Incidence Rate Of Atrial Fibrillation Research Articles

Global association of incidence between atrial fibrillation and the major gastrointestinal cancers: An analysis based on the 2019 Global burden of disease study

Atrial Fibrillation (AF) and gastrointestinal (GI) cancers are age-related diseases with shared environmental risk factors and underlying biological mechanisms. This study aimed to assess the association between AF and GI cancers on a global scale, analyzing incidence data from 204 countries. This ecological study utilized data from the Global Burden of Disease. Spearman's correlation and logistic regression analyses were employed to assess the association between AF and specific GI cancers, including esophagus cancer (EC), colon and rectum cancer (CRC), liver cancer (LC), pancreatic cancer (PC), and stomach cancer (SC). AF, CRC and PC exhibited increasing crude incidence rates from 2000 to 2019, whereas EC and SC demonstrated decreasing trends specifically in females. From 2000 to 2010, there was a noticeable fall in the incidence rate of LC, which was followed by a minor growth through 2019. The age-standardized incidence rate (ASIR) of AF was positively correlated with CRC and PC, but a negative relationship with AF was revealed for EC. Unexpectedly, no significant relationship was discovered for SC and LC associated with AF. Logistic regression analysis revealed a positive correlation between a country's ASIR of AF and its ASIR of CRC, LC and PC. Conversely, these countries demonstrated a decreased ASIR for EC. Our findings showed a significant correlation between national incidence rates of AF with CRC and PC, worldwide. Countries with higher ASIR of AF had higher ASIR of CRC and PC. Additional research is necessary to confirm the association between GI cancers and AF at the individual level.

Incidence of atrial fibrillation in patients with renal infarction: A retrospective cohort analysis of the Korean national health insurance registry

BackgroundRegarding the pathophysiology of renal infarction (RI), cardioembolic causes could have large proportion. However, there are notable variations in prevalence of atrial fibrillation (AF) among patients with RI across different studies, ranging from 17 to 65%. The primary objective of this study is to analyze the incidence of AF in patients with RI. MethodsThis nationwide retrospective cohort study enrolled 5200 patients with RI from the Korean National Institute of Health Services database spanning the years 2013 to 2019. The study accessed the AF incidence rate within 12 months in patients without a prior history of AF. Events occurring within 3 months of RI diagnosis were excluded to mitigate cases diagnosed during the initial screening or those with AF diagnoses that were potentially overlooked in the past. ResultsAF occurred in 19.1% of patients with RI over the entire period (median: 2.5 years, interquartile range 1.04–4.25 years). The majority of AF cases (16.1%) occured within the first year, resulting in an overall incidence rate of 7.0 per 100 person-years. Patients with newly developed AF were, on average, older than those who did not develop AF (64.1 vs. 57.3 years, P < 0.001). The independent predictors of AF were identified as age, male sex, higher body mass index, current smoking, ischemic heart disease, and heart failure. ConclusionsPhysicians should consider the implementation of active rhythm monitoring for patients with RI to identify potential occurrence of subclinical AF, even if not initially diagnosed during the initial screening after RI diagnosis.

Assessing ascertainment bias in atrial fibrillation across US minority groups.

The aim of this study is to define atrial fibrillation (AF) prevalence and incidence rates across minority groups in the United States (US), to aid in diversity enrollment target setting for randomized controlled trials. In AF, US minority groups have lower clinically detected prevalence compared to the non-Hispanic or Latino White (NHW) population. We assess the impact of ascertainment bias on AF prevalence estimates. We analyzed data from adults in Optum's de-identified Clinformatics® Data Mart Database from 2017-2020 in a cohort study. Presence of AF at baseline was identified from inpatient and/or outpatient encounters claims using validated ICD-10-CM diagnosis algorithms. AF incidence and prevalence rates were determined both in the overall population, as well as in a population with a recent stroke event, where monitoring for AF is assumed. Differences in prevalence across cohorts were assessed to determine if ascertainment bias contributes to the variation in AF prevalence across US minority groups. The period prevalence was respectively 4.9%, 3.2%, 2.1% and 5.9% in the Black or African American, Asian, Hispanic or Latino, and NHW population. In patients with recent ischemic stroke, the proportion with AF was 32.2%, 24.3%, 25%, and 24.5%, respectively. The prevalence of AF among the stroke population was approximately 7 to 10 times higher than the prevalence among the overall population for the Asian and Hispanic or Latino population, compared to approximately 5 times higher for NHW patients. The relative AF prevalence difference of the Asian and Hispanic or Latino population with the NHW population narrowed from respectively, -46% and -65%, to -22% and -24%. The study findings align with previous observational studies, revealing lower incidence and prevalence rates of AF in US minority groups. Prevalence estimates of the adult population, when routine clinical practice is assumed, exhibit higher prevalence differences compared to settings in which monitoring for AF is assumed, particularly among Asian and Hispanic or Latino subgroups.

