Hospital Admissions For Atrial Fibrillation Research Articles

Red Blood Cell Distribution Width is a Biomarker of Red Cell Dysfunction Associated with High Systemic Inflammation and a Prognostic Marker in Heart Failure and Cardiovascular Disease: A Potential Predictor of Atrial Fibrillation Recurrence.

At the beginning of the 21st century, approximately 2.3 million US adults had atrial fibrillation (AF), and there has been a 60% increase in hospital admissions for AF. Given that the expectancy is a continuous increase in incidence, it portends a severe healthcare problem. Considerable evidence supports the immune system and inflammatory response in cardiac tissue, and circulatory processes are involved in the physiopathology of AF. In this regard, finding novel inflammatory biomarkers that predict AF recurrence after catheter ablation (CA) is a prime importance global healthcare problem. Many inflammatory biomarkers and natriuretic peptides came out and were shown to have predictive capabilities for AF recurrence in patients undergoing CA. In this regard, some studies have shown that red blood cell distribution width (RDW) is associated with the risk of incident AF. This reviewaimed to provide an update on the evidence of the RDW as a biomarker of red cell dysfunction and its association with high systemic inflammation, and with the risk of incident AF. Through the literature review, we will highlight the most relevant studies of the RDW related to AF recurrence after CA. Many studies demonstrated that RDW is associated with all cause-mortality, heart failure, cardiovascular disease, and AF, probably because RDW is a biomarker of red blood cell dysfunction associated with high systemic inflammation, reflecting an advanced heart disease with prognostic implications in heart failure and cardiovascular disease. Thus, suggesting that could be a potential predictor for AF recurrence after CA. Moreover, the RDW is a parameter included in routine full blood count, which is low-cost, quick, and easy to obtain. We provided an update on the evidence of the most relevant studies of the RDW related to AF recurrence after CA, as well as the mechanism of the high RDW and its association with high systemic inflammation and prognostic marker in cardiovascular disease and heart failure.

Air Pollution and Arrhythmias.

Air pollution is commonly defined as the contamination of the air we breathe by any chemical, physical, or biological agent that is potentially threatening to human and ecosystem health. The common pollutants known to be disease-causing are particulate matter, ground-level ozone, sulphur dioxide, nitrogen dioxide, and carbon monoxide. Although the association between increasing concentrations of these pollutants and cardiovascular disease is now accepted, the association of air pollution and arrhythmias is less well established. In this review we provide an in-depth discussion of the association of acute and chronic air pollution exposure and arrhythmia incidence, morbidity, and mortality, and the purported pathophysiological mechanisms. Increases in concentrations of air pollutants have multiple proarrhythmic mechanisms including systemic inflammation (via increases in reactive oxygen species, tumour necrosis factor, and direct effects from translocated particulate matter), structural remodelling (via an increased risk of atherosclerosis and myocardial infarction or by affecting the cell-to-cell coupling and gap junction function), and mitochondrial and autonomic dysfunction. Furthermore, we describe the associations of air pollution and arrhythmias. There is a strong correlation of acute and chronic air pollutant exposure and the incidence of atrial fibrillation. Acute increases in air pollution increase the risk of emergency room visits and hospital admissions for atrial fibrillation and the risk of stroke and mortality in patients with atrial fibrillation. Similarly, there is a strong correlation of increases of air pollutants and the risk of ventricular arrhythmias, out-of-hospital cardiac arrest, and sudden cardiac death.

Outcomes of patients with a myeloproliferative neoplasm and atrial fibrillation.

