511 PMCID: PMC11868116 DOI: 10.3389/fcvm.2025.1522807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Accepted: 01/27/2025] [Indexed: 03/05/2025] Open
Abstract
Background Pulmonary vein isolation (PVI) remains the cornerstone of catheter ablation in paroxysmal atrial fibrillation (PAF). However, the recurrence of AF after PVI needs further investigation. The left atrial posterior wall (LAPW) is embryologically related to the pulmonary vein and plays an important role in the initiation and maintenance of AF. This study aims to explore the relationship between the 3D electroanatomical mapping parameters of the LAPW and recurrence in patients with PAF. Methods A retrospective analysis was conducted on patients with PAF who underwent PVI. Both clinical and procedural characteristics from the enrolled subjects were collected before PVI. 3D electroanatomical mapping anatomical and electrical parameters were measured and calculated in the CARTO system. Intergroup comparisons and multivariate logistic regression analysis were performed to demonstrate the relationship between the parameters of LAPW and AF recurrence. A combined prediction model for AF recurrence was constructed in this study. Results A total of 120 patients were included in the final analysis. Among procedural characteristics, compared with Group 1 (no recurrence), there was a significantly larger posterior wall surface area (PWSA) (p = 0.013) and a percentage of very low-voltage area (PVLVA) (p < 0.001) in Group 2 (recurrence). Further analysis revealed that there was a significant difference between the two groups in terms of the distribution of VLVA (p = 0.026). Subsequently, in a multivariate logistic regression analysis, both PWSA and PVLVA were found to be independent risk factors for AF recurrence [odds ratio (OR): 1.457, 95% confidence interval (CI): 1.037-2.049, p = 0.030; OR: 1.059, 95% CI: 1.013-1.107, p = 0.012, respectively]. Finally, a prediction model that combined the PWSA with the PVLVA for AF recurrence was constructed to draw the receiver operating characteristic curve. The area under the curve of this model was 0.900 (0.827-0.973) (p < 0.001). The result, evaluated by using the Hosmer-Lemeshow goodness-of-fit test, showed that χ2 = 4.643 (p = 0.796). Conclusions This study demonstrates that both PWSA and PVLVA were independent risk factors for AF recurrence. Moreover, we proposed a model that combined the PWSA with the PVLVA to predict the recurrence of AF, which may provide an approach for screening patients with PAF who may require attention for the LAPW.
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Affiliation(s)
- Yuqiao Chen
- Department of Cardiology, Changzhou Hospital of Traditional Chinese Medicine, Changzhou, Jiangsu, China
| | - Jun Zhuang
- Department of Cardiology, Changzhou Hospital of Traditional Chinese Medicine, Changzhou, Jiangsu, China
| | - Xiaolong Li
- Department of Cardiology, Changzhou Hospital of Traditional Chinese Medicine, Changzhou, Jiangsu, China
| | - Chunqin Zhang
- Department of Cardiology, Changzhou Hospital of Traditional Chinese Medicine, Changzhou, Jiangsu, China
| | - Xinfu Cao
- Department of Cardiology, Changzhou Hospital of Traditional Chinese Medicine, Changzhou, Jiangsu, China
| | - Zhiwei Xu
- Department of Cardiology, Anhui No.2 Provincial People’s Hospital, Hefei, Anhui, China
| | - Xiu Feng
- Department of Echocardiography and Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
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Elendu C, Ogwu NP, Okatta AU, Omeludike EK, Ogelle EC, Obidigbo BT, Joseph MC, Osamuyi EI, Ogidan AO, Jingwa KA, Ottun ARA, Eldorghamy MMF, Gurbanova T, Soltan FEAE, Bhadana U, Nasre VS, Yadav CP, Jaiswal R. Global Research Progress on Radiofrequency Ablation in Cardiology. Ann Med Surg (Lond) 2025; 87:725-747. [PMID: 40110263 PMCID: PMC11918750 DOI: 10.1097/ms9.0000000000002858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Revised: 11/05/2024] [Accepted: 12/01/2024] [Indexed: 03/22/2025] Open
Abstract
Radiofrequency ablation (RFA) has become a cornerstone in treating cardiac arrhythmias, offering a minimally invasive approach to managing conditions such as atrial fibrillation, ventricular tachycardia, and other rhythm disorders. The historical evolution of RFA, from its early inception to its current state, underscores the technological advancements that have significantly enhanced its efficacy and safety. Global trends indicate a steady increase in the adoption of RFA, with notable research contributions from North America, Europe, and Asia. Comparative studies reveal outcome variability driven by differences in patient populations, procedural techniques, and healthcare infrastructures. Despite its success, RFA faces challenges, including complications related to the procedure, patient selection, and long-term efficacy. Emerging technologies, such as integrating artificial intelligence and enhanced imaging modalities, hold promise for overcoming these barriers and further refining the procedure. Gaps in current research are identified, particularly in understanding the long-term outcomes of RFA and its application in complex arrhythmias. The critical role of RFA in modern cardiology is emphasized, along with the potential for future innovations that could expand its therapeutic utility. This synthesis of the latest evidence provides valuable insights for optimizing the use of RFA in managing cardiac arrhythmias.
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Affiliation(s)
| | | | | | | | | | - Babajide T Obidigbo
- York and Scarborough Teaching Hospital NHS Foundation Trust, York, United Kingdom
| | - Mary C Joseph
- Ivan Horbachevsky Ternopil National Medical University, Ukraine
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10
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Dong F, Wu Y, Wang Q, Huang Y, Wu Q. Factors influencing patient engagement in decision-making for catheter ablation of atrial fibrillation: a cross-sectional survey. Eur J Cardiovasc Nurs 2025; 24:150-157. [PMID: 39397539 DOI: 10.1093/eurjcn/zvae141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 08/06/2024] [Accepted: 10/09/2024] [Indexed: 10/15/2024]
Abstract
AIMS Patient engagement in decision-making could improve healthcare quality and health outcome, which has been emphasized in atrial fibrillation (AF) management guidelines. However, patients report relatively low level of engagement in decision-making for catheter ablation (CA). Therefore, this study aims to explore the influencing factors of AF patient engagement in decision-making for CA. METHODS AND RESULTS A cross-sectional study was conducted. A total of 836 patients were recruited from six tertiary hospitals in Shanghai. Adapted version of the Control Preferences Scale, Chinese version of the All Aspects of Health Literacy Scale, Chinese version of the Facilitation of Patient Involvement Scale, and the Atrial Fibrillation Knowledge Questionnaire were used to measure patient engagement in decision-making, health literacy, perception of physician facilitation, and AF knowledge, respectively. Of the 750 patients who returned valid questionnaires, 20.2% of the patients reported active engagement in decision-making, 39.5% reported collaborative engagement, and 40.3% reported passive engagement. Compared with patients perceiving passive engagement, those with collaborative or active engagement were more likely to be female and have higher income, moderate European Heart Rhythm Association (EHRA) class (II and III), higher perception of physician facilitation, higher health literacy, and higher AF knowledge (P < 0.05 for all). The collaborative engagement group exhibited a shorter AF duration. CONCLUSION The degree of patient engagement in CA decision-making varied, with most perceiving passive engagement. Patient engagement in decision-making was influenced by gender, income, duration of AF, EHRA class, perception of physician facilitation, health literacy, and AF knowledge.
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Affiliation(s)
- Fengwei Dong
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaping Wu
- Department of Gastroenterology and Rheumatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Wang
- School of Nursing, Shanghai Jiao Tong University, No. 227 South Chongqing Road, 200025 Shanghai, China
| | - Yan Huang
- Coronary Care Unit, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Wu
- School of Nursing, Shanghai Jiao Tong University, No. 227 South Chongqing Road, 200025 Shanghai, China
- Faculty of Education, East China Normal University, Shanghai, China
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11
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Sukaina M, Waheed M, Rehman S, Hasibuzzaman MA, Meghani R. Demographic trends in mortality with older population due to atrial fibrillation and flutter from 1999-2020. World J Cardiol 2025; 17:99933. [PMID: 39866211 PMCID: PMC11755128 DOI: 10.4330/wjc.v17.i1.99933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Revised: 12/07/2024] [Accepted: 01/07/2025] [Indexed: 01/21/2025] Open
Abstract
Atrial fibrillation (AF)/atrial flutter (AFL) is the most common sustained cardiac arrhythmia. The known risk factors for developing AF/AFL include age, structural heart disease, hypertension, diabetes mellitus, or hyperthyroidism. This study aims to attribute the trends in AF/AFL-related mortalities over the past two decades 1999-2020 concerning race and sex and disparity among them. To the best of our knowledge, this is the first study that estimates the trends and mortality due to AF/AFL from 1999-2020 in older adults in the United States. In this 21-year analysis of mortality data, we found a constant increase in mortality rates due to AF/AFL in older adults. From 1999 to 2020, the overall mortality in older adults aged 65 and above, regardless of sex and race, is found to be almost doubled i.e. about a 50.2% increase in the number of deaths due to AF/AFL. Furthermore, other confounding risk factors such has obesity, prior myocardial infarction, inflammation, hypertension, birth weight, diabetes mellitus, hyperthyroidism, hormone replacement therapy in menopausal women increases the risk in the occurrence or recurrent occurrence of AF.
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Affiliation(s)
- Mahnoor Sukaina
- Department of Internal Medicine, Karachi Medical and Dental College, Karachi 75270, Pakistan
| | - Marium Waheed
- Department of Internal Medicine, Karachi Medical and Dental College, Karachi 75270, Pakistan
| | - Shafi Rehman
- Department of Histopathology, Khyber Medical University, Peshawar, 25000, Pakistan
| | - Md Al Hasibuzzaman
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka 1000, Bangladesh.
| | - Rabab Meghani
- Department of Bioethics, Columbia University, New York, NY 10027, United States
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12
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Yu Q, Zhao L, Tang T, Xin Z, Feng L, Rao X, Shi Y, Tong X, Hu S, You Y, Zhang S, Tang J, Cheng Y, Zhang X, Wang M, Li X. Estimates and trends in death and disability from atrial fibrillation/atrial flutter due to high sodium intake, China, 1990 to 2019. BMC Cardiovasc Disord 2025; 25:49. [PMID: 39863875 PMCID: PMC11762119 DOI: 10.1186/s12872-024-04449-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 12/23/2024] [Indexed: 01/27/2025] Open
Abstract
OBJECTIVE The effect of sodium intake on atrial fibrillation (AF)/atrial flutter (AFL), with respect to sex and age, has yet to be elucidated. This study aims to compare long-term trends in AF/AFL death and disability due to high sodium intake in China from 1990 to 2019. METHODS We utilized data from the Global Burden of Disease study to assess the mortality and disability burden of AF/AFL attributable to high sodium intake (> 5 g/d) in China from 1990 to 2019. Overtime trends and average annual percentage change (AAPC) were analyzed with adjustments for age, sex, period, and cohorts. RESULTS In 2019, the number of AF/AFL deaths and disability-adjusted life years attributable to high sodium intake were 4209.944 (95% UI: [1250.690-8718.238]) and 235484.586 (95% UI: [89136.783-428566.694]), with males comprising 44.81% and 51.95% of cases, respectively. The age-standardized mortality rates (ASMRs) and age-standardized disability rates (ASDRs) of AF/AFL attributable to high sodium intake exhibited downward trends from 1990 to 2019 in China. The AAPC was - 0.221(95% CI: -0.321-0.121)and - 0.631(95% CI: -0.816-0.446) for AF/AFL, respectively. An upward trend was observed in ASMRs for AF and AFL, attributable to high sodium intake due to high salt intake at ages 30-34, 35-39, and 40-44. With an increase in age, the AAPC for ASMRs increased correspondingly, and the AAPC for ASDRs exhibited a decreasing trend. CONCLUSIONS Our findings provide strong evidence that high sodium levels in China significantly affect standard ASMRs and ASDRs for AF and AFL. Notably, different patterns of change are identified across various age groups, emphasizing the pronounced effect of salt reduction on AF and AFL.
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Affiliation(s)
- Qingwen Yu
- Department of Cardiology, Affiliated Hospital of Hangzhou Normal University, Zhejiang Key Laboratory of Medical Epigenetics, School of Basic Medical Sciences,Hangzhou Institute of Cardiovascular Diseases, Engineering Research Center of Mobile Health Management System & Ministry of Education, Hangzhou Normal University, Hangzhou, 310015, China
| | - Lijun Zhao
- Cancer Center, Department of Nuclear Medicine, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, China
| | - Ting Tang
- Department of Cardiology, Affiliated Hospital of Hangzhou Normal University, Zhejiang Key Laboratory of Medical Epigenetics, School of Basic Medical Sciences,Hangzhou Institute of Cardiovascular Diseases, Engineering Research Center of Mobile Health Management System & Ministry of Education, Hangzhou Normal University, Hangzhou, 310015, China
| | - Ziyi Xin
- Department of Cardiology, Affiliated Hospital of Hangzhou Normal University, Zhejiang Key Laboratory of Medical Epigenetics, School of Basic Medical Sciences,Hangzhou Institute of Cardiovascular Diseases, Engineering Research Center of Mobile Health Management System & Ministry of Education, Hangzhou Normal University, Hangzhou, 310015, China
| | - Lanlan Feng
- Department of Cardiology, Affiliated Hospital of Hangzhou Normal University, Zhejiang Key Laboratory of Medical Epigenetics, School of Basic Medical Sciences,Hangzhou Institute of Cardiovascular Diseases, Engineering Research Center of Mobile Health Management System & Ministry of Education, Hangzhou Normal University, Hangzhou, 310015, China
| | - Xiyun Rao
- Department of Cardiology, Affiliated Hospital of Hangzhou Normal University, Zhejiang Key Laboratory of Medical Epigenetics, School of Basic Medical Sciences,Hangzhou Institute of Cardiovascular Diseases, Engineering Research Center of Mobile Health Management System & Ministry of Education, Hangzhou Normal University, Hangzhou, 310015, China
| | - Yongmin Shi
- Department of Cardiology, Affiliated Hospital of Hangzhou Normal University, Zhejiang Key Laboratory of Medical Epigenetics, School of Basic Medical Sciences,Hangzhou Institute of Cardiovascular Diseases, Engineering Research Center of Mobile Health Management System & Ministry of Education, Hangzhou Normal University, Hangzhou, 310015, China
| | - Xuhan Tong
- Department of Cardiology, Affiliated Hospital of Hangzhou Normal University, Zhejiang Key Laboratory of Medical Epigenetics, School of Basic Medical Sciences,Hangzhou Institute of Cardiovascular Diseases, Engineering Research Center of Mobile Health Management System & Ministry of Education, Hangzhou Normal University, Hangzhou, 310015, China
| | - Siqi Hu
- Department of Cardiology, Affiliated Hospital of Hangzhou Normal University, Zhejiang Key Laboratory of Medical Epigenetics, School of Basic Medical Sciences,Hangzhou Institute of Cardiovascular Diseases, Engineering Research Center of Mobile Health Management System & Ministry of Education, Hangzhou Normal University, Hangzhou, 310015, China
| | - Yao You
- Department of Cardiology, Affiliated Hospital of Hangzhou Normal University, Zhejiang Key Laboratory of Medical Epigenetics, School of Basic Medical Sciences,Hangzhou Institute of Cardiovascular Diseases, Engineering Research Center of Mobile Health Management System & Ministry of Education, Hangzhou Normal University, Hangzhou, 310015, China
| | - Shenghui Zhang
- Department of Cardiology, Affiliated Hospital of Hangzhou Normal University, Zhejiang Key Laboratory of Medical Epigenetics, School of Basic Medical Sciences,Hangzhou Institute of Cardiovascular Diseases, Engineering Research Center of Mobile Health Management System & Ministry of Education, Hangzhou Normal University, Hangzhou, 310015, China
| | - Jiake Tang
- Department of Cardiology, Affiliated Hospital of Hangzhou Normal University, Zhejiang Key Laboratory of Medical Epigenetics, School of Basic Medical Sciences,Hangzhou Institute of Cardiovascular Diseases, Engineering Research Center of Mobile Health Management System & Ministry of Education, Hangzhou Normal University, Hangzhou, 310015, China
| | - Yongran Cheng
- School of Public Health, Hangzhou Medical College, Hangzhou, 311300, China
| | - Xingwei Zhang
- Department of Cardiology, Affiliated Hospital of Hangzhou Normal University, Zhejiang Key Laboratory of Medical Epigenetics, School of Basic Medical Sciences,Hangzhou Institute of Cardiovascular Diseases, Engineering Research Center of Mobile Health Management System & Ministry of Education, Hangzhou Normal University, Hangzhou, 310015, China
| | - Mingwei Wang
- Department of Cardiology, Affiliated Hospital of Hangzhou Normal University, Zhejiang Key Laboratory of Medical Epigenetics, School of Basic Medical Sciences,Hangzhou Institute of Cardiovascular Diseases, Engineering Research Center of Mobile Health Management System & Ministry of Education, Hangzhou Normal University, Hangzhou, 310015, China.