Cardiovascular events reported in patients with B-cell malignancies treated with zanubrutinib

AbstractFirst-generation Bruton tyrosine kinase (BTK) inhibitor, ibrutinib, has been associated with an increased risk of cardiovascular toxicities. Zanubrutinib is a more selective, next-generation BTK inhibitor. In this analysis, incidence rates of atrial fibrillation, symptomatic (grade ≥2) ventricular arrhythmia, and hypertension were evaluated in a pooled analysis of 10 clinical studies with zanubrutinib monotherapy in patients (N = 1550) with B-cell malignancies and a pooled analysis of head-to-head studies comparing zanubrutinib with ibrutinib (ASPEN cohort 1; ALPINE). Among the 10 studies, most patients (median age, 67 years) were male (66.3%) and had CLL/SLL (60.5%). Overall incidence and exposure-adjusted incidence rates (EAIR) for atrial fibrillation, symptomatic ventricular arrhythmia, and hypertension were lower with zanubrutinib than ibrutinib. Despite a similar prevalence of preexisting cardiovascular events in ASPEN and ALPINE, atrial fibrillation/flutter incidence rates (6.1% vs 15.6%) and EAIR (0.2 vs 0.64 persons per 100 person-months; P < .0001) were lower with zanubrutinib than with ibrutinib. Symptomatic ventricular arrhythmia incidence was low for both zanubrutinib (0.7%) and ibrutinib (1.7%) with numerically lower EAIR (0.02 vs 0.06 persons per 100 person-months, respectively) for zanubrutinib. The hypertension EAIR was lower with zanubrutinib than ibrutinib in ASPEN but similar between treatment arms in ALPINE. The higher hypertension EAIR in ALPINE was inconsistent with other zanubrutinib studies. However, fewer discontinuations (1 vs 14) and deaths (0 vs 6) due to cardiac disorders occurred with zanubrutinib versus ibrutinib in ALPINE. These data support zanubrutinib as a treatment option with improved cardiovascular tolerability compared with ibrutinib for patients with B-cell malignancies in need of BTK inhibitors. These trials were registered at www.ClinicalTrials.gov as # NCT03053440, NCT03336333, NCT03734016, NCT04170283, NCT03206918, NCT03206970, NCT03332173, NCT03846427, NCT02343120, and NCT03189524.

Birth cohort effects on diagnosed atrial fibrillation incidence: nationwide cohort study from 1980 to 2018

BackgroundThe incidence of atrial fibrillation (AF) shows substantial temporal trends, but the contribution of birth cohort effects is unknown. These effects refer to the relationship between birth year and the...

New-onset hypertension as a contributing factor to the incidence of atrial fibrillation in the elderly.