7070 Background: Patients with myeloproliferative neoplasms (MPN), including essential thrombocythemia (ET), polycythemia vera (PV), and primary myelofibrosis (PMF), are associated with increased risk of cardiovascular (CV) disease including arterial thrombosis (AT). Atrial fibrillation (AF) is also associated with increased risk of AT and often co-exists with MPN. However, thrombotic and bleeding outcomes in patients with MPN compared with those without have not been thoroughly investigated. Methods: Patients aged ≥ 18 years with a hospital admission for AF with and without a history of MPN in 2017 and 2018 were identified using the National Readmission Database. Primary outcomes were 30-day (D) and 90-D any-cause, AT-related (including stroke, myocardial infarction, arterial thromboembolism), and bleeding-related readmissions. Propensity score weighting (PSW) was performed in order to adjust for imbalances between MPN and non-MPN patients. PSW Cox proportional hazards was performed to estimate risk of 90-D readmission in patients with MPN compared with patients without. Results: A total of 468,094 patients with AF were identified with 1,617 patients having a history of MPN. CHA2DS2-VASC (mean 3.8 vs 3.7) and HAS-BLED scores (mean 2.4 vs 2.3), risk scores for AT and bleeding in AF, were similar between MPN and non-MPN patients. After PSW Cox proportional hazards, patients with MPN had an increased risk of 30-D all-cause (HR 1.72, 95% CI 1.70 – 1.74), AT (HR 1.45, 95% CI 1.38 – 1.53), and bleeding (HR 2.21, 95% CI 2.01 – 2.44) re-admissions. MPN patients had an increased risk of 90-day any cause (HR 1.38, 95% CI 1.37 – 1.40) and bleeding (HR 1.76, 95% CI 1.65 – 1.88) but not AT (HR 1.03, 95% CI 0.99 – 1.08) readmissions. Conclusions: Among patients admitted for AF, MPN is associated with increased risk of 30-D and 90-D any-cause and bleeding readmissions and 30-D AT readmissions despite similar CHA2DS2-VASC and HAS-BLED risk scores. Further studies are needed to identify risk factors for bleeding and AT in patients with MPN and AF and improve on current risk scores, which do not include MPN status. [Table: see text]

Seasonal Variation of Atrial Fibrillation Admission and Quality of Care in the United States.

BackgroundCurrently, little is known regarding seasonal variation for atrial fibrillation (AF) in the United States and whether quality of care for AF varies between seasons.Methods and ResultsThe GWTG‐AFib (Get With The Guidelines–AFib) registry was initiated by the American Heart Association to enhance national guideline adherence for treatment and management of AF. Our analyses included 61 291 patients who were admitted at 141 participating hospitals from 2014 to 2018 across the United States. Outcomes included numbers of AF admissions and quality‐of‐care measures (defect‐free care, defined as a patient’s receiving all eligible measures). For quality‐of‐care measures, generalized estimating equations accounting for within‐site correlations were used to estimate odds ratios (ORs) with 95% CIs, adjusting patient and hospital characteristics. The proportion of AF admissions for each season was similar, with the highest percentage of AF admissions being observed in the fall (spring 25%, summer 25%, fall 27%, and winter 24%). Overall, AF admissions across seasons were similar, with no seasonal variation observed. No seasonal variation was observed for incident AF. There were no seasonal differences in care quality (multivariable adjusted ORs and 95% CIs were 0.93 (0.87–1.00) for winter, 1.09 (1.01–1.18) for summer, and 1.08 (0.97–1.20) for fall, compared with spring).ConclusionsIn a nationwide quality improvement registry, no seasonal variation was observed in hospital admissions for AF or quality of care for AF.

Implications of presenting to hospital with AF: the REVIEW AF study

Abstract Background There is a growing burden of hospitalizations due to atrial fibrillation (AF). The implications of hospitalisation to the individual with AF has not been well characterized. Purpose To characterise the consequences of presenting to hospital with AF. Methods Individuals presenting to the emergency department (ED) of three hospitals in South Australia from March 2013 to February 2014 with a primary diagnosis of AF were enrolled. Based on coding and individual electronic medical record review all re-presentations over follow up were characterised as: 1) AF related; 2) cardiovascular related (excluding AF); or 3) all other causes. Mortality over follow up was also determined. Results The study cohort comprised of 437 individuals with an AF related index presentation. Mean age was 69±15 years and 49.9% were male. Individuals were followed for a mean of 3.7±0.4 years. There were 2304 unplanned presentations over follow up. The percentage of the study cohort who presented to the ED or were admitted to hospital over follow up is detailed in Figure 1. Compared to individuals who did not have a hospital admission for AF over follow up, those who were readmitted for AF were more likely to be hypertensive (63.2% vs 49.3%, p<0.001); and have a higher CHA2DS2-VASc score (3.2±1.8 vs 2.7±1.9, p=0.002) and HAS-BLED score (2.0±1.0 vs 1.5±1.1, p<0.001). A total of 71 individuals (16.2%) died during the follow-up period (annual mortality rate of 3.78%). Conclusions A hospital presentation with a primary diagnosis of AF identifies individuals at high risk of repeat hospitalisations and death. Urgent studies are needed to improve management of this high-risk cohort. Figure 1. Repeat hospital presentations in AF Funding Acknowledgement Type of funding source: None