- Jiande First People's Hospital, Hangzhou, 311600, China.
| | - Ximin Li
- Department of Cardiology, Affiliated Hospital of Hangzhou Normal University, Zhejiang Key Laboratory of Medical Epigenetics, School of Basic Medical Sciences,Hangzhou Institute of Cardiovascular Diseases, Engineering Research Center of Mobile Health Management System & Ministry of Education, Hangzhou Normal University, Hangzhou, 310015, China.
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13
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Sharashova E, Gerdts E, Ball J, Schnabel RB, Stylidis M, Tiwari S, Mathiesen EB, Wilsgaard T, Løchen ML. Long-term pulse pressure trajectories and risk of incident atrial fibrillation: the Tromsø Study. Eur Heart J 2025:ehaf005. [PMID: 39820670 DOI: 10.1093/eurheartj/ehaf005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 09/09/2024] [Accepted: 01/01/2025] [Indexed: 01/19/2025] Open
Abstract
BACKGROUND AND AIMS Sex-based differences in the association of long-term trends in pulse pressure with future risk of atrial fibrillation (AF) have been explored using data from the population-based Tromsø Study 1986-2016. METHODS Women (n = 8331) and men (n = 7638) aged ≥20 years who attended at least two of the three Tromsø Study surveys conducted between 1986 and 2001 (the exposure period) were followed up for incident AF throughout 2016 (the follow-up period). Pulse pressure ≥60 mmHg was considered elevated. Group-based trajectory modelling and Cox regression were used for statistical analyses. RESULTS Three long-term trajectory groups for pulse pressure were identified: Group 1 had normal pulse pressure throughout the exposure period, Group 2 had normal pulse pressure at the beginning and elevated pulse pressure at the end of the exposure period, and Group 3 had elevated pulse pressure throughout. Over the follow-up period, 568 (6.8%) women and 798 (10.5%) men developed AF. After adjustment for potential confounders at baseline, the long-term trajectory groups for elevated pulse pressure were associated with increased risk of AF in women, but not in men. In women, the adjusted hazard ratios of AF were 1.60 (95% confidence interval: 1.23, 2.09) for trajectory Group 2 and 2.78 (1.93, 4.02) for trajectory Group 3, compared with Group 1. CONCLUSIONS Long-term elevated pulse pressure trajectories were independently associated with increased risk of AF in women, but not in men. Our findings call for further investigations to understand the mechanisms behind these sex-based differences.
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Affiliation(s)
- Ekaterina Sharashova
- Department of Community Medicine, UiT The Arctic University of Norway, PO Box 6050 Stakkevollan, N-9037 Tromsø, Norway
- Department of Cardiology, University Hospital of North Norway, Postbox 100, 9038 Tromsø, Norway
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jocasta Ball
- Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Renate B Schnabel
- Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Michael Stylidis
- Department of Cardiology, University Hospital of North Norway, Postbox 100, 9038 Tromsø, Norway
| | - Sweta Tiwari
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Research and Innovation Department, Førde Health Trust, Førde, Norway
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, PO Box 6050 Stakkevollan, N-9037 Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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14
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Nayak T, Christensen JT, Bardsley T, Barnes GD, Cameron KA, Passman R, Kansal P, Witt DM, Cavanaugh KL, Fagerlin A, Ozanne EM. Evaluation of patient and encounter decision aid interventions for atrial fibrillation: Baseline characteristics of the RED-AF study - A Randomized Controlled Trial. Contemp Clin Trials 2025; 148:107773. [PMID: 39645031 DOI: 10.1016/j.cct.2024.107773] [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: 05/15/2024] [Revised: 11/18/2024] [Accepted: 11/29/2024] [Indexed: 12/09/2024]
Abstract
BACKGROUND The Randomized Evaluation of Decision Support Interventions for Atrial Fibrillation (RED-AF) trial is a multi-site, randomized controlled clinical trial examining the effectiveness of a patient decision aid and an encounter decision aid in promoting shared decision-making (SDM) during a clinical encounter for patients with atrial fibrillation (AF). We sought to describe baseline characteristics of patients and clinicians in the trial and compare them to the demographics of the larger AF population. We also conducted an analysis of possible predictors of attrition rates at baseline, 6 and 12 months. METHODS This study was a multi-center randomized controlled trial conducted at six academic centers across the U.S. Patients with non-valvular AF who qualify for anticoagulation therapy were eligible for enrollment. Patient demographics and characteristics were evaluated via questionnaires after their baseline clinical encounter. Participating clinicians completed demographic surveys, reporting educational background, specialty, and years of experience. Patient characteristics were analyzed via univariate logistic regression to identify potential trends among those lost to follow-up at each timepoint. FINDINGS A total of 1117 patients were enrolled in the RED-AF trial, with an average age of 69 (SD 9.3). Patients were predominantly male (61.7 %) and white (89.1 %), with 33.7 % reporting graduate or professional education. Clinicians (N = 107) were enrolled from specialties including cardiology (68.2 %), internal medicine (13.1 %), and pharmacy (14.0 %). No significant associations were found between any measured patient characteristics with survey completion at baseline, 6 or 12 months. CONCLUSION The baseline demographics of the RED-AF trial reflect that patient participants were largely similar to prior studies investigating shared-decision making in patients with AF. The lack of association between patient demographics and attrition rates may highlight equity across the tested subgroups for survey completion for the study as a whole.
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Affiliation(s)
- Tanvi Nayak
- Northwestern University Feinberg School of Medicine, USA
| | - Joshua T Christensen
- Department of Population Health Sciences, University of Utah School of Medicine, USA
| | - Tyler Bardsley
- Department of Population Health Sciences, University of Utah School of Medicine, USA
| | - Geoffrey D Barnes
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, USA
| | - Kenzie A Cameron
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, USA
| | - Rod Passman
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, USA
| | - Preeti Kansal
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, USA
| | - Daniel M Witt
- Department of Population Health Sciences, University of Utah School of Medicine, USA; Department of Pharmacotherapy, University of Utah College of Pharmacy, USA
| | - Kerri L Cavanaugh
- Division of Nephrology & Hypertension, Department of Medicine, Vanderbilt University Medical Center, USA
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah School of Medicine, USA
| | - Elissa M Ozanne
- Department of Population Health Sciences, University of Utah School of Medicine, USA.
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15
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Irfan A, Riggs DW, Koromia GA, Gao H, DeFilippis AP, Soliman EZ, Bhatnagar A, Carll AP. Smoking-associated electrocardiographic abnormalities predict cardiovascular mortality. Sci Rep 2024; 14:31189. [PMID: 39730843 DOI: 10.1038/s41598-024-82503-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/05/2024] [Indexed: 12/29/2024] Open
Abstract
Background -Smoking is associated with arrhythmia and sudden cardiac death, but the biological mechanisms remain unclear. In electrocardiogram (ECG) recordings abnormal durations of ventricular repolarization (QT interval), atrial depolarization (P wave), and atrioventricular depolarization (PR interval and segment), predict cardiac arrhythmia and mortality. Previous analyses of the National Health and Nutrition Examination Survey (NHANES) database for associations between smoking and ECG abnormalities were incomplete. To elucidate how smoking affects cardiac excitation, we assessed in a nationally representative sample (NHANES III) the association between serum cotinine and P duration, PR interval, PR segment, rate-corrected QT (QTc), QRS duration, and JT interval. Methods and Results-We analyzed data from 5,653 adults using survey-weighted multinomial logistic regression to estimate associations between tobacco use (> 15 ng/ml serum cotinine) and short (< 5th percentile) or long (> 95th percentile) ECG intervals, relative to reference (5-95th percentile). After adjustment for demographics, risk factors, and conduction-altering medications, smoking was associated with a higher odds of short PR interval, PR segment, and QRS, and long JT. Broader effects of smoking on ECG were also assessed by survey-weighted linear regression of continuous cotinine and ECG, which revealed cotinine inversely associated with PR segment and QTc. Over a 22-year follow-up, many ECG abnormalities predicted cardiovascular mortality in smokers, including long JT, QRS, and QTc, and short QRS, whereas only short JT predicted mortality in nonsmokers. Conclusions -Smoking increases likelihood for rapid atrioventricular and ventricular depolarization and slow ventricular repolarization, which may promote cardiac arrhythmia and mortality.
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Affiliation(s)
- Affan Irfan
- Department of Cardiology, Mayo Clinic, Rochester, MN, USA
- Department of Cardiology Services, Department of Clinical & Translational Sciences, Marshall University, Huntington, WV, USA
- Department of Physiology, School of Medicine, University of Louisville, Louisville, KY, USA
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, USA
| | - Daniel W Riggs
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, USA
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
| | - George A Koromia
- Department of Cardiology Services, Department of Clinical & Translational Sciences, Marshall University, Huntington, WV, USA
| | - Hong Gao
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, USA
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
| | - Andrew Paul DeFilippis
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, USA
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA
- Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Aruni Bhatnagar
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, USA
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA
- Center for Cardiometabolic Science, School of Medicine, University of Louisville, Louisville, KY, USA
- Center for Integrative and Environmental Health Sciences, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Alex P Carll
- Department of Physiology, School of Medicine, University of Louisville, Louisville, KY, USA.
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY, USA.
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX, USA.
- Center for Cardiometabolic Science, School of Medicine, University of Louisville, Louisville, KY, USA.
- Center for Integrative and Environmental Health Sciences, School of Medicine, University of Louisville, Louisville, KY, USA.
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16
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Huang JY, Cai AP, Tsang CTW, Wu MZ, Gu WL, Guo R, Zhang JN, Zhu CY, Hung YM, Lip GYH, Yiu KH. The association of haemoglobin A1c variability with adverse outcomes in patients with atrial fibrillation prescribed anticoagulants. Eur J Prev Cardiol 2024; 31:2073-2083. [PMID: 39140113 DOI: 10.1093/eurjpc/zwae249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/20/2024] [Accepted: 07/17/2024] [Indexed: 08/15/2024]
Abstract
AIMS The association of haemoglobin A1c (HbA1c) variability with the risk of adverse outcomes in patients with atrial fibrillation (AF) prescribed anticoagulants remains unclear. This study aimed to evaluate the association of HbA1c variability with the risk of ischaemic stroke (IS)/systemic embolism (SE) and all-cause mortality among patients with non-valvular AF prescribed anticoagulants. METHODS AND RESULTS Patients newly diagnosed with AF from 2013 to 2018 were included. Variability in HbA1c, indexed by the coefficient of variation (CV), was determined for those with at least three HbA1c measurements available from the time of study enrolment to the end of follow-up. To evaluate whether prevalent diabetes would modify the relationship between HbA1c variability and outcomes, participants were divided into diabetes and non-diabetes groups. The study included 8790 patients (mean age 72.7% and 48.5% female). Over a median follow-up of 5.5 years (interquartile range 5.2, 5.8), the incident rate was 3.74 per 100 person-years for IS/SE and 4.89 for all-cause mortality in the diabetes group. The corresponding incident rates in the non-diabetes group were 2.41 and 2.42 per 100 person-years. In the diabetes group, after adjusting for covariates including mean HbA1c, greater HbA1c variability was significantly associated with increased risk of IS/SE [hazard ratio (HR) = 1.65, 95% confidence interval (CI): 1.27-2.13) and all-cause mortality (HR = 1.24, 95% CI: 1.05-1.47) compared with the lowest CV tertile. A similar pattern was evident in the non-diabetes group (IS/SE: HR = 1.58, 95% CI: 1.23-2.02; all-cause mortality: HR = 1.35, 95% CI: 1.10-1.64). CONCLUSION Greater HbA1c variability was independently associated with increased risk of IS/SE and all-cause mortality among patients with AF, regardless of diabetic status.