Hypertension and atrial fibrillation are closely related. However, hypertension is already prevalent in young adults, but atrial fibrillation usually occurs in the elderly. In the present analysis, we investigated incident atrial fibrillation in relation to new-onset hypertension in an elderly Chinese population. Our study participants were elderly (≥65 years) hypertensive residents, recruited from community health centers in the urban Shanghai (n = 4161). Previous and new-onset hypertension were defined as the use of antihypertensive medication or elevated systolic/diastolic blood pressure (≥140/90 mmHg), respectively, at entry and during follow-up on ≥ 2 consecutive clinic visits. Atrial fibrillation was detected by a 30-s single-lead electrocardiography (ECG, AliveCor® Heart Monitor) and further evaluated with a regular 12-lead ECG. During a median of 2.1 years follow-up, the incidence rate of atrial fibrillation was 7.60 per 1000 person-years in all study participants; it was significantly higher in patients with new-onset hypertension (n = 368) than those with previous hypertension (n = 3793, 15.76 vs. 6.77 per 1000 person-years, P = 0.02). After adjustment for confounding factors, the hazard ratio for the incidence of atrial fibrillation was 2.21 (95% confidence interval 1.15-4.23, P = 0.02) in patients with new-onset hypertension versus those with previous hypertension. The association was even stronger in those aged ≥ 75 years (hazard ratio 2.70, 95% confidence interval 1.11-6.56, P = 0.03). In patients with previous hypertension, curvilinear association (P for non-linear trend = 0.04) was observed between duration of hypertension and the risk of incident atrial fibrillation, with a higher risk in short- and long-term than mid-term duration of hypertension. Our study showed a significant association between new-onset hypertension and the incidence of atrial fibrillation in elderly Chinese. In an elderly Chinese population with previous and new-onset hypertension, we found that the new-onset hypertension during follow-up, compared with previous hypertension, was associated with a significantly higher risk of incident atrial fibrillation. In patients with previous hypertension, curvilinear association was observed between duration of hypertension and the risk of incident atrial fibrillation, with a higher risk in short- and long-term than mid-term duration of hypertension.

Hearing disorders, genetic predisposition, and risk of new-onset atrial fibrillation: A prospective cohort study in the UK biobank

BackgroundAtrial fibrillation (AF) is the most common sustained arrhythmia and is associated with significant morbidity and mortality. Hearing impairment has been linked to several cardiovascular diseases. However, the association between hearing disorders, genetic predisposition, and new-onset AF remains largely unknown. MethodsA total of 476,773 participants (mean age 56.5 years) free of AF at baseline (from 2006 to 2010) were included from the UK Biobank study. The presence of hearing disorders including hearing difficulty and tinnitus was self-reported through the touchscreen questionnaire. AF was defined using ICD-10 code: I48 and was followed till February 1st. 2022. The Cox model was used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CI). ResultsDuring a median follow-up of 13.0 years, the AF incidence rate was 2.9 per 1000 person-years. After adjustments for potential confounders, the presence of hearing difficulty (HR, 1.35; 95% CI: 1.32–1.39) and the use of hearing aid (1.45; 1.37–1.53) were significantly associated with risk of new-onset AF. Compared to individuals without tinnitus, the AF risk increased by 17% among those who experienced tinnitus occasionally (1.17; 1.09–1.25), 23% among those who experienced tinnitus frequently (1.23; 1.10–1.39), and 32% among those who experienced tinnitus consistently (1.32; 1.22–1.42). No significant difference was observed across different groups of genetic risk score for AF onset. ConclusionsOur study provides evidence regarding significant associations of hearing difficulty, use of hearing aid, and tinnitus with risk of incident AF. Findings highlight the potential that screening hearing disorders can benefit AF prevention.

Day-to-day home blood pressure variability and risk of atrial fibrillation in a general Japanese population: the Hisayama Study.

Several prospective studies have reported that higher visit-to-visit blood pressure variability (BPV) is associated with atrial fibrillation (AF). However, no studies have investigated the association between day-to-day BPV assessed by home blood pressure measurement and the development of AF. A total of 2,827 community-dwelling Japanese aged ≥40 years without prior AF were followed up for 10 years (2007-2017). Day-to-day home BPV (defined as coefficients of variation [CoV] of home systolic blood pressure [SBP] for 28 days) were categorized into 4 groups according to the quartiles: Q1, ≤4.64%; Q2, 4.65%-5.70%; Q3, 5.71%-7.01%; Q4, ≥7.02%. The hazard ratios for developing AF were estimated using a Cox proportional hazards model. During the follow-up period, 134 participants developed new-onset AF. The crude incidence rates of AF increased significantly with higher CoV levels of home SBP: 2.1, 4.7, 5.3, and 8.8 per 1000 person-years in the first, second, third, and fourth quartiles, respectively (P for trend <0.01). After adjusting for potential confounders, increased CoV levels of home SBP were associated significantly with a higher risk of AF (P for trend =0.02). The participants in the highest quartile of CoV had a 2.18-fold (95% confidence intervals: 1.18-4.04) increased risk of developing AF compared to those in the lowest quartile. The present findings suggest that increased day-to-day home BPV levels are associated with a higher risk of the development of AF in a general Japanese population.