Short term changes in ambient temperature and acute risk of atrial fibrillation episodes

IntroductionAtrial fibrillation is one of the most common arrhythmias, currently prevalent in approximately 1-3 % of the population but predicted to increase substantially due to an aging population. It is associated with a higher risk of stroke, dementia, and mortality, as well as reduced quality of life. A seasonal pattern of hospital admissions for atrial fibrillation has been observed, with increased cases during the colder months. Previous studies suggest associations between short-term decreases in ambient temperature and acute onset of atrial fibrillation episodes, but the evidence is limited.MethodWe screened 8,899 randomly selected 75-yearolds living in Stockholm for atrial fibrillation using home-based short-term ambulatory 1-lead ECG-measurements 2-4 times a day for 14 days. Screenings were carried out in 2012-2013 and 2016-2018. We used generalized estimating equations to quantify the association between ambient temperature obtained from a fixed monitoring station and risk of atrial fibrillation, adjusting for day of week, time of day and relative humidity. We explored different exposure windows and susceptible subgroups.ResultsAmong 218 participants with 469 atrial fibrillation episodes during the screening period we did not observe a statistically significant association between 24-hour prior ambient temperature and atrial fibrillation [-1% (95% CI -2%; 1%) per 1°C). We explored different exposure windows ranging from 6 to 48 hours as well as lagged exposures 12-24 hours and 24-48 hours with similar suggestive but non-significant inverse associations. A more pronounced and statistically significant association was observed for participants with diabetes [-5% (95% CI -9%; -1%) per 1°C). We did not observe any difference in the association by sex or hypertension.ConclusionOverall, short-term temperature was not strongly associated with triggering of atrial fibrillation episodes. However, there was some evidence to suggest an association between a drop in temperature and increased risk of atrial fibrillation among participants with diabetes.

Anticoagulant Initiation During Hospital Admissions for Atrial Fibrillation in South-East Queensland, Australia

Anticoagulation reduces stroke risk in patients with atrial fibrillation (AF) but under-prescribing in eligible patients has been commonly reported. Introduction of the direct acting oral anticoagulants (DOACs) was considered to potentially improve prescribing due to increased anticoagulant options. At the time of release to the Australian market, there were limited studies investigating anticoagulant usage during hospitalisations for AF. Therefore, the aim of this study was to investigate prescribing of oral anticoagulants during hospitalisation admissions for AF during the time of DOAC introduction to the Australian market. A retrospective study was conducted of admissions to a tertiary Queensland hospital during 1 July 2012 to 10 June 2015. Patients were categorised according to oral anticoagulant therapy on both hospital admission and discharge. Changes to therapy and patient factors associated with prescribing were analysed. A total of 1,911 patients were included with 3,396 admissions during the study period. There was a significant increase in the number of patients initiated on anticoagulant therapy during their first admission with higher rates of initiation of DOACs compared to warfarin. Ischaemic heart disease and high bleed risk were significantly associated with reduced prescribing of anticoagulant therapy on first and second admission respectively, while patients with a history of stroke or transient ischaemic attack were significantly more likely to receive therapy. The introduction of the DOACs to the Australian market increased initiation of anticoagulants to hospitalised patients with AF across all stroke risk categories. The availability of greater anticoagulant options has increased initiation of therapy but there remains potential to further optimise anticoagulant prescribing by targeting therapy according to guidelines and patient factors.