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Affiliation(s)
- Jia-Yi Huang
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shen Zhen Hospital, Shen Zhen, 518000, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Room 1929B/K1931, Block K, Hong Kong, 999077, China
| | - An-Ping Cai
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Christopher Tze Wei Tsang
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Room 1929B/K1931, Block K, Hong Kong, 999077, China
| | - Mei-Zhen Wu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Room 1929B/K1931, Block K, Hong Kong, 999077, China
| | - Wen-Li Gu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Room 1929B/K1931, Block K, Hong Kong, 999077, China
| | - Ran Guo
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Room 1929B/K1931, Block K, Hong Kong, 999077, China
| | - Jing-Nan Zhang
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Room 1929B/K1931, Block K, Hong Kong, 999077, China
| | - Ching-Yan Zhu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Room 1929B/K1931, Block K, Hong Kong, 999077, China
| | - Yik-Ming Hung
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Room 1929B/K1931, Block K, Hong Kong, 999077, China
| | - Gregory Y H Lip
- Department of Cardiology, Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, L14 3PE, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, DK-9220, Denmark
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong-Shen Zhen Hospital, Shen Zhen, 518000, China
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Room 1929B/K1931, Block K, Hong Kong, 999077, China
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17
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He Q, Fan X, Li B, He Q, Cao Y, Zhang H. Prognostic Value of Four Objective Nutritional Indices in Predicting Long-Term Prognosis in Elderly Patients with Atrial Fibrillation: A Retrospective Cohort Study. Clin Interv Aging 2024; 19:2043-2056. [PMID: 39649109 PMCID: PMC11625436 DOI: 10.2147/cia.s493726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Accepted: 11/21/2024] [Indexed: 12/10/2024] Open
Abstract
Background Several objective and comprehensive nutritional assessment methods have been used for predicting adverse outcomes in elderly patients with various diseases. However, their predictive value for long-term adverse outcomes in elderly patients with atrial fibrillation (AF) is unclear. This study aimed to explore the prognostic significance of the four nutritional indices, namely Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), Controlling Nutritional Status (CONUT), and High-Sensitivity Modified Glasgow Prognostic Score (HS-mGPS), in evaluating the long-term prognosis in elderly patients with AF. Methods This retrospective study was conducted at a single center and included a total of 261 elderly patients with AF from December 2015 to December 2021. Patients were divided into all-cause death and survival groups based on the follow-up results. Kaplan-Meier analysis and COX regression were conducted to explore the relationship between all-cause mortality and nutritional scores. In addition, Receiver Operating Characteristic (ROC) curves were used to compare the predictive value of the four nutritional screening tools for the endpoint event. Results During the follow-up period, 119 cases (45.59%) of all-cause mortality were recorded. The cumulative incidence of all-cause death was significantly higher in participants with a lower PNI, lower GNRI, higher CONUT, and higher HS-mGPS levels. And the low PNI (HR 1.325, 95% CI 1.032-2.857, P=0.025) and the high HS-mGPS (HR 2.166, 95% CI 1.281-4.326, P=0.023) groups were independently and significantly associated with increased risk of all-cause death analyzed by multivariate COX regression. Additionally, PNI showed the best area under the curve value (AUC: 0.696, 95% CI 0.632-0.760 P < 0.001) for the prediction of all-cause mortality compared with the other nutritional indices. Conclusion Among the four nutritional risk screening tools, PNI might be a simple and useful indicator in predicting the long-term prognosis of elderly patients with AF.
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Affiliation(s)
- Qingwei He
- The Fifth School of Clinical Medicine, Air Force Clinical Medical School, Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
| | - Xingman Fan
- Department of Cardiology, Air Force Medical Center, Air Force Medical University, PLA, Beijing, 100142, People’s Republic of China
- Graduate School, Hebei North University, Zhangjiakou, Hebei, 075000, People’s Republic of China
| | - Bowen Li
- Graduate School, Hebei North University, Zhangjiakou, Hebei, 075000, People’s Republic of China
| | - Qiongyi He
- The Fifth School of Clinical Medicine, Air Force Clinical Medical School, Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
| | - Yukun Cao
- Department of Cardiology, Air Force Medical Center, Air Force Medical University, PLA, Beijing, 100142, People’s Republic of China
| | - Haitao Zhang
- The Fifth School of Clinical Medicine, Air Force Clinical Medical School, Anhui Medical University, Hefei, Anhui, 230032, People’s Republic of China
- Department of Cardiology, Air Force Medical Center, Air Force Medical University, PLA, Beijing, 100142, People’s Republic of China
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18
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Terada T, Keir DA, Murias JM, Vidal-Almela S, Buckley J, Reed JL. Variability of cardiopulmonary exercise testing in patients with atrial fibrillation and determination of exercise responders to high-intensity interval training and moderate-to-vigorous intensity continuous training. Appl Physiol Nutr Metab 2024; 49:1636-1645. [PMID: 39116459 DOI: 10.1139/apnm-2024-0060] [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] [Indexed: 08/10/2024]
Abstract
Disabling atrial fibrillation (AF)-related symptoms and different testing settings may influence day-to-day cardiopulmonary exercise testing (CPET) measurements, which can affect exercise prescription for high-intensity interval training (HIIT) and moderate-to-vigorous intensity continuous training (M-VICT) and their outcomes. This study examined the reliability of CPET in patients with AF and assessed the proportion of participants achieving minimal detectable changes (MDC) in peak oxygen consumption (V̇O2peak) following HIIT and M-VICT. Participants were randomized into HIIT or M-VICT after completing two baseline CPETs: one with cardiac stress technologists (CPETdiag) and the other with a research team of exercise specialists (CPETresearch). Additional CPET was completed following 12 weeks of twice-weekly training. The reliability of CPETdiag and CPETresearch was assessed by intraclass correlation coefficient (ICC) and dependent t tests. The MDC score was calculated for V̇O2peak using a reliable change index. The proportion of participants achieving MDC was compared between HIIT and M-VICT using chi-square analysis. Eighteen participants (69 ± 7 years, 33% females) completed two baseline CPETs. The ICCs were significant for all measured variables. However, peak power output (POpeak: 124 ± 40 vs. 148 ± 40 watts, p < 0.001) and HR (HRpeak: 136 ± 22 vs. 148 ± 30 bpm, p = 0.023) were significantly greater in CPETresearch than CPETdiag. Few participants achieved MDC in V̇O2peak (5.6 mL/kg/min) with no difference between HIIT (0%) and M-VICT (10.0%, p = 0.244). POpeak and HRpeak differed significantly in patients with AF when CPETs were repeated under different settings. Caution must be practised when prescribing exercise intensity based on these measures as under-prescription may increase the number of exercise non-responders.
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Affiliation(s)
- Tasuku Terada
- School of Life Sciences, Division of Physiology, Pharmacology, and Neuroscience, University of Nottingham, Nottingham, UK
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Daniel A Keir
- School of Kinesiology, The University of Western Ontario, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Cardiac Rehabilitation and Secondary Prevention Program, St. Joseph's Health Care, London, ON, Canada
| | - Juan M Murias
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
| | - Sol Vidal-Almela
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - John Buckley
- School of Allied Health Professions, Keele University, Stafford, UK
| | - Jennifer L Reed
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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19
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Nielsen MT, Hykkelbjerg Nielsen M, Andersen S, Riahi S, Geisler UW, Lynge Pedersen M, Albertsen N. Quality of care among patients diagnosed with atrial fibrillation in Greenland. Int J Circumpolar Health 2024; 83:2311965. [PMID: 38332615 PMCID: PMC10860410 DOI: 10.1080/22423982.2024.2311965] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024] Open
Abstract
This cross-sectional study sought to assess the prevalence of atrial fibrillation (AF) diagnosis in Greenland among various age groups and examine the corresponding quality of care. We collected data from Greenland's electronic medical records and evaluated the quality of care using six internationally recommended indicators, which are: percentage of AF patients with an assessment of smoking status within the previous year, an assessment of body mass index within the previous year, assessment of blood pressure within the previous year, measurement of thyroid stimulating hormone (TSH), treatment with an anticoagulant and percentage of patients with a measurement of serum-creatinine. We found the prevalence of AF among patients aged 20 years or older in Greenland to be 1.75% (95% CI 1.62-1.88). We found an increasing prevalence of AF with age and a greater proportion of men than women until the age of 74 years. Our study suggests that the associated quality of care could be higher as the requirement of only one of the six quality indicators was met. A lack of registration may partly explain this, and initiatives to improve the quality of care are recommended.
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Affiliation(s)
| | - Maja Hykkelbjerg Nielsen
- Steno Diabetes Centre Greenland, Queen Ingrid’s Hospital, Nuuk, Greenland
- Greenland Centre for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
- Department of Clinical Medicine, Incuba/Skejby, Aarhus University Hospital, Aarhus, Denmark
| | - Stig Andersen
- Greenland Centre for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, University of Aalborg, Aalborg, Denmark
| | - Sam Riahi
- Department of Clinical Medicine, University of Aalborg, Aalborg, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Michael Lynge Pedersen
- Steno Diabetes Centre Greenland, Queen Ingrid’s Hospital, Nuuk, Greenland
- Greenland Centre for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | - Nadja Albertsen
- Greenland Centre for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, University of Aalborg, Aalborg, Denmark
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20
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O'Keefe EL, O'Keefe JH, Abuissa H, Metzinger M, Murray E, Franco G, Lavie CJ, Harris WS. Omega-3 and Risk of atrial fibrillation: Vagally-mediated double-edged sword. Prog Cardiovasc Dis 2024:S0033-0620(24)00168-3. [PMID: 39617283 DOI: 10.1016/j.pcad.2024.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 11/26/2024] [Indexed: 12/08/2024]
Abstract
OBJECTIVE Studies regarding effects of omega-3 fatty acids, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), on risk of atrial fibrillation (AF) have reported discordant results. The aim of this review is to clarify effects of marine omega-3 intake on risk of AF. PATIENTS AND METHODS A PubMed search was performed using terms: atrial fibrillation, omega-3, EPA, DHA, vagal tone. We summarized findings from randomized clinical trials (RCTs), epidemiology studies, and meta-analyses evaluating effects/associations of DHA + EPA on risk of AF. Also, vagal tone was explored as a mediator between omega-3 and risk of AF. RESULTS Meta-analyses of 8 RCTs and 17 prospective cohort studies comprised of 83,112 and 54,799 individuals, respectively, investigated the link between omega-3 intake and incident AF. The RCTs reported that treatment with DHA and/or EPA was associated with a 24 % increased relative risk of AF (absolute risk 4.0 % vs 3.3 %; relative risk [RR] 1.24, 95 % confidence interval [CI] 1.11-1.38, p = 0.0002). This was dose-dependent; DHA + EPA doses of ∼1000 mg/d increased AF risk ∼12 %, whereas 1800 to 4000 mg/d increased AF risk by ∼50 %. In contrast, observational studies focused on DHA + EPA blood levels or dietary intake have generally reported that higher omega-3 levels/consumption are associated with lower AF risk. Maximal AF risk reduction. (12 %) occurred at ∼650 mg/d of dietary DHA + EPA. Other studies have indicated that omega-3 fatty acids can dose-dependently increase vagal tone, which could explain the biphasic relationship between DHA + EPA and AF risk. Experimental studies show that low-level vagal stimulation decreases risk of AF, whereas high-level vagal stimulation increases risk of AF. CONCLUSION Higher consumption of dietary omega-3 is associated with decreased AF risk. In contrast, pharmaceutical dosing of omega-3 increases AF in a dose-dependent manner, which may be mediated by vagal tone.
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Affiliation(s)
- Evan L O'Keefe
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, United States of America
| | - James H O'Keefe
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, United States of America.
| | - Hussam Abuissa
- Department of Clinical Cardiac Electrophysiology, Creighton University School of Medicine, Omaha, NE, United States of America
| | - Mark Metzinger
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, United States of America
| | - Ellen Murray
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, United States of America
| | - Grant Franco
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, United States of America
| | - Carl J Lavie
- Oschner Heart and Vascular Institute, New Orleans, LA, United States of America
| | - William S Harris
- Fatty Acid Research Institute, Sioux Falls, SD, United States of America; Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, United States of America
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21
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Liu Y, Pang X, Wang Y, Liu X, Jiang H. Evaluation of the efficacy and safety of acupuncture assisted treatment for atrial fibrillation: A systematic review and meta-analysis based on randomized controlled trials. Medicine (Baltimore) 2024; 103:e40474. [PMID: 39612438 PMCID: PMC11608700 DOI: 10.1097/md.0000000000040474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 10/24/2024] [Indexed: 12/01/2024] Open
Abstract
BACKGROUND To systematically evaluate the efficacy and safety of acupuncture in the treatment of atrial fibrillation (AF). METHODS Eight databases were searched. The search time limit is from January 2000 to November 2023. All randomized controlled trials on acupuncture treatment of AF were included. After the literature screening, data extraction and quality evaluation were carried out independently according to the inclusion and exclusion criteria, and the included literature was analyzed by Meta using RevMan 5.4 software. RESULTS A total of 15 research studies on randomized controlled trials were included, involving 1960 patients. The results of the meta-analysis showed that acupuncture therapy could increase the sinus cardioversion rate of patients with AF, and the difference was statistically significant (relative risk = 1.21, 25% confidence interval (CI) [1.11, 1.31], P < .001). The clinically effective rate of the acupuncture plus drug treatment group was higher than that of the drug treatment group (relative risk = 1.32, 95% CI [1.19, 1.46], P < .01). Acupuncture plus other conventional therapies treatment was more helpful in reducing the ventricular rate of patients with AF (mean difference = -7.89, 95% CI [-14.52, -1.26], P = .006). The cardioversion time of patients with AF treated with acupuncture plus conventional therapies was shorter than those treated with traditional therapies alone (standardized mean difference = -1.82, 95% CI [-3.28, -0.35], P = .01). No severe adverse reactions such as hemorrhage, hematoma, or local infection caused by acupuncture were reported in the study. CONCLUSION The available evidence shows that acupuncture can effectively improve the total clinical effective rate and sinus rhythm recovery rate, shorten the recovery time of sinus rhythm, and reduce the ventricular rate, and there are no apparent adverse reactions. However, a limited number of studies may affect the generalizability of the findings. Future studies should include more extensive and diverse studies to enhance the power and generalizability of the findings.