Higher Cumulative Blood Pressure in Midlife Predicts an Increased Risk of Atrial Fibrillation: Evidence From the Atherosclerosis Risk in Communities Study.

Elevated blood pressure (BP) is reportedly associated with an increased risk of atrial fibrillation (AF). However, the association between cumulative BP exposure in midlife and incident AF in mid-to-late life remains unclear. Participants enrolled in the ARIC (Atherosclerosis Risk in Communities) study with 4 consecutive BP measurements and no prevalent AF at baseline were included. Cumulative BP was calculated as the area under the curve from visit 1 to visit 4. Incident AF was identified by study visit ECGs, hospital discharge codes, or death certificates. A total of 9892 participants were included (44.6% men and mean age 62.9±5.7 years at visit 4) with 1550 (15.7%) individuals who developed new-onset AF during an average follow-up of 15.4 years. The incidence rates of AF per 1000 person-years across the 4 quartiles of cumulative systolic BP were 7.9, 9.2, 12.5, and 16.9, respectively. After multivariable adjustment, the hazard ratios for incident AF among participants in the highest quartile of cumulative systolic BP, pulse pressure, and mean arterial pressure were 1.48 (95% CI, 1.27-1.72), 1.81 (95% CI, 1.53-2.13), and 1.22 (95% CI, 1.05-1.41), respectively, compared with those in the lowest quartile. The addition of cumulative systolic BP or pulse pressure slightly improved the ability to predict new-onset AF. Higher exposure to cumulative systolic BP, pulse pressure, and mean arterial pressure was significantly associated with increased risk of incident AF.

Risk of atrial fibrillation in patients with systemic sclerosis: a nationwide population-based study.

Atrial fibrillation (AF) is the most common arrhythmia in the general population causing substantial economic burden, morbidity, and mortality. The incidence rate and risk of AF in patients with systemic sclerosis (SSc) are unclear. We aimed to assess the incidence rate of AF in patients with SSc, and the risk of incident AF in patients with SSc compared with the general population. The Korean National Health Insurance Service database was used as the data source. Patients with claims data for SSc between 2010 and 2017 were extracted from the database along with 1:5 age- and sex-matched controls. The index date was the earliest date with claims data for SSc between 2010 and 2017. The follow-up duration was from the index date to 2019. Multivariable Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for AF in patients with SSc. Overall, 2,519 patients with SSc and 12,595 age- and sex-matched controls were included. Over a mean follow-up duration of 5.2±2.6 years, the incidence rates of AF were 3.52 and 1.68 per 1,000 person-years for patients with SSc and controls, respectively. Compared with controls, patients with SSc had a significantly higher risk of incident AF (adjusted HR = 2.095, 95% CI = 1.466-2.994). Patients with SSc had a two-fold higher risk of incident AF than controls. Given the significant economic burden, morbidity, and mortality that AF poses, close monitoring for incident AF in patients with SSc is warranted.

Interaction of genetic risk and lifestyle on the incidence of atrial fibrillation

BackgroundThe relationship between combined genetic predisposition and lifestyle and the risk of incident atrial fibrillation (AF) is unclear. Therefore, we aimed to assess a possible interaction between lifestyle and genetics...

Genetic risk, modifiable risk factors, and atrial fibrillation in the Danish diet, cancer, and health cohort