Changes in atrial fibrillation admissions following daylight saving time transitions

BackgroundDaylight saving time (DST) imposes a twice-yearly hour shift. The transitions to and from DST are associated with decreases in sleep quality and environmental hazards. Detrimental health effects include increased incidence of acute myocardial infarction (MI) following the springtime transition and increased ischemic stroke following both DST transitions. Conditions effecting sleep are known to provoke atrial fibrillation (AF), however the effect of DST transitions on AF are unknown. MethodsAdmitted patients aged 18–100 with primary ICD9 code of AF between 2009 and 2016 were included. The number of admissions was compiled and means were compared for the Monday to Thursday period and the entire seven day interval following each DST transition and the entire year for the entire cohort and separated by gender. Significance was determined with Wilcoxon nonparametric tests. ResultsAdmission data for 6089 patients were included, with mean age of 68 years and 53% female. A significant increase was found in mean AF admissions over the Monday to Thursday period (3.09 vs 2.47 admissions/day [adm/d], P = 0.017) and entire week (2.48 vs 2.09 adm/d, P = 0.025) following the DST spring transition compared to the yearly mean. When separated by gender, women exhibited an increase in AF admissions following the DST spring transition (1.78 vs 1.28 adm/d for Monday to Thursday period, P = 0.036 and 1.38 vs 1.11 adm/d for entire week, P = 0.050) while a non-significant increase was seen in men. No significant differences were found following the autumn transition for the entire cohort or when separated by gender. ConclusionAn increase in AF hospital admissions was found following the DST springtime transition. When separated by gender, this finding persisted only among women. This finding adds to evidence of negative health effects associated with DST transitions and factors that contribute to AF episodes.

Socioeconomic differences in outcomes after hospital admission for atrial fibrillation or flutter

To examine socioeconomic differences in care and outcomes in a 1-year period beginning 30 days after hospital discharge for first-time atrial fibrillation or flutter (AF) hospitalization. This nationwide register-based follow-up cohort study investigated AF 30-day discharge survivors in Denmark during 2005-2014 and examined associations between patient's socioeconomic status (SES) and selected outcomes during a 1-year follow-up period beginning 30 days post-discharge after first-time hospitalization for AF. Patient SES was defined in four groups (lowest, second lowest, second highest, and highest) according to each patient's equivalized income. SES of the included 150544 patients was: 27.7% lowest (n = 41648), 28.1% second lowest (n = 42321), 23.7% second highest (n = 35656), and 20.5% highest (n = 30919). Patients of lowest SES were older and more often women. Within 1-year follow-up, patients of lowest SES were less often rehospitalized or seen in outpatient clinics due to AF, or treated with cardioversion or ablation and were slightly more often diagnosed with stroke and heart failure (HF) and significantly more likely to die (16.1% vs. 14.9%, 11.3% and 8.1%). Hazard ratios for all-cause mortality were 0.64 (95% confidence interval 0.61-0.68) for highest vs. lowest SES, adjusted for CHA2DS2-VASc score, chronic obstructive pulmonary disease, rate- and rhythm-controlling drugs, and cohabitation status. In 30-day survivors of first-time hospitalization due to AF, lowest SES is associated with increased 1-year all-cause and cardiovascular mortality and fewer cardioversions, ablations, readmissions, and outpatient contacts due to AF. Our findings indicate a need for socially differentiated rehabilitation following hospital discharge for first-time AF.

196Trends in hospital admissions for atrial fibrillation in Australia: a relentless rise

196Trends in hospital admissions for atrial fibrillation in Australia: a relentless rise

Increased prevalence of major depressive disorder in patients who get admitted with atrial fibrillation with worse outcomes