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Affiliation(s)
- Yuqing Liu
- Shandong University of Traditional Chinese Medicine, First Clinical Medical College, Jinan City, Shandong Province, China
| | - Xuemeng Pang
- Shandong Provincial Third Hospital, Jinan City, Shandong Province, China
| | - Yajuan Wang
- Shandong University of Traditional Chinese Medicine, Second Clinical Medical College, Jinan City, Shandong Province, China
| | - Xu Liu
- Shandong University of Traditional Chinese Medicine, First Clinical Medical College, Jinan City, Shandong Province, China
| | - Hongju Jiang
- Shandong University of Traditional Chinese Medicine, First Clinical Medical College, Jinan City, Shandong Province, China
- The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan City, Shandong Province, China
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22
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Lahcen AA, Labib M, Caprio A, Annabestani M, Sanchez-Botero L, Hsue W, Liu CF, Dunham S, Mosadegh B. Design, Testing, and Validation of a Soft Robotic Sensor Array Integrated with Flexible Electronics for Mapping Cardiac Arrhythmias. MICROMACHINES 2024; 15:1393. [PMID: 39597205 PMCID: PMC11596174 DOI: 10.3390/mi15111393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Revised: 11/01/2024] [Accepted: 11/14/2024] [Indexed: 11/29/2024]
Abstract
Cardiac mapping is a crucial procedure for diagnosing and treating cardiac arrhythmias. Still, current clinical techniques face limitations including insufficient electrode coverage, poor conformability to complex heart chamber geometries, and high costs. This study explores the design, testing, and validation of a 64-electrode soft robotic catheter that addresses these challenges in cardiac mapping. A dual-layer flexible printed circuit board (PCB) was designed and integrated with sensors into a soft robotic sensor array (SRSA) assembly. Design considerations included flex PCB layout, routing, integration, conformity to heart chambers, sensor placement, and catheter durability. Rigorous SRSA in vitro testing evaluated the burst/leakage pressure, block force for electrode contact, mechanical integrity, and environmental resilience. For in vivo validation, a porcine model was used to demonstrate the successful deployment, conformability, and acquisition of electrograms in both the ventricles and atria. This catheter-deployable SRSA represents a meaningful step towards translating the integration of soft robotic actuators and stretchable electronics for clinical use, showcasing the unique mechanical and electrical performance that these designs enable. The high-density electrode array enabled rapid 2 s data acquisition with detailed spatial and temporal resolution, as illustrated by the clear and consistent cardiac signals recorded across all electrodes. The future of this work will lie in enabling high-density, anatomically conformable devices for detailed cardiac mapping to guide ablation therapy and other interventions.
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Affiliation(s)
- Abdellatif Ait Lahcen
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Michael Labib
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Alexandre Caprio
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Mohsen Annabestani
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Lina Sanchez-Botero
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Weihow Hsue
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - Christopher F. Liu
- Department of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Simon Dunham
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Bobak Mosadegh
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, Weill Cornell Medicine, New York, NY 10021, USA
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23
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Beisenbayeva A, Bekbossynova M, Bakytzhanuly A, Aleushinova U, Bekmetova F, Chinybayeva A, Abdrakhmanov A, Beyembetova A. Improvements in Cardiopulmonary Exercise Test Results in Atrial Fibrillation Patients After Radiofrequency Ablation in Kazakhstan. Diagnostics (Basel) 2024; 14:2355. [PMID: 39518323 PMCID: PMC11544845 DOI: 10.3390/diagnostics14212355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Revised: 10/14/2024] [Accepted: 10/21/2024] [Indexed: 11/16/2024] Open
Abstract
This prospective study evaluates the impact of radiofrequency ablation (RFA) on cardiorespiratory indicators in patients with long-standing persistent atrial fibrillation admitted to the Heart Center UMC between January 2022 and April 2024 in Astana, Kazakhstan. The study aims to assess the functional cardiac benefits of RFA. Out of 717 registered atrial fibrillation patients, 104 were examined before and 3 months after ablation, focusing on cardiorespiratory parameters. A before-and-after analysis using linear mixed models was applied to evaluate changes in cardiorespiratory parameters post-RFA. Significant improvements were noted across various measures. VO2 max increased from 11.5 ± 4.4 mL/kg/min to 18.0 ± 4.5 mL/kg/min (p < 0.001). Oxygen uptake improved from 7.2 ± 2.6 mL/beat to 11.0 ± 3.4 mL/beat (p < 0.001). The 6-min walking test distance rose from 306 ± 82 m to 400 ± 48 m (p < 0.001). METs increased from 4.4 ± 1.6 to 8.0 ± 1.3 (p < 0.001). Heart rate at peak exercise decreased from 175.5 ± 18.6 to 147.2 ± 12.3 beats per minute (p < 0.001). NT-proBNP levels decreased from 1357 ± 1182 to 415 ± 339 pg/mL (p < 0.001). Patients with persistent atrial fibrillation undergoing RFA showed functional improvements in CPET indicators such as VO2 max, METs, O2 pulse, heart rate, and the 6-min walking test. Improvements were also seen in Nt-proBNP analysis. These results emphasize the need for longitudinal follow-up to optimize outcomes and minimize medical risks.
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Affiliation(s)
- Akmaral Beisenbayeva
- Corporate Fund ”University Medical Center”, Heart Center, Astana 010000, Kazakhstan
- Department of Cardiology, Non-Profit Joint Stock Company “Medical University Astana”, Astana 010000, Kazakhstan; (A.C.); (A.A.)
| | | | - Abay Bakytzhanuly
- Corporate Fund ”University Medical Center”, Heart Center, Astana 010000, Kazakhstan
| | - Uldana Aleushinova
- Corporate Fund ”University Medical Center”, Heart Center, Astana 010000, Kazakhstan
| | - Feruza Bekmetova
- Republican Specialized Scientific Practical-Medical Center of Cardiology, Astana 010000, Kazakhstan
| | - Assel Chinybayeva
- Department of Cardiology, Non-Profit Joint Stock Company “Medical University Astana”, Astana 010000, Kazakhstan; (A.C.); (A.A.)
| | - Ayan Abdrakhmanov
- Department of Cardiology, Non-Profit Joint Stock Company “Medical University Astana”, Astana 010000, Kazakhstan; (A.C.); (A.A.)
| | - Altynay Beyembetova
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan;
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24
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Noubiap JJ, Tang JJ, Teraoka JT, Dewland TA, Marcus GM. Minimum National Prevalence of Diagnosed Atrial Fibrillation Inferred From California Acute Care Facilities. J Am Coll Cardiol 2024; 84:1501-1508. [PMID: 39269390 DOI: 10.1016/j.jacc.2024.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 07/09/2024] [Accepted: 07/12/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Prevalence estimates of atrial fibrillation (AF) from large populations have not been updated for >2 decades. Using data from 1996 to 1997, a previous study projected that there would be 3.3 million adults with AF in the United States in 2020. OBJECTIVES The purpose of this study was to determine the contemporary age-, sex-, and race-standardized prevalence and the number of adults with diagnosed AF in the United States. METHODS We merged California's state-wide health care databases to assemble a cohort of adults aged ≥20 years who received hospital-based care in California from 2005 to 2019. International Classification of Diseases codes were used to identify AF and other comorbidities. After accounting for deaths, we utilized the U.S. Census to calculate the national age-, sex-, and race-standardized estimates of diagnosed AF. RESULTS Of 29,250,310 patients (mean age 50.6 ± 19.8 years, 53.8% women, 50.1% White), 2,003,867 (6.8%) had an AF diagnosis. The proportion of patients with diagnosed AF increased from 4.49% in 2005 to 2009 to 6.82% in 2015 to 2019. Over time, AF patients became relatively younger, were less likely to be female or White, and were more likely to have hypertension and diabetes. Standardizing based on age-, sex-, race-, and ethnicity-based proportions to the U.S. population, we estimate that the current national prevalence of diagnosed AF is at least 10.55 million (95% CI: 10.48-10.62 million), comprising 4.48% (95% CI: 4.47%-4.49%) of the adult population. CONCLUSIONS The prevalence of diagnosed AF in the United States is higher than previously estimated. More efficient prevention and treatment strategies are needed to curb the burden of AF in the United States.
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Affiliation(s)
- Jean Jacques Noubiap
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Janet J Tang
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Justin T Teraoka
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Thomas A Dewland
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Gregory M Marcus
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA.
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25
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Mecha M, Sisay Y, Melaku T. Epidemiology and clinical implications of atrial fibrillation among stroke patients in Ethiopia: a comprehensive systematic review and meta-analysis. BMC Neurol 2024; 24:391. [PMID: 39402449 PMCID: PMC11479544 DOI: 10.1186/s12883-024-03894-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 10/02/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is a significant risk factor for stroke, imposing a substantial burden on healthcare systems. While studies have shown varying AF prevalence among stroke patients, limited pooled data exists in low-resource settings like Ethiopia. This hinders our understanding of the problem's extent and limits effective prevention and management strategies. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence of atrial fibrillation among stroke patients in Ethiopia. METHODS The searches were carried out in electronic databases such as PubMed/MEDLINE, EMBASE, Science Direct, Web of Science, and Google Scholar. Observational study designs were selected, and studies published until 30 November 2023 addressing the prevalence of atrial fibrillation among stroke patients were identified. Endnote citation manager software version X9 for Windows was used to collect and organize the search outcomes and remove duplicate articles. The relevant data were extracted from the included studies using a format prepared in Microsoft Excel and exported to STATA 18.0 software for the outcome measures analyses and subgrouping. RESULTS Twenty-three research articles were included in the final analysis. These studies evaluated a total of 4,544 stroke patients, of whom 529 were diagnosed with atrial fibrillation (AF). The overall pooled prevalence of AF among stroke patients was 13% [95% CI: (10%, 17%)]. Subgroup analysis by region revealed that the highest pooled prevalence of AF was 16% [95% CI: (8%, 25%)] in the Amhara region, followed by the Oromia region at 15% [95% CI: (7%, 23%)]. In Addis Ababa City, the pooled prevalence of AF among stroke patients was 11% [95% CI: (7%, 15%)]. The Tigray region reported a pooled prevalence of 9% [95% CI: (6%, 11%)]. However, one study from the Southern Nations, Nationalities, and Peoples' Region reported a lower prevalence of AF among stroke patients at 7% [95% CI: (3%, 11%)]. CONCLUSION In summary, the study revealed that AF is prevalent among stroke patients in Ethiopia, with regional differences in prevalence. The high prevalence of AF emphasizes the necessity for effective management strategies to prevent recurrent strokes. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD: CRD42024581661.
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Affiliation(s)
- Mohammed Mecha
- Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Yordanos Sisay
- Department of Epidemiology, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | - Tsegaye Melaku
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia.
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26
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Li BMH, Yang ASH, Cheng MCY, Huang HK, Lai ECC. Risk of suicide in patients with atrial fibrillation receiving different oral anticoagulants: a nationwide analysis using target trial emulation framework. BMC Med 2024; 22:451. [PMID: 39394165 PMCID: PMC11470551 DOI: 10.1186/s12916-024-03645-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 09/20/2024] [Indexed: 10/13/2024] Open
Abstract
BACKGROUND The suicide risk in patients with atrial fibrillation receiving novel oral anticoagulants or warfarin has not been evaluated in real-world practice. Moreover, reducing vitamin K levels may increase the suicide risk, underscoring the importance of selecting appropriate oral anticoagulants to prevent unintended outcomes. Therefore, we aimed to evaluate the association between different types of oral anticoagulants and the risk of attempted and completed suicide among patients with atrial fibrillation. METHODS This nationwide study retrieved data from Taiwan's National Health Insurance Research Database from 2012 to 2020. This study included patients with atrial fibrillation aged 20 years and older who newly received oral anticoagulant treatment, and who had no contraindications for NOACs and no history of suicide-related events. The main outcomes were suicide-related outcomes, including attempted suicide and completed suicide. This study employed the target trial emulation framework to improve the causal inference for the observed association. RESULTS: A total of 103,768 (71.74%) patients taking NOACs and 40,877 (28.26%) patients taking warfarin were included in this study. Compared to those receiving warfarin, patients receiving NOACs were associated with a lower risk of suicide-related outcomes (HR, 0.82; 95% CIs, 0.69-0.96). CONCLUSIONS The findings of this cohort study suggested that patients receiving NOACs were associated with a lower risk of suicidal attempts but similar risk of complete suicide, compared to those receiving warfarin. Considering the risk of suicide, NOACs could be the preferred anticoagulants for patients with atrial fibrillation.
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Affiliation(s)
- Brian Meng-Hsun Li
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Population Health Data Center, National Cheng Kung University, Tainan, Taiwan
| | - Avery Shuei-He Yang
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Population Health Data Center, National Cheng Kung University, Tainan, Taiwan
| | - Michael Chun-Yuan Cheng
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Population Health Data Center, National Cheng Kung University, Tainan, Taiwan
| | - Huei-Kai Huang
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Population Health Data Center, National Cheng Kung University, Tainan, Taiwan.
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Timmis A, Aboyans V, Vardas P, Townsend N, Torbica A, Kavousi M, Boriani G, Huculeci R, Kazakiewicz D, Scherr D, Karagiannidis E, Cvijic M, Kapłon-Cieślicka A, Ignatiuk B, Raatikainen P, De Smedt D, Wood A, Dudek D, Van Belle E, Weidinger F. European Society of Cardiology: the 2023 Atlas of Cardiovascular Disease Statistics. Eur Heart J 2024; 45:4019-4062. [PMID: 39189413 DOI: 10.1093/eurheartj/ehae466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/22/2024] [Accepted: 07/03/2024] [Indexed: 08/28/2024] Open
Abstract
This report from the European Society of Cardiology (ESC) Atlas Project updates and expands upon the 2021 report in presenting cardiovascular disease (CVD) statistics for the ESC member countries. This paper examines inequalities in cardiovascular healthcare and outcomes in ESC member countries utilizing mortality and risk factor data from the World Health Organization and the Global Burden of Disease study with additional economic data from the World Bank. Cardiovascular healthcare data were collected by questionnaire circulated to the national cardiac societies of ESC member countries. Statistics pertaining to 2022, or latest available year, are presented. New material in this report includes contemporary estimates of the economic burden of CVD and mortality statistics for a range of CVD phenotypes. CVD accounts for 11% of the EU's total healthcare expenditure. It remains the most common cause of death in ESC member countries with over 3 million deaths per year. Proportionately more deaths from CVD occur in middle-income compared with high-income countries in both females (53% vs. 34%) and males (46% vs. 30%). Between 1990 and 2021, median age-standardized mortality rates (ASMRs) for CVD decreased by median >50% in high-income ESC member countries but in middle-income countries the median decrease was <12%. These inequalities between middle- and high-income ESC member countries likely reflect heterogeneous exposures to a range of environmental, socioeconomic, and clinical risk factors. The 2023 survey suggests that treatment factors may also contribute with middle-income countries reporting lower rates per million of percutaneous coronary intervention (1355 vs. 2330), transcatheter aortic valve implantation (4.0 vs. 153.4) and pacemaker implantation (147.0 vs. 831.9) compared with high-income countries. The ESC Atlas 2023 report shows continuing inequalities in the epidemiology and management of CVD between middle-income and high-income ESC member countries. These inequalities are exemplified by the changes in CVD ASMRs during the last 30 years. In the high-income ESC member countries, ASMRs have been in steep decline during this period but in the middle-income countries declines have been very small. There is now an important need for targeted action to reduce the burden of CVD, particularly in those countries where the burden is greatest.