Abstract Background The etiology of AF is multifactorial. Genetic susceptibility and lifestyle contribute to atrial fibrillation (AF) risk.(1,2) However, the relationship between combined genetic predisposition and lifestyle risk factors on AF risk is unclear. Purpose We aimed to assess a possible interaction between modifiable risk factors and genetics on AF risk. Methods We included AF cases and a randomly drawn subcohort of 4,040 participants from the Danish Diet, Cancer, and Health study. Modifiable risk factors were assessed including smoking, body mass index, physical activity, diet, alcohol consumption, total cholesterol, and blood pressure. Based on cumulation of risk factors, a risk factor profile was determined for all participants and categorized as poor, intermediate, and ideal. Based on DNA sequence polymorphisms, we calculated a genetic risk score for AF, and categorized participants as having a low (quintile 1), intermediate (quintile 2-4) or high (quintile 5) genetic risk. Diagnoses of AF and/or atrial flutter were obtained from the Danish National Patient Register. We used weighted Cox proportional hazards regression to assess hazard ratios of AF. Results 3,094 AF cases occurred during a median follow-up of 12.9 years. Median age at baseline in the subcohort was 55 years (25th-75th percentile 52-60) and 2,092 (55%) were women. Participants at intermediate and high genetic risk had higher rates of AF compared with those at low genetic risk. Likewise, intermediate, and poor risk factor profiles were associated with higher rates of AF compared with those having ideal risk factor profiles. Weighted cumulative incidence proportions and hazard ratios of AF according to genetic risk and modifiable risk factors are shown in Figure 1. Within each category of genetic risk, incidence rates per 1,000 person-years were gradually higher with worse modifiable risk factor profiles. (Figure 2). For participants with high genetic risk, the incidence rates of AF per 1,000 person years were 5.0 (95% CI 3.4-7.3) for ideal, 6.6 (95% CI 5.4-8.1) for intermediate, and 10.4 (95% CI 9.2-11.8) for poor risk factor profiles. On an additive scale, there was a statistically significant interaction between genetic risk and modifiable risk factors (relative excess risk due to interaction=0.86 (95% 0.68-1.03, p&amp;lt;0.001). Conclusions A genetic risk score and modifiable risk factors were each associated with AF risk. The rates of AF increased gradually with cumulation of modifiable risk factors within each category of the genetic risk score, and we found an additive interaction between genetic risk and the modifiable risk factor profile. This underlines the importance of risk factor modification in primary AF prevention.Figure 1Figure 2

Five-year changes in weight and risk of atrial fibrillation in women and men from the Danish diet, cancer, and health cohort

Abstract Background Overweight and obesity are causal risk factors for atrial fibrillation (AF).(1) Mendelian randomization studies indicated a higher risk of AF with each unit increase in body mass index (BMI).(1) In observational studies, weight gain was associated with a higher risk of incident AF compared to stable weight.(2,3) However, the results are conflicting regarding the association between weight loss and risk of incident AF.(4,5). Purpose We aimed to assess the association between five-year changes in weight and absolute and relative rates of incident AF in women and men from the Danish Diet, Cancer, and Health Cohort. Methods In the Danish cohort study Diet, Cancer, and Health, participants were invited to attend a recruitment research examination and a second examination 5 years later. Height, weight, and several lifestyle factors were assessed at both examinations. We calculated BMI and BMI changes between first and second examination. BMI changes were categorized into following groups: &amp;lt;-5 kg/m2, ≥-5 to &amp;lt;-2.5 kg/m2, ≥-2.5 to &amp;lt;2.5 kg/m2, ≥2.5 to &amp;lt;5 kg/m2 and ≥5 kg/m2. Diagnoses of AF and comorbidities were retrieved from the Danish National Patient Registry. We used multivariable-adjusted Cox proportional hazards models to assess hazard ratios (HR) of AF according to changes in BMI. Results 43,758 participants without prior AF were included in the study. The median age was 62 (25th-75th percentile, 58-66) years and 54% were women. Over 15.7 years median follow-up time 5,312 participants had incident AF. From the first to the second measure, 39,076 (89%) of participants had stable weight, 2,627 (6%) lost weight, and 2,055 (5%) gained weight. The incidence rates of AF per 1,000 person-years were 8.4 (95% CI 8.1-8.6) among participants with stable weight, 12.4 (95% CI 9.6-16.1) among those with weight loss ≥5 kg/m2, and 15.4 (95% CI 11.7-20.2) among those who gained ≥5 kg/m2. Compared to participants with stable weight, individuals who gained ≥2.5 to &amp;lt;5 kg/m2 had a higher hazard of AF (HR 1.24, 95% CI 1.09-1.41). Among participants who gained ≥5 kg/m2 the rate of AF was also higher compared to stable weight (HR 1.95, 95% CI 1.48-2.56). There was no statistically significant association between weight loss, regardless of degree, and rate of AF. Figure 1 shows the HR of AF by BMI changes from first to second measure compared to stable weight using restricted cubic splines. In sex-stratified analyses, the association between weight gain of ≥5 BMI units (kg/m2) and higher AF rate was present for both women and men. Conclusions In this cohort study, five-year weight gain was associated with higher long-term risk of AF compared to stable weight. However, we found no associations between weight loss and long-term risk of AF.Figure 1