ObjectiveTo determine trends and impact on outcomes of atrial fibrillation (AF) in patients with pre-existing major depressive disorder(MDD).BackgroundWhile post-AF MDD has been extensively studied, contemporary studies including temporal trends on impact of pre-AF MDD on AF and post-AF outcomes are lacking.MethodsWe used Nationwide Inpatient Sample (NIS) from Healthcare Cost and Utilization Project (HCUP) from 2002 to 2012. We identified AF and MDD as primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD9CM) codes, and used Cochrane-Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR).ResultsWe analyzed total of 3,887,827 AF hospital admissions from 2002 to 2012 of which 6.78% had MDD. Proportion of hospitalizations with MDD increased from 4.93% to 14.19% (P-trend < 0.001). Utilization of atrial cardioversion was lower in patients with MDD (34.37% vs. 40.52%, P < 0.001). In-hospital mortality was significantly lower in patients with MDD (aOR0.749; 95% CI 0.664–0.846; P < 0.001) but discharge to specialty care was higher (aOR 1.695; 95%CI 1.650–1.741; P < 0.001). In addition, median length of hospitalization (2.5 vs. 2.13 days; P < 0.001) and median cost of hospitalization (28,246 vs. 22,663; P < 0.001) was higher in hospitalizations with MDD.ConclusionsOur study displayed an increasing proportion of patients with MDD admitted due to AF in the last decade with lower mortality but higher morbidity post-AF. In addition, there was significantly less utilization of atrial cardioversion in this population along with higher median length and cost of hospitalization. There is a need to explore the reasons behind this disparity in outcomes and atrial cardioversion utilization in order to improve post-AF outcomes in this vulnerable population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Increased prevalence of psychosis in patients who get admitted with atrial fibrillation with worse outcomes

ObjectiveTo determine trends and impact on outcomes of atrial fibrillation (AF) in patients with pre-existing psychosis.BackgroundWhile post-AF psychosis has been extensively studied, contemporary studies including temporal trends on the impact of pre-AF psychosis on AF and post-AF outcomes are largely lacking.MethodsWe used Nationwide Inpatient Sample (NIS) from the healthcare cost and utilization project (HCUP) from year's 2002–2012. We identified AF and psychosis as primary and secondary diagnosis respectively using validated international classification of diseases, 9th revision, and Clinical Modification (ICD-9-CM) codes, and used Cochrane–Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR).ResultsWe analyzed total of 3.887.827AF hospital admissions from 2002–2012 of which 1.76% had psychosis. Proportion of hospitalizations with psychosis increased from 5.23% to 14.28% (P trend < 0.001). Utilization of atrial-cardioversion was lower in patients with psychosis (0.76%v vs. 5.79%, P < 0.001). In-hospital mortality was higher in patients with Psychosis (aOR 1.206; 95%CI 1.003–1.449; P < 0.001) and discharge to specialty care was significantly higher (aOR 4.173; 95%CI 3.934–4.427; P < 0.001). The median length of hospitalization (3.13 vs. 2.14 days; P < 0.001) and median cost of hospitalization (16.457 vs. 13.172; P < 0.001) was also higher in hospitalizations with psychosis.ConclusionsOur study displayed an increasing proportion of patients with Psychosis admitted due to AF with higher mortality and extremely higher morbidity post-AF, and significantly less utilization of atrial-cardioversion. There is a need to explore reasons behind this disparity to improve post-AF outcomes in this vulnerable population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Long-Term Exposure to Traffic-Related Air Pollution and Risk of Incident Atrial Fibrillation: A Cohort Study.

Background:Atrial fibrillation is the most common sustained arrhythmia and is associated with cardiovascular morbidity and mortality. The few studies conducted on short-term effects of air pollution on episodes of atrial fibrillation indicate a positive association, though not consistently.Objectives:The aim of this study was to evaluate the long-term impact of traffic-related air pollution on incidence of atrial fibrillation in the general population.Methods:In the Danish Diet, Cancer, and Health cohort of 57,053 people 50–64 years old at enrollment in 1993–1997, we identified 2,700 cases of first-ever hospital admission for atrial fibrillation from enrollment to end of follow-up in 2011. For all cohort members, exposure to traffic-related air pollution assessed as nitrogen dioxide (NO2) and nitrogen oxides (NOx) was estimated at all present and past residential addresses from 1984 to 2011 using a validated dispersion model. We used Cox proportional hazard model to estimate associations between long-term residential exposure to NO2 and NOx and risk of atrial fibrillation, after adjusting for lifestyle and socioeconomic position.Results:A 10 μg/m3 higher 10-year time-weighted mean exposure to NO2 preceding diagnosis was associated with an 8% higher risk of atrial fibrillation [incidence rate ratio: 1.08; 95% confidence interval (CI): 1.01, 1.14] in adjusted analysis. Though weaker, similar results were obtained for long-term residential exposure to NOx. We found no clear tendencies regarding effect modification of the association between NO2 and atrial fibrillation by sex, smoking, hypertension or myocardial infarction.Conclusion:We found long-term residential traffic-related air pollution to be associated with higher risk of atrial fibrillation. Accordingly, the present findings lend further support to the demand for abatement of air pollution.Citation:Monrad M, Sajadieh A, Christensen JS, Ketzel M, Raaschou-Nielsen O, Tjønneland A, Overvad K, Loft S, Sørensen M. 2017. Long-term exposure to traffic-related air pollution and risk of incident atrial fibrillation: a cohort study. Environ Health Perspect 125:422–427; http://dx.doi.org/10.1289/EHP392