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Affiliation(s)
- Adam Timmis
- The William Harvey Research Institute, Queen Mary University London, London E1 4NS, UK
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, and EpiMaCT, Inserm 1098/IRD270, Limoges University, Limoges, France
| | - Panos Vardas
- Biomedical Research Foundation Academy of Athens and Hygeia Hospitals Group, HHG, Athens, Greece
- European Society of Cardiology, European Heart Agency, European Heart Health Institute, Brussels, Belgium
| | - Nick Townsend
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol BS8 1TZ, UK
| | - Aleksandra Torbica
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Radu Huculeci
- European Society of Cardiology, European Heart Agency, European Heart Health Institute, Brussels, Belgium
| | - Denis Kazakiewicz
- European Society of Cardiology, European Heart Agency, European Heart Health Institute, Brussels, Belgium
| | - Daniel Scherr
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Efstratios Karagiannidis
- Second Department of Cardiology, General Hospital 'Hippokration', Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marta Cvijic
- Department of Cardiology, University Medical Centre Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Barbara Ignatiuk
- Department of Cardiology, Humanitas Gavazzeni University Hospital, Bergamo, Italy
| | - Pekka Raatikainen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Angela Wood
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Dariusz Dudek
- Instytut Kardiologii, Uniwersytet Jagielloński, Collegium Medicum, Kraków, Poland
| | - Eric Van Belle
- Cardiologie, Institut cœur-poumon, CHU de Lille, Lille, France
| | - Franz Weidinger
- Department of Cardiology and Intensive Care Medicine, Landstrasse Clinic, Vienna, Austria
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Yuniadi Y, Supit AI, Hanafy DA, Raharjo SB, Hermanto DY, Basalamah F, Hartono B, Agustinus R, Chandranegara AF, Ahmad C, Iqbal M, Tondas AE, El‐Rasyid H, Haryadi H, Lukito AA, Tanubudi D, Yansen I, Maharani E, Julario R, Rizal A, Antara PS, Amir M. Prevalence of atrial fibrillation based on tertiary hospital survey in Indonesia: A smartphone-based diagnosis. J Arrhythm 2024; 40:1102-1107. [PMID: 39416241 PMCID: PMC11474569 DOI: 10.1002/joa3.13137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/17/2024] [Accepted: 08/13/2024] [Indexed: 10/19/2024] Open
Abstract
Objective Atrial fibrillation (AF) is one of the most common arrhythmic disorders worldwide. This study aims to describe the prevalence of AF in various cities in Indonesia using single-lead hand held electrocardiography linked to a smartphone-based application. Methods This is a cross-sectional epidemiological study conducted at tertiary hospital of major cities in Indonesia, between January 2018 and July 2019. The AliveCor Kardia™ Mobile system device was used as a screening tool for AF and confirmed its finding with clinical diagnoses made by cardiologists. Results A total of 9773 subjects were enrolled in this study. The prevalence of AF reported by the device and cardiologist was 3.2% and 3.5%, respectively. AF prevalences are equal in men than women. The majority of subjects (56%) are having low risk for stroke or systemic thromboembolism. Prevalence of risk factors such as heart failure, hypertension, diabetes, and history of stroke among AF patients were 50%, 22.9%, 31.9%, 13.5%, and 5.8%, respectively. Conclusion The prevalence of AF at referral hospitals visitors based on smartphone diagnosis in Indonesia is 3.2%.
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Affiliation(s)
- Yoga Yuniadi
- National Cardiovascular Center Harapan Kita, Jakarta and Department of Cardiology and Vascular MedicineFaculty of Medicine, Universitas IndonesiaJakartaIndonesia
| | - Alice I. Supit
- National Cardiovascular Center Harapan Kita, Jakarta and Department of Cardiology and Vascular MedicineFaculty of Medicine, Universitas IndonesiaJakartaIndonesia
| | - Dicky A. Hanafy
- National Cardiovascular Center Harapan Kita, Jakarta and Department of Cardiology and Vascular MedicineFaculty of Medicine, Universitas IndonesiaJakartaIndonesia
| | - Sunu B. Raharjo
- National Cardiovascular Center Harapan Kita, Jakarta and Department of Cardiology and Vascular MedicineFaculty of Medicine, Universitas IndonesiaJakartaIndonesia
| | - Dony Y. Hermanto
- National Cardiovascular Center Harapan Kita, Jakarta and Department of Cardiology and Vascular MedicineFaculty of Medicine, Universitas IndonesiaJakartaIndonesia
| | - Faris Basalamah
- Mitra Keluarga Hospital Bekasi Timur, West JavaBekasiIndonesia
| | | | | | | | - Chaerul Ahmad
- Hasan Sadikin Hospital, Bandung, and Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas PadjadjaranBandungIndonesia
| | - Mohammad Iqbal
- Hasan Sadikin Hospital, Bandung, and Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas PadjadjaranBandungIndonesia
| | | | - Hauda El‐Rasyid
- M Djamil Hospital, Padang, West Sumatera and Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas AndalasPadangIndonesia
| | | | | | | | | | - Erika Maharani
- Sardjito Hospital, Yogyakarta, and Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Gajah MadaYogyakartaIndonesia
| | - Rerdin Julario
- Sutomo District Hospital, Surabaya, and Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas AirlanggaEast JavaIndonesia
| | - Ardian Rizal
- Saiful Anwar Hospital, Malang, and Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas BrawijayaMalangIndonesia
| | - Putra S. Antara
- IGNG Ngoerah Hospital, Denpasar, Bali, and Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas UdayanaBaliIndonesia
| | - Muzakkir Amir
- Wahidin Sudirohusodo Hospital, Makassar, South Sulawesi, and Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas HasanuddinMakassarIndonesia
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Ji Y, Ning Z. Paeoniflorin Inhibits Atrial Fibrosis and Atrial Fibrillation in Angiotensin II-Infused Mice Through the PI3K-Akt Pathway. Dose Response 2024; 22:15593258241277919. [PMID: 39469468 PMCID: PMC11514121 DOI: 10.1177/15593258241277919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 08/05/2024] [Indexed: 10/30/2024] Open
Abstract
Objective: The investigation aimed to analyze the effect of Paeoniflorin (PF) on the initiation of atrial fibrosis and atrial fibrillation (AF) induced by angiotensin II (Ang II) and explore its associated underlying mechanism. Introduction: PF has anti-inflammatory, immunomodulatory, antioxidant, hepatoprotective, and hypolipidemic properties. However, the protective effect of PF against atrial fibrosis and AF remains unclear. Methods: Male C57BL/6 mice aged 8-10 weeks, with 40 individuals, were subjected to subcutaneous infusion of either saline or Ang II at a dosage of 2.0 mg/kg/day. Furthermore, PF at a dosage of 100 mg/kg/day was administered through gavage once daily for 28 days. Morphological, histological, and biochemical examinations were undertaken. AF was elicited through in vivo transesophageal burst pacing. Results: PF treatment significantly improved AF in Ang II-infused mice. In addition, PF attenuated cardiac hypertrophy, atrial fibrotic area, atrial apoptosis and oxidative stress in Ang II-induced mice. The effect of PF on the PI3K-Akt pathway reduced the expression of phosphoinositide 3-kinase (p-PI3K) and Phosphorylated Akt (p-Akt) in Ang II-induced mice. Conclusion: PF may, therefore, avert Ang II-induced atrial fibrosis and AF by inhibiting the PI3K-Akt pathway.
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Affiliation(s)
- Yaqiong Ji
- Department of Cardiology, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhongping Ning
- Department of Cardiology, Shanghai Pudong New Area Zhoupu Hospital(Shanghai Health Medical College Affiliated Zhoupu Hospital), Shanghai, China
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Leven C, Delavenne X, Roche C, Bressollette L, Couturaud F, Lacut K, Thereaux J. Full-dose rivaroxaban in patients with a history of bariatric surgery: bridging the knowledge gap through a phase 1 study. J Thromb Haemost 2024; 22:2844-2854. [PMID: 39002729 DOI: 10.1016/j.jtha.2024.06.024] [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: 03/14/2024] [Revised: 06/14/2024] [Accepted: 06/24/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Bariatric surgery (BS) induces significant changes in gastrointestinal anatomy, potentially influencing the pharmacokinetics of orally administered drugs such as rivaroxaban. OBJECTIVES This phase 1 study aimed to assess the pharmacokinetics and safety of full-dose rivaroxaban in post-BS patients. METHODS The ABSORB (Rivaroxaban Pharmacokinetics and Pharmacodynamics After Bariatric Surgery and in Morbid Obesity) study was a single-center, nonrandomized, multiple-dose, parallel-design bioequivalence trial. Adult patients with stable weight after Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) were compared with subjects with class III obesity and healthy controls. Participants received 20 mg of rivaroxaban daily for 8 days. RESULTS Post-BS patients exhibited altered rivaroxaban pharmacokinetics, suggesting reduced absorption. Mean area under the concentration-time curve from time 0 to 24 hours after the first dose (RYGB, 1806.8 ng.h/mL; SG, 1648.9 ng.h/mL) was lower compared with that in controls (1893.5 ng.h/mL). At steady state, the area under the concentration-time curve values remained lower in BS groups (RYGB, 2129.9 ng.h/mL; SG, 1946.4 ng.h/mL) than in controls (2224.8 ng.h/mL). The maximum concentration after the first dose was lower in post-RYGB subjects (214.9 ng/mL) than in controls (264.1 ng/mL). This difference was less pronounced at steady state (RYGB, 256.9 ng/mL vs controls, 288.8 ng/mL). Neither BS group met bioequivalence criteria compared with controls, whereas the group with class III obesity met bioequivalence criteria compared with controls at steady state. CONCLUSION Rivaroxaban displayed minor pharmacokinetic variations in post-BS patients. Given reported interindividual variability in the general population, these variations are unlikely to be of clinical significance. Our findings support rivaroxaban use in BS patients, emphasizing the need for further research in this area.
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Affiliation(s)
- Cyril Leven
- Institut national de la santé et de la recherche médicale, Unité Mixte de Recherche 1304 (Groupe d'étude de la thrombose de Bretagne occidentale), University of Brest, Brest, France; Department of Biochemistry and Pharmaco-Toxicology, Centre Hospitalier Universitaire Brest, Brest, France.
| | - Xavier Delavenne
- Institut national de la santé et de la recherche médicale, Unité Mixte de Recherche 1059 (Santé ingénierie biologie Saint-Etienne), Université Jean Monnet Saint-Étienne, Mines Saint-Étienne, Saint-Étienne, France
| | - Charles Roche
- Department of General, Digestive and Metabolic Surgery, Centre Hospitalier Universitaire Brest, Brest, France
| | - Luc Bressollette
- Institut national de la santé et de la recherche médicale, Unité Mixte de Recherche 1304 (Groupe d'étude de la thrombose de Bretagne occidentale), University of Brest, Brest, France; Department of Internal Medicine, Vascular Medicine and Pneumology, Centre Hospitalier Universitaire Brest, Brest, France
| | - Francis Couturaud
- Institut national de la santé et de la recherche médicale, Unité Mixte de Recherche 1304 (Groupe d'étude de la thrombose de Bretagne occidentale), University of Brest, Brest, France; Department of Internal Medicine, Vascular Medicine and Pneumology, Centre Hospitalier Universitaire Brest, Brest, France
| | - Karine Lacut
- Institut national de la santé et de la recherche médicale, Unité Mixte de Recherche 1304 (Groupe d'étude de la thrombose de Bretagne occidentale), University of Brest, Brest, France; Department of Internal Medicine, Vascular Medicine and Pneumology, Centre Hospitalier Universitaire Brest, Brest, France
| | - Jérémie Thereaux
- Institut national de la santé et de la recherche médicale, Unité Mixte de Recherche 1304 (Groupe d'étude de la thrombose de Bretagne occidentale), University of Brest, Brest, France; Department of General, Digestive and Metabolic Surgery, Centre Hospitalier Universitaire Brest, Brest, France
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31
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Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns HJGM, De Potter TJR, Dwight J, Guasti L, Hanke T, Jaarsma T, Lettino M, Løchen ML, Lumbers RT, Maesen B, Mølgaard I, Rosano GMC, Sanders P, Schnabel RB, Suwalski P, Svennberg E, Tamargo J, Tica O, Traykov V, Tzeis S, Kotecha D. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2024; 45:3314-3414. [PMID: 39210723 DOI: 10.1093/eurheartj/ehae176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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Welfordsson P, Danielsson AK, Björck C, Grzymala-Lubanski B, Hambraeus K, Lidin M, Haugen Löfman I, Scheffel Birath C, Nilsson O, Braunschweig F, Wallhed Finn S. Feasibility of alcohol interventions in cardiology: a qualitative study of clinician perspectives in Sweden. Eur J Cardiovasc Nurs 2024; 23:668-674. [PMID: 38445448 DOI: 10.1093/eurjcn/zvae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 03/07/2024]
Abstract
AIMS This study aimed to identify barriers and facilitators to implementing alcohol screening and brief interventions (SBI) in cardiology services. METHODS AND RESULTS This was a qualitative study. Individual, semi-structured interviews were conducted with 24 clinical cardiology staff (doctors, nurses, and assistant nurses) of varying experience levels and from various clinical settings (high-dependency unit, ward, and outpatient clinic), in three regions of Sweden. Reflexive thematic analysis was used, with deductive coding applying the Capability, Opportunity, Motivation (COM-B) theoretical framework. A total of 41 barriers and facilitators were identified, including 12 related to capability, 9 to opportunity, and 20 to motivation. Four themes were developed: (i) uncharted territory, where clinicians expressed a need to address alcohol use but lacked knowledge and a roadmap for implementing SBI; (ii) cardiology as a cardiovascular specialty, where tasks were prioritized according to established roles; (iii) alcohol stigma, where alcohol was reported to be a sensitive topic that staff avoid discussing with patients; and (iv) window of opportunity, where staff expressed potential for implementing SBI in routine cardiology care. CONCLUSION Findings suggest that opportunities exist for early identification and follow-up of hazardous alcohol use within routine cardiology care. Several barriers, including low knowledge, stigma, a lack of ownership, and a greater focus on other risk factors, must be addressed prior to the implementation of SBI in cardiology. To meet current clinical guidelines, there is a need to increase awareness and to improve pathways to addiction care. In addition, there may be a need for clinicians dedicated to alcohol interventions within cardiology services. REGISTRATION OSF (osf.io/hx3ts).