Risk of incident atrial fibrillation and subsequent use of oral anticoagulants in patients with dementia

Abstract Background Dementia and atrial fibrillation (AF) have many shared risk factors, and the presence of AF is associated with a higher risk of incident dementia. Although patients with dementia have higher risk of adverse cardiovascular events, there are limited data on the risks of incident AF, and the associated AF-related clinical outcomes. Patients with dementia are under-represented in randomised trials, and even if AF is present, oral anticoagulants (OAC) are not prescribed frequently. We aimed to report the incidence of newly-diagnosed AF in dementia patients, and the impact on stroke and bleeding outcomes with vitamin K antagonist (VKA, eg warfarin) and non-VKA OAC (NOACs). Methods Nationwide cohort study of 544,074 patients with dementia, compared to 554,074 age- and sex-matched patients without dementia. Results Rates of newly-diagnosed AF were higher in patients with dementia compared to those without history of dementia (1.89 per 100 person-years vs 1.78 per 100 person-years, respectively); adjusted risk of incident AF was greater in all types of dementia, pre-senile/senile dementia and vascular dementia (Figure 1). When compared to non-OAC users, warfarin use was associated with higher risk of ischaemic stroke (aHR, 1.290; 95% CI, 1.156 - 1.440), intracranial hemorrhage (ICH) risk (aHR, 1.678; 95% CI, 1.346 - 2.09) and major bleeding (aHR, 1.192; 95% CI, 1.073 - 1.323). NOAC use was associated with lower risk of ischaemic stroke (aHR, 0.42; 95% CI, 0.352 - 0.501) and major bleeding (aHR; 0.504, 95% CI, 0.433 - 0.587), when compared to non-OAC use (Figure 2). Conclusions In this large nationwide cohort of dementia patients, the incidence rate of newly-diagnosed or incident AF was higher in patients with dementia compared to patients without dementia. Compared to non-OAC users, NOAC use was associated with a lower risk of ischaemic stroke and major bleeding. Patients with dementia require a holistic approach to their care and management, including the use of NOACs to reduce their risks of clinical events.

The importance of active rhythm monitoring in patients with renal infarction: Korean national health insurance registry

Abstract Background/Introduction Several studies reported that approximately 50% of renal infraction (RI) is caused by cardioembolic disease, particularly associated with atrial fibrillation (AF). However, in the Korean national health insurance database (NHIS), from 2013 to 2019, the prevalence of AF in patients with RI was only 15%. So, we aimed to analyze the incidence of newly developed AF in RI patients. Method This nationwide population-based retrospective cohort study included 5,200 patients with RI using the NHIS database from 2002 to 2012. We analyzed the incidence rate of AF during 12 months among the patients without previous history of AF. We selected clinical events after three months of RI diagnosis to exclude cases diagnosed by initial screening or with previously missed diagnosis of AF. The definition of RI, AF, and comorbidities use the ICD-10-CM codes. Result During the total follow-up period (median 2.5 years, interquartile range 1.04-4.25), AF occurred in 19.1% of RI patients (n=993). Most cases (n=837, 16.1%) occurred within a year, and the incidence of AF was 3.965 per 10,000 person-year. Patients with newly developed AF had a higher proportion of older age than those without AF (64.1 vs. 57.3 years, P&amp;lt;0.001). The prevalence of comorbidities, including hypertension (HTN), ischemic heart disease (IHD), and heart failure (HF), was higher in those with AF. The independent predictors of AF were age (adjusted hazard ratio [aHR] 1.05, 95% CI 1.04-1.05, P&amp;lt;0.001), male (aHR 1.26, 95% CI 1.09-1.45, P=0.002), body mass index (BMI) (aHR 1.04, 95% CI 1.02-1.06, P &amp;lt;0.001), current smoker (aHR 1.20, 95% CI 1.03-1.40, P =0.023), IHD (aHR 1.20, 95% CI 1.00-1.45, P =0.050) and HF (aHR 1.70, 95% CI 1.25-2.33, P =0.001). Additionally, the incidence of all-cause death was 14.264 per 10,000 person-year during the follow-up period. Conclusion Even if AF is not diagnosed in the initial screening after diagnosis of RI, the physician should consider active rhythm monitoring to detect subclinical AF for optimal management in these patients. Especially it might be helpful to reduce the burden of recurrent embolic events in those with risk factors, such as older age, male, higher BMI, current smoker, IHD, or HF.Cox regression analysisAtrial fibrillation cumulative incidence