Hospital-level variation and predictors of admission after ED visits for atrial fibrillation: 2006 to 2011

BackgroundOutpatient management of atrial fibrillation can be a safe alternative to inpatient admission after emergency department (ED) visits. We aim to describe trends and predictors of hospital admission for atrial fibrillation and determine the variation in admission among US hospitals. MethodsWe analyzed ED visits and hospital admissions for adult patients with a principal diagnosis of atrial fibrillation or atrial flutter in the Nationwide Emergency Department Sample 2006 to 2011. We identified patient and hospital characteristics associated with admission using hierarchical multivariate logistic regression. We analyzed admission rates overall and for patients at low risk of thromboembolic complications (CHA2DS2-VASc score 0). We compared hospital-level variance with residual variance to estimate the intraclass correlation in models with and without hospital characteristics. ResultsFrom 2006 to 2011, annual ED visits for atrial fibrillation and atrial flutter increased by 30.9% and admission rates decreased from 69.7% to 67.4% (P= .02). Admission was associated with setting (metropolitan teaching vs nonmetropolitan, odds ratio = 1.93 [1.62-2.29]) and region (Northeast vs West, odds ratio = 2.09 [1.67-2.60]). Among patients with 0 CHA2DS2-VASc score, the national average admission rate was 46.4%. The intraclass correlation was 20.7% adjusting for patient characteristics and hospital clustering, and 19.2% after additionally adjusting for hospital variables. ConclusionsFrom 2006 to 2011, ED visits for atrial fibrillation in the United States increased by almost a third, with a minimal change in ED admission rates. One-fifth of variation in admission rates is due to hospital site and not explained by hospital characteristics. Hospital-specific practice patterns may identify opportunities to increase outpatient management.

Using Phase-Based Costing of Real-World Data to Inform Decision-Analytic Models for Atrial Fibrillation.

Atrial fibrillation (AF) poses a significant economic burden. An increasing number of interventions for AF require cost-effectiveness analysis with decision-analytic modeling to demonstrate value. However, high-quality cost estimates of AF that can be used to inform decision-analytic models are lacking. The objectives of this study were to determine whether phase-based costing methods are feasible and practical for informing decision-analytic models outside of oncology. Patients diagnosed with AF between 1January 2003 and 30June 2011 in Ontario, Canada were identified based on a hospital admission for AF using administrative data housed at the Institute for Clinical Evaluative Sciences. Patient observations were then divided into phases based on clinical events typically used for decision-analytic modeling (i.e., minor stroke/transient ischemic attack [TIA], moderate to severe ischemic stroke, myocardial infarction, extracranial hemorrhage [ECH], intracranial hemorrhage [ICH], multiple events, death from an event, or death from other causes). First 30-day and greater than 30-day costs of healthcare resources in each health state were estimated based on a validated methodology. All costs are reported in 2013 Canadian dollars (Can$) and from a healthcare payer perspective. Patients (n=109,002) with AF who did not experience a clinical event incurred costs of Can$1566 per 30days, on average. The average 30-day cost of experiencing a fatal clinical event was Can$42,871, but the cost of dying from all other causes was much smaller (Can$12,800). The clinical events associated with the highest short-term costs were ICH (Can$22,347) and moderate to severe ischemic stroke (Can$19,937). The lowest short-term costs were due to minor ischemic stroke/TIA (Can$12,515) and ECH (Can$12,261). Patients who had experienced a moderate to severe ischemic stroke incurred the highest long-term costs. Real-world Canadian data and a phase-based costing approach were used to estimate short- and long-term costs associated with AF-related major clinical events. The results of this study can also inform decision-analytic models for AF.