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Affiliation(s)
- Paul Welfordsson
- Department of Global Public Health, Karolinska Institutet, 113 65 Solna, Sweden
| | | | - Caroline Björck
- Department of Women's and Children's Health, Akademiska sjukhuset, Uppsala University, 752 37 Uppsala, Sweden
- Centre for Research and Development, Region Gävleborg, 801 88 Gävle, Sweden
- Department of Caring Sciences, University of Gävle, 801 76 Gävle, Sweden
| | - Bartosz Grzymala-Lubanski
- Centre for Research and Development, Region Gävleborg, 801 88 Gävle, Sweden
- Department of Public Health and Clinical Medicine, Umeå University, 907 37 Umeå, Sweden
- Department of Cardiology, Gävle Hospital, 801 88 Gävle, Sweden
| | | | - Matthias Lidin
- Department of Medicine Solna, Karolinska Institutet, 171 64 Stockholm, Sweden
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Ida Haugen Löfman
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, 171 76 Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, 141 52 Stockholm, Sweden
| | | | - Olga Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, 171 64 Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, 171 76 Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, 141 52 Stockholm, Sweden
| | - Sara Wallhed Finn
- Department of Global Public Health, Karolinska Institutet, 113 65 Solna, Sweden
- Centre for Dependency Disorders, 11435 Stockholm, Sweden
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Chinyere TC, Chinyere IR. Management of Left Atrial Tachyrhythms in the Setting of HFpEF with Pulsed-Field Ablation: Treating Fire with Water? THERAPEUTICS 2024; 1:42-51. [PMID: 39398098 PMCID: PMC11467807 DOI: 10.3390/therapeutics1010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/15/2024]
Abstract
Atrial fibrillation (AF) in the setting of heart failure (HF) with preserved ejection fraction (HFpEF) is a prevalent comorbidity and is enabled by adverse left atrial (LA) remodeling, dilation, and scar tissue formation. These changes are facilitated by poor left ventricular compliance. A growing body of clinical evidence and medical guidelines suggest that managing atrial tachyrhythms with catheter ablation (CA) is paramount to treating concomitant HF. This recommendation is complicated in that thermal CA modalities, namely radiofrequency ablation and cryoablation, are both therapeutic via inducing additional scar tissue. AF treatment with thermal CA may compound the atrial scar burden for patients who already have extensive scars secondary to HFpEF. Therefore, thermal CA could act as "gasoline" to the slowly burning "fire" within the LA, increasing the rate of AF recurrence. Pulsed-field ablation (PFA), which utilizes high-voltage irreversible electroporation, is a non-thermal CA technique that is capable of disrupting reentrant microcircuits and arrhythmogenic foci without inducing significant scar burden. PFA has the potential to mitigate the strong fibrosis response to thermal CA that predisposes to AF by serving as "water" rather than "gasoline". Thus, PFA may increase the efficacy and durability of CA for AF in HFpEF, and subsequently, may decrease the risk of procedural complications from repeat CAs. In this article, we provide a summary of the clinical concepts underlying HFpEF and AF and then summarize the data to date on the potential of PFA being a superior CA technique for AF in the setting of comorbid HFpEF.
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Affiliation(s)
| | - Ikeotunye Royal Chinyere
- Sarver Heart Center, University of Arizona, Tucson, AZ 85724, USA
- Banner University Medicine, Banner University Medical Center—Tucson, Banner Health, Tucson, AZ 85719, USA
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Zuhair M, Keene D, Kanagaratnam P, Lim PB. Percutaneous Neuromodulation for Atrial Fibrillation. Card Electrophysiol Clin 2024; 16:281-296. [PMID: 39084721 DOI: 10.1016/j.ccep.2023.09.001] [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] [Indexed: 08/02/2024]
Abstract
Percutaneous neuromodulation is emerging as a promising therapeutic approach for atrial fibrillation (AF). This article explores techniques such as ganglionated plexi (GP) ablation, and vagus nerve stimulation, pinpointing their potential in modulating AF triggers and maintenance. Noninvasive methods, such as transcutaneous low-level tragus stimulation, offer innovative treatment pathways, with early trials indicating a significant reduction in AF burden. GP ablation may address autonomic triggers, and the potential for GP ablation in neuromodulation is discussed. The article stresses the necessity for more rigorous clinical trials to validate the safety, reproducibility, and efficacy of these neuromodulation techniques in AF treatment.
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Affiliation(s)
- Mohamed Zuhair
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK.
| | - Daniel Keene
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK
| | - Prapa Kanagaratnam
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK
| | - Phang Boon Lim
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12, UK
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35
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Vidal-Almela S, Marçal IR, Wong J, Terada T, Nguyen BO, Joensen AM, Mills MT, Bittman J, Prud'Homme D, Reed JL. Sex Differences in Changes in Cardiorespiratory Fitness and Additional Health Outcomes Following Exercise Training in Adults With Atrial Fibrillation: A Systematic Review and Meta-Analysis. J Cardiopulm Rehabil Prev 2024; 44:E52-E63. [PMID: 39240677 DOI: 10.1097/hcr.0000000000000891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
PURPOSE Improving cardiorespiratory fitness (CRF) through exercise training is associated with lower morbidity and mortality in patients with atrial fibrillation (AF). Smaller CRF improvements have been suggested in females than males with cardiovascular disease following exercise training. This systematic review compared changes in CRF (primary) and additional physical and mental health outcomes following exercise training between females and males with AF. REVIEW METHODS Five bibliographic databases were searched to identify prospective studies implementing exercise training in patients with AF. The mean difference (MD) in the change following exercise training was compared between sexes using random-effects meta-analyses. SUMMARY Sex-specific data were obtained from 19 of 63 eligible studies, with 886 participants enrolled in exercise training (n = 259 [29%] females; female: 68 ± 7 years, male: 66 ± 8 years). Exercise training was 6 weeks to 1 year in duration and mostly combined moderate- to vigorous-intensity aerobic and resistance training, 2 to 6 d/wk. Changes in CRF did not differ between sexes (MD = 0.15: 95% CI, -1.08 to 1.38 mL O2/kg/min; P = .81; I2 = 27%). Severity of AF (MD = 1.00: 95% CI, 0.13-1.87 points; I2 = 0%), general health perceptions (MD = -3.71: 95% CI, -6.88 to -0.55 points; I2 = 22%), and systolic blood pressure (MD = 3.11: 95% CI, 0.14-6.09 mmHg; I2 = 42%) improved less in females than in males. Females may benefit from more targeted exercise training programs given their smaller improvement in several health outcomes than males. However, our findings are largely hypothesis-generating, considering the limited sample size and underrepresentation of females (29% females in our review vs 47% females with AF globally).
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Affiliation(s)
- Sol Vidal-Almela
- Author Affiliations: Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada (Dr Vidal-Almela, Mss Marçal and Wong, and Drs Terada and Reed); School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada (Dr Vidal-Almela, Mss Marçal and Wong, and Dr Reed); Physiology, Pharmacology and Neuroscience, School of Life Sciences, University of Nottingham, Queen's Medical Center, Nottingham, United Kingdom (Dr Terada); Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands (Dr Nguyen); Department of Cardiology, North Denmark Regional Hospital, Hjoerring, Denmark (Dr Joensen); Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (Dr Mills); Division of Community Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (Dr Bittman); Université de Moncton, Moncton, New Brunswick, Canada (Dr Prud'homme); and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada (Dr Reed)
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Fang CW, Hsieh CY, Yang HY, Tsai CF, Sung SF. Comparative effectiveness and safety of direct oral anticoagulants and warfarin in atrial fibrillation patients with dementia. Eur Stroke J 2024:23969873241274598. [PMID: 39215489 PMCID: PMC11569543 DOI: 10.1177/23969873241274598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 07/24/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION Developing an effective stroke prevention strategy is crucial for elderly atrial fibrillation (AF) patients with dementia. This is due to the limited and inconsistent evidence available on this topic. In this nationwide, population-based cohort study, we aim to compare the effectiveness and safety of direct oral anticoagulants (DOACs) and warfarin in AF patients with dementia. PATIENTS AND METHODS We identified AF patients with dementia, aged 50 years or older, from Taiwan's National Health Insurance Research Database between 2010 and 2019. The primary outcome was a composite of hospitalizations due to ischemic stroke, acute myocardial infarction, intracranial hemorrhage, or major bleeding, as well as all-cause mortality. We used 1:1 propensity score matching and Cox proportional hazard models to adjust for confounding factors when comparing outcomes between warfarin and DOAC (apixaban, dabigatran, edoxaban, or rivaroxaban) users or warfarin and each individual DOAC. RESULTS There were 2952 patients in the DOAC-warfarin matched cohort. The apixaban-, dabigatran-, edoxaban-, and rivaroxaban-warfarin matched cohorts had 2346, 2554, 1684, and 2938 patients, respectively. The DOAC group, when compared to warfarin, was associated with a lower risk of both the composite outcome (hazard ratio (HR), 0.81; 95% confidence interval (CI) 0.69-0.95) and ischemic stroke (HR 0.65; 95% CI 0.48-0.87). Apixaban (HR 0.79; 95% CI 0.66-0.94), dabigatran (HR 0.64; 95% CI 0.53-0.77), and rivaroxaban (HR 0.82; 95% CI 0.70-0.97) were also associated with a lower risk of the composite outcome. DISCUSSION AND CONCLUSION Compared to warfarin, DOACs, whether as a group or apixaban, dabigatran, or rivaroxaban individually, were associated with a reduced risk of the composite outcome in elderly patients with concurrent AF and dementia.
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Affiliation(s)
- Chen-Wen Fang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan City, Taiwan
- Department of Neurology, National Taiwan University Hospital, Yunlin Branch, Douliu City, Taiwan
| | - Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan
| | - Hsin-Yi Yang
- Clinical Data Center, Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Ching-Fang Tsai
- Clinical Data Center, Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
- Department of Nursing, Fooyin University, Kaohsiung, Taiwan
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Tang J, Zhang Q, Peng S, Li H, Hu W, Hao M, Liu Y, Sun M, Cao W, Yin N, Liu X, Xu T. Differences in global, regional, and national time trends in disability-adjusted life years for atrial fibrillation and flutter, 1990-2019: an age-period-cohort analysis from the 2019 global burden of disease study. Front Cardiovasc Med 2024; 11:1401722. [PMID: 39267808 PMCID: PMC11390633 DOI: 10.3389/fcvm.2024.1401722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 08/14/2024] [Indexed: 09/15/2024] Open
Abstract
Background Atrial fibrillation and flutter, collectively referred to as AF/AFL, pose substantial public health challenges across nations of different economic statuses. Abjective This research is intended to assess the discrepancies in global, regional, and national trends in DALYs for atrial fibrillation and flutter throughout 1990 and 2019. Methods The GBD 2019 report included statistics on AF/AFL. An age-period-cohort (APC) model was used to calculate the changes in DALYs from ages 30 to 34 years up to 95 + years. The model calculated both net drifts and local drifts in DALYs. In addition, we analysed the relative risks for certain time periods and birth cohorts from 1990 to 2019 in order to assess their impact. In order to measure the changes over time in the age-standardized rate (ASR) of DALYs caused by AF/AFL, we calculated the average annual percentage changes (AAPCs) based on age, gender, socio-demographic index (SDI), and location. This approach enables us to analyse the impact of age, period, and cohort on trends in DALYs, which may uncover disparities in the management of AF/AFL. Results The global number of DALYs cases was 8,393,635 [95% uncertainty interval (UI): 6,693,987 to 10,541,461], indicating a 121.6% rise (95% UI: 111.5 to 132.0) compared to 1990. From 1990 to 2019, the worldwide ASR of DALYs decreased by 2.61% (95% UI -6.9 to 1.3). However, the other SDI quintiles, except for high SDI and high-middle SDI, had an increase. During the last three decades, high-income nations in the Asia Pacific region had the most significant reduction in ASR of DALYs, whereas Central Asia experienced the highest rise (with a net drift of -0.9% [95% Confidence Interval (CI): -1.0 to -0.9] and 0.6% [95% CI: 0.5 to 0.7], respectively). Approximately 50% of the burden of AF/AFL has been transferred from areas with high and high-middle SDI to those with lower SDI. There was an inverse relationship between the AAPC and the SDI. In addition, men and older individuals were shown to have a greater burden of AF/AFL DALYs. Conclusion The findings of this research demonstrate that the worldwide impact of AF/AFL remains significant and increasing, with the burden differing depending on SDI. The exhaustive and comparable estimates provided by these results may contribute to international efforts to attain equitable AF/AFL control.
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Affiliation(s)
- Juan Tang
- Department of Scientific Research, Zigong First People's Hospital, Zigong, China
| | - Qingwei Zhang
- Division of Gastroenterology and Hepatology, Key Laboratory Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Shengxian Peng
- Department of Scientific Research, Zigong First People's Hospital, Zigong, China
| | - Huan Li
- Chongqing College of Electronic Engineering, Chongqing, China
| | - Weike Hu
- Department of Scientific Research, Zigong First People's Hospital, Zigong, China
| | - Min Hao
- Department of Scientific Research, Zigong First People's Hospital, Zigong, China
| | - Yue Liu
- Department of Scientific Research, Zigong First People's Hospital, Zigong, China
| | - Mengyan Sun
- Department of Continuing Education, Oxford University, Oxford, United Kingdom
| | - Wenzhai Cao
- Department of Cardiology, Zigong First People's Hospital, Zigong, China
| | - Niying Yin
- Department of Blood Transfusion, Suqian First Hospital, Suqian, China
| | - Xiaozhu Liu
- Department of Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Te Xu
- Department of Cardiovascular Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Yuan Y, Zhang H, Xia E, Zhao X, Gao Q, Mu H, Liu X, Tian Y, Liu L, Shen Q, Sheng L. BMP2 Diminishes Angiotensin II-Induced Atrial Fibrillation by Inhibiting NLRP3 Inflammasome Signaling in Atrial Fibroblasts. Biomolecules 2024; 14:1053. [PMID: 39334820 PMCID: PMC11430365 DOI: 10.3390/biom14091053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/10/2024] [Accepted: 08/13/2024] [Indexed: 09/30/2024] Open
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia to affect 1% of the global population and increases with age. Atrial fibrosis is a crucial substrate for promoting structural remodeling to cause atrial arrhythmogenesis. Bone morphogenic protein 2 (BMP2) has been reported to be involved in cardiac fibrogenesis. However, its role in modulating atrial fibrosis to affect AF development remains unknown. Our study aimed to investigate the expression of BMP2 under different AF conditions and the effect of BMP2 on the progression of atrial fibrosis using an angiotensin II (Ang II) rat model and an ex vivo cardiac fibroblast model. The qRT-PCR and Western blot assay showed increased BMP2 mRNA and protein levels in the atria of chronic AF patients and the right atria of a tachypacing rabbit model. In contrast, the levels of BMP2 receptor mRNA were comparable. The AF incidence of the Ang II rat was higher than that of a control rat, which was reduced by BMP2 treatment. Masson staining demonstrated an anti-fibrogenic impact on BMP2-subjected rat atria compared to only Ang II-treated rat atria. RNA-sequencing indicated the potential function of blocking NLRP3-associted inflammasome activation in BMP2-treated rat atrial tissues. In vitro, transfecting BMP2 shRNA into neonatal rat atrial fibroblasts upregulated the mRNA levels of NLRP3/Caspase-1/p20/ASC and the secretion of IL-1β and IL-6. In contrast, recombinant BMP2 protein attenuated the increased levels of the NLRP3 inflammasome pathway induced by Ang II. In summary, BMP2 opposes atrial fibrosis to alleviate AF susceptibility by inhibiting the activation of the inflammasome in atrial fibroblasts.