Abstract 17799: Increasing Incidence of Atrial Fibrillation and Flutter in the United States: A Population-Based Time-Trend Analysis Using the Global Burden of Diseases Database, 2000-2019

Introduction: Atrial fibrillation (AF) and flutter (AFL) are the most common sustained arrhythmia in clinical practice. There is limited data on recent age and sex-specific incidence rates. Aim: This study aimed to analyze incidence rates of AF and AFL in the US, focusing on age and gender-specific trends using the Global Burden of Disease (GBD) 2019 database. Methods: Incidence data was obtained from the GBD 2019 database. Age-adjusted incidence rates were stratified by gender into males and females. Age-specific trends were assessed in two age sub-groups: younger adults (≤55 years) and older adults (&gt;55 years). Time-trends, reported as annual percentage change (APC) and average APC (AAPC), were estimated using Joinpoint Regression Software (v.4.9.0.1, NCI) utilizing Monte Carlo permutation analysis. Results: 607,599 patients were diagnosed with AF and AFL in the US in 2019. Overall, AF and AFL incidence rates have increased in older adults and but remained stable in younger adults (AAPC= 2.2 vs. 0.9; AAPC difference= 1.3, P&lt;0.001). Age-specific trends were neither identical (P&lt;0.001) nor parallel (P&lt;0.001) suggesting that incidence rates are different and increasing at a greater rate in older adults compared to younger adults. However, for both men and women incidence rates have increased over the past two decades at the same rate (AAPC= 2.3 vs. 2.2: AAPC difference= 0.1, P=0.67). Conclusions: Our study showed that AF and AFL incidence increased over the past two decades. This increase is primarily driven by older adults. Further research is warranted to understand the factors contributing to this increase, especially in older adults.

Five-year changes in weight and risk of atrial fibrillation in the Danish Diet, Cancer, and Health Cohort.

Obesity is a major risk factor for atrial fibrillation (AF). Compared with stable weight, gaining weight was associated with a higher risk of incident AF in observational studies. The results, however, are conflicting regarding weight loss and risk of AF. This study aimed to assess the association between 5-year weight changes and risk of incident AF. The study was based on participants from the Danish Diet, Cancer, and Health Cohort. Body mass index (BMI) was assessed at a baseline examination and at a second examination 5 years later. Diagnoses of AF and co-morbidities were retrieved from the Danish National Patient Registry. In total, 43 758 participants without prior AF were included. The median age was 61 years and 54% were female. During a median follow-up of 15.7 years, 5312 individuals had incident AF (incidence rate 8.6/1000 person-years). Compared with stable weight, weight gain between 2.5 and 5 BMI units (kg/m2) was associated with a higher risk of AF [hazard ratio (HR) 1.24, 95% confidence interval (CI) 1.09-1.41]. Weight gain of 5 or more BMI units (kg/m2) was associated with a HR of 1.95 (95% CI 1.48-2.56) of incident AF. However, there was no statistically significant association between weight loss and risk of AF. Five-year weight gain was associated with greater risk of AF compared with stable weight in the Danish Diet, Cancer, and Health Cohort. There was no statistically significant association between weight loss and risk of AF.