The Content of Elements in Rainwater and its Relation to the Frequency of Hospitalization for Atrial Fibrillation in Opole Voivodship, Poland, During 2000–2002

The elemental composition of rainwater is a suitable indirect indicator of the presence of chemical elements in airborne dust. As such, rainwater is considered a suitable monitor for environmental or natural pollution. The yearly content of chemical elements in rainwater may be considered a good indicator for determining the influence of these environmental factors on human body. We decided to investigate the relationship between chemical elements in rainwater and the frequency of hospitalizations for atrial fibrillation (I48, ICD10) on the population of the region of Opole Voivodship, Poland during the years 2000-2002. The voivodship or province has a population of one million and is divided into 12 counties that have between 44,000 and 151,000 inhabitants. We calculated the yearly average number of hospitalizations by reasons of atrial fibrillation per 10,000 inhabitants in particular counties. The average content of the chosen chemical elements in kilograms per hectare per year was calculated for each county individually and the data evaluated by means of Spearman's correlation coefficient. There is a high positive correlation between chromium in rainwater and hospital admissions for atrial fibrillation (r = 0.62) and mild positive correlation with cadmium (r = 0.57), lead (r = 0.57), zinc (r = 0.50), and chloride (r = 0.48). There are no significant differences between male and female patients. The biological activities of these elements, which may include enhanced adrenergic stimulation, remodeling of calcium or other ion channels, or the cytotoxic effects of hexavalent chromium may explain the positive correlations here reported.

Atrial Fibrillation and Heart Failure

Atrial fibrillation (AF) and heart failure have emerged as new cardiovascular epidemics over the last decade.1 Heart failure affects ≈5 million patients in the United States, and >550 000 patients are diagnosed with new heart failure each year.2 Although the incidence of heart failure remained stable over the past 50 years, the prevalence of heart failure in the United States has steadily increased. Heart failure is the primary reason for 12 to 15 million office visits and 6.5 million hospital days yearly.3 From 1990 to 1999, the annual number of hospitalizations increased from ≈800 000 to >1 million for heart failure as a primary diagnosis and from 2.4 to 3.6 million for heart failure as a primary or secondary diagnosis.4 The steadily increasing number of patients with heart failure is due partially to better treatment and “salvage” of patients with acute myocardial infarctions earlier in life.2 As a consequence, heart failure carries a significant economic burden on our society because it is the most common discharge diagnosis and because more Medicare dollars are spent for the diagnosis and treatment of heart failure than for any other diagnosis.5 In 2007, the American Heart Association estimated that $33 billion was spent on heart failure alone.6 AF is the most common arrhythmia in clinical practice, accounting for approximately one third of admissions resulting from cardiac rhythm disturbances. An estimated 2.3 million people in North America have AF. During the last 20 years, hospital admissions for AF have increased by 66% for a number of reasons, including the aging of the population, the rising prevalence of chronic heart disease, and more frequent diagnosis as a result of increased monitoring.7 The recent Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study projected that the prevalence of AF …

Abstract 4013: The Impact of Atrial Fibrillation on the outcomes of patients suffering a second Myocardial Infarction