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Affiliation(s)
- Yue Yuan
- Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
| | - Hang Zhang
- Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
| | - Erwen Xia
- Department of General Medicine, The First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
| | - Xinbo Zhao
- Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
| | - Qiang Gao
- Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
| | - Hongyuan Mu
- Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
| | - Xingzuo Liu
- Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
| | - Yuanye Tian
- Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
| | - Lei Liu
- Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
| | - Qiuling Shen
- Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
| | - Li Sheng
- Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin 150001, China
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Mehani SHM, Helmy ZM, Adel W, Mohamed MI. Revealing the role of high-intensity interval training combined with inspiratory muscle training on atrial fibrillation associated with chronic heart failure: is there a shift towards anti-remodelling adaptation? Eur J Prev Cardiol 2024; 31:1420-1424. [PMID: 38551090 DOI: 10.1093/eurjpc/zwae125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 03/13/2024] [Accepted: 03/24/2024] [Indexed: 06/09/2024]
Affiliation(s)
- Sherin Hassan Mohammed Mehani
- Physical Therapy Department for Cardiovascular/Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Beni-Suef University, Nile East Compus, New Beni Suef City, Beni-Suef 2730430, Egypt
| | - Zeinab Mohammed Helmy
- Physical Therapy Department for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Walaa Adel
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud Ibrahim Mohamed
- Physical Therapy Department for Cardiovascular/Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Beni-Suef University, Nile East Compus, New Beni Suef City, Beni-Suef 2730430, Egypt
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Ren J, Wang H, Lai S, Shao Y, Che H, Xue Z, Qi X, Zhang S, Dai J, Wang S, Li K, Gan W, Si Q. Machine learning-based model to predict composite thromboembolic events among Chinese elderly patients with atrial fibrillation. BMC Cardiovasc Disord 2024; 24:420. [PMID: 39134969 PMCID: PMC11321189 DOI: 10.1186/s12872-024-04082-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 07/30/2024] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVE Accurate prediction of survival prognosis is helpful to guide clinical decision-making. The aim of this study was to develop a model using machine learning techniques to predict the occurrence of composite thromboembolic events (CTEs) in elderly patients with atrial fibrillation(AF). These events encompass newly diagnosed cerebral ischemia events, cardiovascular events, pulmonary embolism, and lower extremity arterial embolism. METHODS This retrospective study included 6,079 elderly hospitalized patients (≥ 75 years old) with AF admitted to the People's Liberation Army General Hospital in China from January 2010 to June 2022. Random forest imputation was used for handling missing data. In the descriptive statistics section, patients were divided into two groups based on the occurrence of CTEs, and differences between the two groups were analyzed using chi-square tests for categorical variables and rank-sum tests for continuous variables. In the machine learning section, the patients were randomly divided into a training dataset (n = 4,225) and a validation dataset (n = 1,824) in a 7:3 ratio. Four machine learning models (logistic regression, decision tree, random forest, XGBoost) were trained on the training dataset and validated on the validation dataset. RESULTS The incidence of composite thromboembolic events was 19.53%. The Least Absolute Shrinkage and Selection Operator (LASSO) method, using 5-fold cross-validation, was applied to the training dataset and identified a total of 18 features that exhibited a significant association with the occurrence of CTEs. The random forest model outperformed other models in terms of area under the curve (ACC: 0.9144, SEN: 0.7725, SPE: 0.9489, AUC: 0.927, 95% CI: 0.9105-0.9443). The random forest model also showed good clinical validity based on the clinical decision curve. The Shapley Additive exPlanations (SHAP) showed that the top five features associated with the model were history of ischemic stroke, high triglyceride (TG), high total cholesterol (TC), high plasma D-dimer, age. CONCLUSIONS This study proposes an accurate model to stratify patients with a high risk of CTEs. The random forest model has good performance. History of ischemic stroke, age, high TG, high TC and high plasma D-Dimer may be correlated with CTEs.
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Affiliation(s)
- Jiefeng Ren
- Department of Geriatric Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Medical School of Chinese PLA, Beijing, 100853, China
| | - Haijun Wang
- Department of Geriatric Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Song Lai
- Department of the Third Health Care, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Yi Shao
- Health Management Center, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, 250012, Shandong, China
| | - Hebin Che
- Medical Big Data Research Center, Chinese PLA General Hospital, Fuxing Road 28#, Haidian district, Beijing, 100853, China
| | - Zaiyao Xue
- Department of Geriatric Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Medical School of Chinese PLA, Beijing, 100853, China
| | - Xinlian Qi
- Department of Geriatric Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Medical School of Chinese PLA, Beijing, 100853, China
| | - Sha Zhang
- Department of Geriatric Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Medical School of Chinese PLA, Beijing, 100853, China
| | - Jinkun Dai
- Department of Geriatric Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Beijing Goodwill Hessian Health Technology, Dongcheng District, Beijing, 100007, China
| | - Sai Wang
- Department of Geriatric Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Beijing Goodwill Hessian Health Technology, Dongcheng District, Beijing, 100007, China
| | - Kunlian Li
- Department of Geriatric Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Beijing Goodwill Hessian Health Technology, Dongcheng District, Beijing, 100007, China
| | - Wei Gan
- Department of Geriatric Cardiology, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Beijing Goodwill Hessian Health Technology, Dongcheng District, Beijing, 100007, China
| | - Quanjin Si
- Department of the Third Health Care, National Clinical Research Center for Geriatric Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
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Yaghoubi M, Roumiani PH, Nozari F, Simiyari S, Azarboo A, Zadeh Tabatabaei MSH, Khadembashiri MM, Khadembashiri MA. The burden of atrial fibrillation/flutter in the Middle East and North Africa region and its associated risk factors from 1990 to 2019. BMC Cardiovasc Disord 2024; 24:366. [PMID: 39014302 PMCID: PMC11251306 DOI: 10.1186/s12872-024-04019-2] [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: 04/15/2024] [Accepted: 06/27/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Atrial fibrillation and flutter (AFF) are the most common cardiac arrhythmias globally, contributing to substantial morbidity and mortality. The Middle East and North Africa (MENA) region face unique challenges in managing cardiovascular diseases, including AFF, due to diverse sociodemographic factors and healthcare infrastructure variability. This study aims to comprehensively evaluate the burden of AFF in MENA from 1990 to 2019. METHODS Data were obtained from the Global Burden of Diseases Study 2019, a comprehensive source incorporating diverse data inputs. The study collected global, regional, and national Age-Standardized Incidence Rate (ASIR), Age-Standardized Mortality Rate (ASMR), and Age-Standardized Disability-Adjusted Rate (ASDR), Mortality across sex, age groups, and years. LOESS regression was employed to determine the relationship between age-standardized rates attributed to AFF and Socio-Demographic Index (SDI). RESULTS The study found minimal change in ASIR of AFF in MENA from 1990 to 2019, with a slight increase observed in ASMR and ASDR during the same period. Notably, AFF burden was consistently higher in females compared to males, with age showing a direct positive relationship with AFF burden. Iraq, Iran, and Turkey exhibited the highest ASIR, while Qatar, Bahrain, and Oman had the highest ASMR and ASDR in 2019. Conversely, Kuwait, Libya, and Turkey displayed the lowest ASMR and ASDR rates. CONCLUSION This study underscores the persistent burden of AFF in MENA and identifies significant disparities across countries. High systolic blood pressure emerged as a prominent risk factor for mortality in AFF patients. Findings provide crucial insights for policy-making efforts, resource allocation, and intervention strategies aimed at reducing the burden of cardiovascular diseases in the MENA region.
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Affiliation(s)
- Mohammad Yaghoubi
- Cardiology Department, Azerbaijan Medical University, Baku, Azerbaijan
| | | | - Fateme Nozari
- Cardiology Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Saba Simiyari
- Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Azarboo
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Marçal IR, Vidal-Almela S, Blanchard C, Prince SA, Way KL, Reed JL. Sex Differences in Physical Activity Levels and Sitting Time in Patients With Atrial Fibrillation. J Cardiopulm Rehabil Prev 2024; 44:280-288. [PMID: 38836648 DOI: 10.1097/hcr.0000000000000867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
PURPOSE While research demonstrates low levels of physical activity (PA) among adults living with atrial fibrillation (AF), there is limited evidence investigating sex differences in moderate to vigorous intensity physical activity (MVPA) and sedentary time in this population. The primary aim was to examine sex differences in MVPA levels and sitting time between women and men with AF. Secondary aims explored sex differences in sociodemographic factors, outcome expectations, and task self-efficacy toward PA levels. METHODS This was a subanalysis of the CHAMPLAIN-AF cohort study. Women and men with AF completed a survey, including the Short-Form International Physical Activity Questionnaire. RESULTS A total of 210 women (median = 66.0 yr: 95% CI, 63.5-68.0) and 409 men (median = 66.0 yr: 95% CI, 64.0-67.0) were included. No sex differences were observed in median weekly MVPA (60 min/wk: 95% CI, 0-120 in women vs 120 min/wk: 95% CI, 85-150 in men) and daily sitting time (5.5 hr/d: 95% CI, 5.0-6.0 in women vs 6.0 hr/d: 95% CI, 5.0-6.0 in men). Women engaged in significantly less vigorous-intensity PA than men ( P = .03) and demonstrated significantly lower task self-efficacy ( P < .01). Significant positive correlations in PA levels with outcome expectations (mostly weak) and task self-efficacy (mostly strong) were observed in both sexes. CONCLUSION Most women and men with AF did not meet the global MVPA guidelines but met the sitting time recommendation. Women presented with lower vigorous-intensity physical activity levels and confidence than men. Strategies to increase physical activity behavior, considering sociodemographic factors and task self-efficacy, are needed and may differ between sexes.
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Affiliation(s)
- Isabela R Marçal
- Author Affiliations: Exercise Physiology and Cardiovascular Health Laboratory, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, (Mss Marçal and Vidal-Almela, and Drs Way and Reed); Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, (Ms Marçal and Dr Reed); Faculty of Medicine, Dalhousie University, Halifax, Canada (Dr Blanchard); Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Canada (Dr Prince); Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia (Dr Way); and Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada (Dr Reed)
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Kwiringira A, Migisha R, Bulage L, Kwesiga B, Kadobera D, Upenytho G, Mbaka P, Harris JR, Hayes D, Ario AR. Group-based Education and monitoring program delivered by community health workers to improve control of high blood pressure in island districts of lake victoria, Uganda. BMC PRIMARY CARE 2024; 25:191. [PMID: 38807067 PMCID: PMC11134886 DOI: 10.1186/s12875-024-02444-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/22/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Individuals living in communities with poor access to healthcare may be unaware of their high blood pressure (BP). While the use of community health workers (CHWs) can address gaps in human resources for health, CHWs in Uganda have not been used previously for BP screening and management. We report the results of an initiative to train CHWs to evaluate BP and to administer group-based education in Kalangala and Buvuma Island Districts of Lake Victoria, Uganda. METHODS We randomly selected 42 of 212 villages. We trained CHWs based in island districts on measuring BP. CHWs visited all households in the selected villages and invited all adults ≥ 18 years to be screened for high BP. We used the World Health Organization's STEPwise tool to collect data on demographic and behavioral characteristics and BP measurements. High blood pressure was defined as systolic BP (SBP) ≥ 140 mm Hg and/or diastolic BP (DBP) ≥ 90 mm Hg over three readings. CHWs created and led fortnight support groups for individuals identified with high blood pressure at baseline. At each group meeting, CHWs re-measured BP and administered an intervention package, which included self-management and lifestyle education to participants. The paired t-test was used to compare mean values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) before and after the intervention. Generalized estimating equations (GEE) were used to model longitudinal changes in BP. RESULTS We trained 84 CHWs to measure BP and deliver the intervention package. Among 2,016 community members, 570 (28.3%) had high blood pressure; of these, 63 (11.1%) had a previous diagnosis of hypertension. The comparison of SBP and DBP before and after the intervention revealed significant reductions in mean SBP from 158mmHg (SD = 29.8) to 149 mmHg (SD = 29.8) (p < 0.001) and mean DBP from 97mmHg (SD = 14.3) to 92mmHg (p < 0.001). GEE showed decreases of -1.133 (SBP) and - 0.543 mmHg (DBP)/fortnight. CONCLUSION High BP was common but previously undiagnosed. The CHW-led group-based self-management and education for controlling high BP was effective in the island districts in Uganda. Scaling up the intervention in other hard-to-reach districts could improve control of high BP on a large scale.
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Affiliation(s)
- Andrew Kwiringira
- Uganda Public Health Fellowship Program, Kampala, Uganda.
- Uganda National Institute of Public Health, Kampala, Uganda.
- Department of Planning Financing and Policy, Ministry of Health, Kampala, Uganda.
| | - Richard Migisha
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Benon Kwesiga
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Daniel Kadobera
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | - George Upenytho
- Department of Community Health, Ministry of Health, Kampala, Uganda
| | - Paul Mbaka
- Department of Planning Financing and Policy, Ministry of Health, Kampala, Uganda
| | - Julie R Harris
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Donald Hayes
- Division of Heart Disease and Stroke Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alex R Ario
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
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Valli H, Tindale A, Butt H, Beattie CJ, Adasuriya G, Warraich M, Ahmad M, Banerjee A, Providencia R, Haldar S. Weight reduction interventions for the management of atrial fibrillation in overweight and obese people. Cochrane Database Syst Rev 2024; 5:CD014768. [PMID: 39908074 PMCID: PMC11091950 DOI: 10.1002/14651858.cd014768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2025]
Abstract
OBJECTIVES This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the efficacy of weight loss interventions as adjunctive treatment for reducing atrial fibrillation burden.