Association between the accumulation of elevated serum γ-glutamyltransferase level and risk of atrial fibrillation: a nationwide cohort study

Atrial fibrillation (AF) is the most common cardiac arrhythmia. The association between AF and γ-Glutamyltransferase (GGT) was not fully established. This study demonstrated the independent association of cumulative GGT score and AF incidence with the dose-response relationship. Using the Korean National Health Insurance Corporation database, adult subjects who had 4 consecutive annual health examinations from 2009 to 2012 were enrolled. A cumulative GGT score was calculated as the cumulative number of the highest GGT quartile amongst four examinations (0–4 times). A multivariable Cox proportional hazards regression analysis was performed. Among a total of 3,500,847 people included, AF was developed in 27,752 people (0.793%) during a median of 8.0 years of follow up. The incidence rate of AF and adjusted hazard ratio were increased by a stepwise manner in the higher quartile group and cumulative GGT score group. In subgroup analysis, this trend was more prominent in the elderly, people without hypertension, non-obese people, and people without any four comorbidities (diabetes mellitus, hypertension, dyslipidemia, and obesity). Our results suggest multiple accumulation of elevated GGT levels in health examination might be a useful marker for risk stratification of AF development, especially in the elderly and healthy population.

New-onset atrial fibrillation after percutaneous patent foramen ovale closure: a meta-analysis

BackgroundThe exact incidence and predictors of new-onset atrial fibrillation (AF) after percutaneous closure of patent foramen ovale (PFO) are unknown.ObjectiveWe sought to find post-procedural AF incidence rates and differences due to different screening strategies and devices.MethodsA systematic search was conducted in Cochrane, MEDLINE and EMBASE. Controlled trials fulfilling the inclusion criteria were included into this meta-analysis. The incidence of new-onset AF was the primary outcome. Further parameters were surveillance strategy, device type, AF treatment and neurological events. New AF was determined as early onset within one month after implantation and late thereafter.Results8 controlled trials and 16 cohort studies were eligible for quantitative analysis. 7643 patients received percutaneous PFO closure after cryptogenic stroke or transient ischaemic attack, 117 with other indications, whereas 1792 patients formed the control group. Meta-analysis of controlled trials showed an AF incidence of 5.1% in the interventional and 1.6% in the conservative arm, respectively (OR 3.17, 95% CI 1.46–6.86, P = 0.03, I2 = 55%). 4.7% received high-quality surveillance strategy with Holter-ECG or Loop recorder whereby AF incidence was overall higher compared to the low-quality group with 12-lead ECG only (3.3–15% vs. 0.2–4.3%). Heterogeneous results on time of AF onset were found, limited by different follow-up strategies. CardioSEAL and Starflex seemed to have higher AF incidences in early and late onset with 4.5% and 4.2%, respectively.ConclusionPercutaneous PFO closure led to higher AF post-procedural incidence compared to the conservative strategy. Heterogeneity in surveillance and follow-up strategy limited the generalizability.Trial RegistrationRegistered on PROSPERO (CRD42022359945).Graphical abstract

Racial differences in atrial fibrillation-related bleeding and mortality

Abstract Funding Acknowledgements Type of funding sources: None. Background Adverse outcomes associated with atrial fibrillation (AF) in Asians have not yet been fully elucidated. This study was designed to study racial differences in the risk for bleeding and the effect of new-onset AF on bleeding and mortality. Methods This study is based on a patient-level comparative analysis of UK Biobank and Korean National Health Insurance Service-Health Screening data. The primary outcome was intracranial hemorrhage (ICH). The secondary outcomes were major bleeding and gastrointestinal (GI) bleeding. Five-year incidence rates (IR), rate difference (IR in those with AF minus IR in those without AF) and rate ratio (IR in those with AF divided by IR in those without AF) of the outcomes were calculated. Results Between 2005 and 2012, we identified 422,121 Asians (mean [SD] age, 55.1 [8.4] years; 54.2% of men) and 380,763 Whites (mean [SD] age, 57.1 [8.0] years; 45.1% of men). During the five-year follow-up period, the IR of AF per 1000 person-years were 2.29 (95% CI, 2.22–2.35) in Asians and 3.55 (95% CI, 3.46–3.63) in Whites. The IR of ICH was greater in Asians with and without AF than in corresponding White groups. The rate difference for ICH was 1.84 (95% CI, 1.18–2.51) in Asians and 0.80 (95% CI, 0.56–1.04) in Whites. For major bleeding, the IR of Asians were not only higher than those of Whites, but also the rate difference was 1.3-fold higher in Asians than in Whites. However, different tendencies were observed for GI bleeding. Conclusion Despite the higher incidence of AF in Whites, Asians with AF have a worse prognosis in terms of ICH and major bleeding. However, further studies are needed to explain the different trends of gastrointestinal bleeding.