In the past 20 years, significant increases in hospital admissions for atrial fibrillation (AF) and in survival of acute myocardial infarction (MI) have been observed. We examined the occurrence of AF and its effect on short and long term outcomes of first MI(FMI) and second MI(SMI). Hospitalized MIs from MIDAS (Myocardial Infarction Data Acquisition System, N=269,110) in New Jersey from 1986 to 2005 were included in the analysis. The rate of the co-exiting MI and AF and 30-day and 1 year mortality were investigated. Approximately 11 %( N=26,631) of FMI patients had a second event. The rate of co-existing AF for the FMI was 9.6% in 1986 and 16.2% in 2005, a 40.9% increase; while AF increased 60.4%, from 7.7% to 20.5% for SMI. Patients with AF were older (76.5 vs 69.3), more likely to be female (43.6% vs 39.4%), to have subendocardial infarction (58.5% vs 49.2%). Patients AF were less likely to be black in racial (4.2% vs 8.4%) and to receive percutaneous coronary interventions (PCI) (6.1% vs 10.4 %). There were more strokes (2% vs 0.9%) and heart failure hospitalizations (HF, 58% vs 39%) in the AF group(p<0.0001). Thirty-day mortality rates (AF vs non-AF) were 20.9% and 13.8% for the FMIs; and 21.5% vs 14.2% for SMIs. One-year mortality rates were 37.4% and 20.5% at FMI, and 43.3% and 28.1% at the SMI, respectively. When adjusting for age, gender, race, MI site, PCI, year of MI, diabetes, stroke and HF, AF increased the 30 day mortality by 36%( OR1.36 95% CI 1.32–1.41) for FMI, and by 33% (OR 1.33(1.22–1.46)] for SMI. The effect of AF on mortality was more pronounced at 1 year [FMI 1.54(1.50 –1.58), SMI:1.44(1.34 –1.55)]. Current AF as well as the history of AF increased both 30-day [OR for current AF: 1.35(1.22–1.50), history of AF: 1.17(1.04 –1.32)] and 1-year mortality [current AF: 1.5(1.4 –1.6), history of AF: 1.21(1.11–1.33)]. The rate of AF in MI patients has increased, especially SMIs. AF remains as a strong predictor of worse outcome for patients suffering a second MI. Both the history of AF and current AF were associated with higher mortality in MI patients.

Increasing US Emergency Department Visit Rates and Subsequent Hospital Admissions for Atrial Fibrillation from 1993 to 2004

Atrial fibrillation is a significant public health problem that is becoming increasingly prevalent. The clinical epidemiology of US emergency department (ED) visits for atrial fibrillation is uncertain. This study seeks to describe recent trends in ED visits for atrial fibrillation. ED visits with a primary diagnosis of atrial fibrillation were analyzed using data from the US National Hospital Ambulatory Medical Care Survey, 1993 to 2004. During the 12-year period, there were approximately 2.7 million (95% confidence interval [CI] 2.4 to 3.0 million) ED visits for atrial fibrillation in the United States, and the population-adjusted visit rate increased from 0.6 to 1.2 per 1,000 US population (P for trend=.02). Similarly, the absolute number of visits increased 88%, from 300,000 (95% CI 209,000 to 392,000) in 1993 to 1994 to 564,000 (95% CI 423,000 to 705,000) in 2003 to 2004. Approximately 64% (95% CI 59% to 69%) of these patients were admitted to the hospital, a rate that remained constant throughout the 12-year period (P for trend=.73). Admission rates were significantly lower in the western region of the United States (48%; 95% CI 36% to 60% versus 76%; in the Northeast, 95% CI 68% to 84%). Patient characteristics and ED management did not materially differ by admission status. In a multivariate model, congestive heart failure was the only predictor of admission but accounted for only 14% of admissions. From 1993 to 2004, the population-adjusted rate of ED visits for atrial fibrillation increased, whereas the proportion admitted to the hospital remained stable. Patient characteristics and ED management were similar regardless of admission status, and there were relatively few predictors of admission.

Is there a clinically significant seasonal component to hospital admissions for atrial fibrillation?

BackgroundAtrial fibrillation is a common cardiac dysrhythmia, particularly in the elderly. Recent studies have indicated a statistically significant seasonal component to atrial fibrillation hospitalizations.MethodsWe conducted a retrospective population cohort study using time series analysis to evaluate seasonal patterns of atrial fibrillation hospitalizations for the province of Ontario for the years 1988 to 2001. Five different series methods were used to analyze the data, including spectral analysis, X11, R-Squared, autocorrelation function and monthly aggregation.ResultsThis study found evidence of weak seasonality, most apparent at aggregate levels including both ages and sexes. There was dramatic increase in hospitalizations for atrial fibrillation over the years studied and an age dependent increase in rates per 100,000. Overall, the magnitude of seasonal difference between peak and trough months is in the order of 1.4 admissions per 100,000 population. The peaks for hospitalizations were predominantly in April, and the troughs in August.ConclusionsOur study confirms statistical evidence of seasonality for atrial fibrillation hospitalizations. This effect is small in absolute terms and likely not significant for policy or etiological research purposes.