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Affiliation(s)
- Haseeb Valli
- Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | | | - Haroun Butt
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | | | - Mazhar Warraich
- Department of Internal Medicine, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Mahmood Ahmad
- Department of Cardiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Amitava Banerjee
- Institute of Health Informatics Research, University College London, London, UK
| | - Rui Providencia
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Shouvik Haldar
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
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45
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Callanan A, Quinlan D, Kearney PM, O'Sullivan S, Zhi GTY, Crichton A, Howell MW, Bradley C, Buckley C. Opportunistic atrial fibrillation screening in primary care in Ireland: results of a pilot screening programme. Open Heart 2024; 11:e002563. [PMID: 38724265 PMCID: PMC11086480 DOI: 10.1136/openhrt-2023-002563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/12/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Atrial fibrillation (AF), a common, frequently asymptomatic cardiac arrhythmia, is a major risk factor for stroke. Identification of AF enables effective preventive treatment to be offered, potentially reducing stroke risk by up to two-thirds. There is international consensus that opportunistic AF screening is valuable though uncertainty remains about the optimum screening location and method. Primary care has been identified as a potential location for AF screening using one-lead ECG devices. METHODS A pilot AF screening programme is in primary care in the south of Ireland. General practitioners (GPs) were recruited from Cork and Kerry. GPs invited patients ≥65 years to undergo AF screening. The screening comprised a one-lead ECG device, Kardia Mobile, blood pressure check and ascertainment of smoking status. Possible AF on one-lead ECG was confirmed with a 12-lead ECG. GPs also recorded information including medical history, current medication and onward referral. The Keele Decision Support tool was used to assess patients for oral anticoagulation (OAC). RESULTS 3555 eligible patients, attending 52 GPs across 34 GP practices, agreed to undergo screening. 1720 (48%) were female, 1780 (50%) were hypertensive and 285 (8%) were current smokers. On the one-lead ECG, 3282 (92%) were in normal sinus rhythm, 101 (3%) had possible AF and among 124 (4%) the one-lead ECG was unreadable or unclassified. Of the 101 patients with possible AF, 45 (45%) had AF confirmed with 12-lead ECG, an incidence rate of AF of 1.3%. Among the 45 confirmed AF cases, 27 (60%) were commenced on OAC therapy by their GP. CONCLUSION These findings suggest that AF screening in primary care may prove useful for early detection of AF cases that can be assessed for treatment. One-lead ECG devices may be useful in the detection of paroxysmal AF in this population and setting. Current OAC of AF may be suboptimal.
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Affiliation(s)
- Aileen Callanan
- School of Public Health, University College Cork, Cork, Ireland
| | | | | | - Susanne O'Sullivan
- Cork Kerry Community Healthcare, Health Service Executive, Dublin, Ireland
| | | | - Alyssa Crichton
- Department of General Practice, University College Cork, Cork, Ireland
| | | | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Claire Buckley
- School of Public Health, University College Cork, Cork, Ireland
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46
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Zuin M, Bertini M, Vitali F, Turakhia M, Boriani G. Heart Failure-Related Death in Subjects With Atrial Fibrillation in the United States, 1999 to 2020. J Am Heart Assoc 2024; 13:e033897. [PMID: 38686875 PMCID: PMC11179935 DOI: 10.1161/jaha.123.033897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/15/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Population-based data on heart failure (HF)-related death in patients with atrial fibrillation (AF) are lacking. We assessed HF-related death in people with AF in the United States over the past 21 years and examined differences by age, sex, race, ethnicity, urbanization, and census region. METHODS AND RESULTS Data were extracted from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research to determine trends in age-adjusted mortality rates per 100 000 people, due to HF-related death among subjects with AF aged ≥15 years. To calculate nationwide annual trends, we assessed the average annual percent change (AAPC) and annual percent change with relative 95% CIs using joinpoint regression. Between 1999 and 2020, 916 685 HF-related deaths (396 205 men and 520 480 women) occurred among US adults having a concomitant AF. The overall age-adjusted mortality rates increased (AAPC: +4.1% [95% CI, 3.8-4.4]; P<0.001), especially after 2011 (annual percent change, +6.8% [95% CI, 6.2-7.4]; P<0.001) in men (AAPC, +4.8% [95% CI, 4.4-5.1]; P<0.001), in White subjects (AAPC: +4.2% [95% CI, 3.9 to 4.6]; P<0.001) and in subjects aged <65 years (AAPC: +7.5% [95% CI, 6.7-8.4]; P<0.001). The higher percentage of deaths were registered in the South (32.8%). During the first year of the COVID-19 pandemic, a significant excess in HF-related deaths among patients with AF aged >65 years was observed. CONCLUSIONS A worrying increase in the HF-related mortality rate among patients with AF has been observed in the United States over the past 2 decades.
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Affiliation(s)
- Marco Zuin
- Cardiology Unit, Department of Translational Medicine Sant'Anna University Hospital, University of Ferrara Ferrara Italy
| | - Matteo Bertini
- Cardiology Unit, Department of Translational Medicine Sant'Anna University Hospital, University of Ferrara Ferrara Italy
| | - Francesco Vitali
- Cardiology Unit, Department of Translational Medicine Sant'Anna University Hospital, University of Ferrara Ferrara Italy
| | - Mintu Turakhia
- Division of Cardiovascular Medicine, The Center for Digital Health Stanford University Stanford CA USA
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences Italy University of Modena and Reggio Emilia, Policlinico di Modena Modena Italy
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47
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Kell DB, Lip GYH, Pretorius E. Fibrinaloid Microclots and Atrial Fibrillation. Biomedicines 2024; 12:891. [PMID: 38672245 PMCID: PMC11048249 DOI: 10.3390/biomedicines12040891] [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: 03/08/2024] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Atrial fibrillation (AF) is a comorbidity of a variety of other chronic, inflammatory diseases for which fibrinaloid microclots are a known accompaniment (and in some cases, a cause, with a mechanistic basis). Clots are, of course, a well-known consequence of atrial fibrillation. We here ask the question whether the fibrinaloid microclots seen in plasma or serum may in fact also be a cause of (or contributor to) the development of AF. We consider known 'risk factors' for AF, and in particular, exogenous stimuli such as infection and air pollution by particulates, both of which are known to cause AF. The external accompaniments of both bacterial (lipopolysaccharide and lipoteichoic acids) and viral (SARS-CoV-2 spike protein) infections are known to stimulate fibrinaloid microclots when added in vitro, and fibrinaloid microclots, as with other amyloid proteins, can be cytotoxic, both by inducing hypoxia/reperfusion and by other means. Strokes and thromboembolisms are also common consequences of AF. Consequently, taking a systems approach, we review the considerable evidence in detail, which leads us to suggest that it is likely that microclots may well have an aetiological role in the development of AF. This has significant mechanistic and therapeutic implications.
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Affiliation(s)
- Douglas B. Kell
- Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown St, Liverpool L69 7ZB, UK
- The Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, Søltofts Plads, Building 220, 2800 Kongens Lyngby, Denmark
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Private Bag X1 Matieland, Stellenbosch 7602, South Africa
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool L7 8TX, UK;
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark
| | - Etheresia Pretorius
- Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown St, Liverpool L69 7ZB, UK
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Private Bag X1 Matieland, Stellenbosch 7602, South Africa
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48
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Vinter N, Cordsen P, Johnsen SP, Staerk L, Benjamin EJ, Frost L, Trinquart L. Temporal trends in lifetime risks of atrial fibrillation and its complications between 2000 and 2022: Danish, nationwide, population based cohort study. BMJ 2024; 385:e077209. [PMID: 38631726 PMCID: PMC11019491 DOI: 10.1136/bmj-2023-077209] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES To examine how the lifetime risks of atrial fibrillation and of complications after atrial fibrillation changed over time. DESIGN Danish, nationwide, population based cohort study. SETTING Population of Denmark from 1 January 2000 to 31 December 2022. PARTICIPANTS 3.5 million individuals (51.7% women and 48.3% men) who did not have atrial fibrillation at 45 years of age or older were followed up until incident atrial fibrillation, migration, death, or end of follow-up, whichever came first. All 362 721 individuals with incident atrial fibrillation (46.4% women and 53.6% men), but with no prevalent complication, were further followed up until incident heart failure, stroke, or myocardial infarction. MAIN OUTCOME MEASURES Lifetime risk of atrial fibrillation and lifetime risks of complications after atrial fibrillation over two prespecified periods (2000-10 v 2011-22). RESULTS The lifetime risk of atrial fibrillation increased from 24.2% in 2000-10 to 30.9% in 2011-22 (difference 6.7% (95% confidence interval 6.5% to 6.8%)). After atrial fibrillation, the most frequent complication was heart failure with a lifetime risk of 42.9% in 2000-10 and 42.1% in 2011-22 (-0.8% (-3.8% to 2.2%)). Individuals with atrial fibrillation lost 14.4 years with no heart failure. The lifetime risks of stroke and of myocardial infarction after atrial fibrillation decreased slightly between the two periods, from 22.4% to 19.9% for stroke (-2.5% (-4.2% to -0.7%)) and from 13.7% to 9.8% for myocardial infarction (-3.9% (-5.3% to -2.4%). No evidence was reported of a differential decrease between men and women. CONCLUSION Lifetime risk of atrial fibrillation increased over two decades of follow-up. In individuals with atrial fibrillation, about two in five developed heart failure and one in five had a stroke over their remaining lifetime after atrial fibrillation diagnosis, with no or only small improvement over time. Stroke risks and heart failure prevention strategies are needed for people with atrial fibrillation.
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Affiliation(s)
- Nicklas Vinter
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Diagnostic Centre, University Clinic for Development of Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Pia Cordsen
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laila Staerk
- Department of Clinical Medicine, Copenhagen University Hospital-Amager and Hvidovre, Copenhagen, Denmark
| | - Emelia J Benjamin
- Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Lars Frost
- Diagnostic Centre, University Clinic for Development of Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ludovic Trinquart
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
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Andrade JG, Moss JWE, Kuniss M, Sadri H, Wazni O, Sale A, Ismyrloglou E, Chierchia GB, Kaplon R, Mealing S, Bainbridge J, Bromilow T, Lane E, Khaykin Y. The Cost-Effectiveness of First-Line Cryoablation vs First-Line Antiarrhythmic Drugs in Canadian Patients With Paroxysmal Atrial Fibrillation. Can J Cardiol 2024; 40:576-584. [PMID: 38007219 DOI: 10.1016/j.cjca.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/24/2023] [Accepted: 11/20/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND The EARLY-AF (NCT02825979), STOP AF First (NCT03118518), and Cryo-FIRST (NCT01803438) randomised controlled trials (RCTs) demonstrated that cryoballoon pulmonary vein isolation reduces atrial fibrillation (AF) recurrence compared with antiarrhythmic drugs (AADs) in patients with symptomatic paroxysmal atrial fibrillation (PAF). The present study developed a cost-effectiveness model (CEM) of first-line cryoablation compared with first-line AADs for PAF, from the Canadian health care payer's perspective. METHODS Data from the 3 RCTs were analysed to estimate key CEM parameters. The model structure used a decision tree for the first 12 months and a Markov model with a 3-month cycle length for the remaining lifetime time horizon. Costs were set at 2023 Canadian dollars, health benefits were expressed as quality-adjusted life years (QALYs), and both were discounted 3% annually. Probabilistic sensitivity analysis (PSA) considered parameter uncertainty. RESULTS The statistical analysis estimated that first-line cryoablation generates a 47% reduction (P < 0.001) in the rate of AF recurrence, a 73% reduction in the rate of subsequent ablation (P < 0.001), and a 4.3% (P = 0.025) increase in health-related quality of life, compared with first-line AADs. The PSA indicates that an individual treated with first-line cryoablation accrues less costs (-$3,862) and more QALYs (0.19) compared with first-line AADs. Cryoablation is cost-saving in 98.4% of PSA iterations and has a 99.9% probability of being cost-effective at a cost-effectiveness threshold of $50,000 per QALY gained. Cost-effectiveness results were robust to changes in key model parameters. CONCLUSIONS First-line cryoballoon ablation is cost-effective when compared with AADs for patients with symptomatic PAF.
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Affiliation(s)
- Jason G Andrade
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Joe W E Moss
- York Health Economics Consortium, York, United Kingdom
| | - Malte Kuniss
- Kerckhoff Clinic Heart Centrum, Department of Cardiology, Bad Nauheim, Germany
| | | | | | | | | | | | | | | | | | - Tom Bromilow
- York Health Economics Consortium, York, United Kingdom
| | - Emily Lane
- York Health Economics Consortium, York, United Kingdom
| | - Yaariv Khaykin
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
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50
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Li S, Zhang Z, Ding Y, Yu T, Qin Z, Guo S. Dissecting the associations of KCNH2 genetic polymorphisms with various types of cardiac arrhythmias. Gene 2024; 899:148132. [PMID: 38181928 DOI: 10.1016/j.gene.2024.148132] [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: 11/10/2023] [Revised: 12/16/2023] [Accepted: 01/02/2024] [Indexed: 01/07/2024]
Abstract
BACKGROUND Cardiac arrhythmia, a common cardiovascular disease, is closely related to genetic polymorphisms. However, the associations between polymorphisms in KCNH2 and various arrhythmias remain inadequately explored. METHODS Guided by the assumption that KCNH2 genetic polymorphisms significantly contribute to the development of arrhythmias, we thoroughly explored the associations between 85 KCNH2 genetic variations and 16 cardiac arrhythmias in a sample obtained from the UK Biobank (UKBB, N = 307,473). The illnesses documented in the electronic medical records of the sample were mapped to a phecode system for a more accurate representation of distinct phenotypes. Survival analysis was used to test the effect of KCNH2 variants on arrhythmia incidence, and a phenotype-wide association study (PheWAS) was performed to investigate the effect of KCNH2 polymorphisms on 102 traits, including physical measurements, biomarkers, and hematological indicators. RESULTS Novel associations of variants rs2269001 and rs7789585 in KCNH2 with paroxysmal tachycardia (PT) and atrial fibrillation/flutter (AF/AFL), respectively, were identified. Moreover, with an increase in the number of minor alleles of these two variants, the incidence rates of PT and AF/AFL decreased. In addition, the PheWAS results suggested that these two single nucleotide polymorphisms were associated with multiple parameters in physical measurements and neutrophil percentage. CONCLUSION The multiple novel associations observed in this study illustrate the importance of KCNH2 genetic variations in the pathogenesis of arrhythmia.
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Affiliation(s)
- Sen Li
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China.
| | - Zhang Zhang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China.
| | - Yining Ding
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China.
| | - Tingting Yu
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China.
| | - Zongshi Qin
- Peking University Clinical Research Institute, Peking University, Beijing, China.
| | - Shuzhen Guo
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
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