Mortality In Atrial Fibrillation Patients Research Articles

All-cause mortality trends in patients hospitalized for atrial fibrillation in Sweden: Role of age, stroke risk, and education.

The incidence of atrial fibrillation (AF) has long been increasing, and AF is associated with increased mortality. Over time, mortality trends may differ between subgroups depending on their underlying risk patterns and treatments. To explore all-cause-mortality trends over time in patients hospitalized for incident AF, and the effects of age, stroke risk, and education level. Patients hospitalized for incident AF between January 1995 and December 2003 were selected from Swedish national registries. Based on date of index admission, patients were divided into four cohorts and followed for five years. Age- and sex-matched controls were selected. Kaplan-Meier estimates and Cox regressions with trend analysis were used for statistical evaluation. There were 64,489 patients (mean age 72±10.1years) and 116,893 controls. There was a significantly decreasing trend in the relative risk of all-cause mortality in AF patients over time, with a trend hazard ratio of 0.94 (95% confidence interval [CI] 0.92-0.96, p<0.001) in women and 0.91 (95% CI 0.89-0.93, p<0.001) in men. The mortality trends did not differ significantly between AF patients and controls. The mortality risk remained unchanged in women aged 18-64years, in patients with low stroke risk, and in patients with post-secondary education. The all-cause mortality risk decreased over time in both patients and controls, but subgroup analysis revealed an unchanged mortality trend in women aged 18-64years, in patients with low stroke risk, and in patients with post-secondary education.

Abstract 10311: Atrioventricular Junctional Ablation in Patients With Atrial Fibrillation With and Without Heart Failure: A Meta-Analysis

Introduction: Rapid atrial fibrillation (AF) leads to heart failure (HF), but can also result from cardiac remodelling during HF. Atrioventricular junctional ablation (AVJA) cures rapid AF at the cost of permanent pacemaker dependency. We compared mortality in AF patients treated with AVJA to pharmacological therapy. Methods: We performed data searches in the PubMed, Central, and Embase till Marts 31, 2022. Inclusion criteria were observational and randomised controlled trials evaluating mortality and left ventricular ejection fraction (LVEF) in patients with AF. An exclusion criterion was lack of a parallel study design.Our primary endpoint was all-cause mortality. A secondary endpoint was the mean difference (MD) in LVEF during the follow-up. Endpoints were assessed through meta-analyses computing hazard ratios (HRs) and MDs. Mantel-Haenszel and DerSimonian random effect models were applied, respectively. LVEF&lt;41% was used as a surrogate for HF in a sensitivity analysis. Results: Overall,1738 studies were found from the data searches. Of these, 24 fulfilled the inclusion criteria (HF, N=15). The range of age was 60-75 years and 14 to 74% were women. The follow-up time varied between 3 to 96 months. AVJA as compared with pharmacological therapy reduced all-cause mortality by 27% in patients with AF (Fig. 1), whereas the LVEF MD between groups was not significantly different (Fig. 2). In HF patients, mortality was significantly favouring AVJA as compared with pharmacological therapy (HR, 0.68; 95% confidence interval [CI], 0.51 to 0.91; P=0.009) but not for the LVEF (MD, 1.12; 95% CI, -2.90 to 5.14; P=0.54). In patients without HF, neither mortality nor the LVEF MD were significantly different between AJVA and pharmacological therapy (results not reported). Conclusion: Mortality was significantly reduced in the AVJA group as compared with the pharmacological therapy group. This benefit was only persistent in HF patients in a sensitivity analysis.

Rhythm versus rate control for atrial fibrillation in heart failure with preserved ejection fraction.

There are few prospective studies assessing the benefits of rhythm control of atrial fibrillation (AF) in patients with heart failure and preserved ejection fraction (HFpEF), which accounts for 50% of all heart failure patients. Conduct a meta-analysis to assess the effects of rhythm control (ablation and/or antiarrhythmic medications) vs rate control on all-cause mortality in AF patients with HFpEF. Databases were searched for studies reporting the effect of rhythm control vs rate control on mortality in patients with HFpEF (Ovid MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar, and EBSCO CINAHL). The search was not restricted to time or publication status. The primary endpoint was all-cause mortality. The minimum duration of follow-up required for inclusion was 1 year. The literature search identified 1210 candidate studies; 5 studies and 16,825 patients were included. The study population had 57% men with a mean age of 71± 2.5 years. Rhythm control for AF was associated with lower all-cause mortality (odds ratio 0.735, 95% confidence interval 0.665-0.813; P < .001) as compared to rate control. Rhythm control for AF in patients with HFpEF was associated with decreased all-cause mortality.

Impact of preexisting diabetes mellitus on cardiovascular and all-cause mortality in patients with atrial fibrillation: A meta-analysis.

ObjectiveTo determine the impact of preexisting diabetes mellitus on cardiovascular and all-cause mortality in patients with atrial fibrillation (AF) by conducting a meta-analysis.MethodsPubMed and Embase databases were comprehensively searched for relevant studies publishing until May 19, 2022. Cohort studies or post-hoc analyses of clinical trials that investigated the association of diabetes mellitus with cardiovascular or all-cause mortality in AF patients were included.ResultsA total of 21 studies with 526,136 AF patients were identified. The pooled prevalence of diabetes mellitus in patients with AF was 26%. The summary multivariable-adjusted risk ratio (RR) of all-cause mortality was 1.37 (95% confidence intervals [CIs] 1.23–1.53) for patients with diabetes versus those without diabetes. Moreover, diabetes mellitus was also associated with an increased risk of cardiovascular mortality (RR 1.46; 95% CI 1.34–1.58). Stratified analyses suggested that the impact of diabetes on all-cause and cardiovascular mortality was consistently observed in each named subgroup.ConclusionThe presence of diabetes mellitus in patients with AF is associated with an increased risk of cardiovascular and all-cause mortality, even after adjustment for important confounding factors.

Gender difference in association between diabetes mellitus and all-cause mortality in atrial fibrillation patients

ObjectiveThere may be gender difference in correlation of diabetes mellitus (DM) and cardiovascular events. We attempt to investigate whether there is gender-heterogeneity in one-year outcomes of atrial fibrillation (AF) patients with DM or not. MethodsPatients who were diagnosed with AF admitted to the emergency departments in the Chinese AF Multicenter Registry study were enrolled. Basic demographics information, initial Blood Pressure and heart rate, medical histories, and treatments of each patient were collected. Follow-up was carried out with a mean duration of one year. The primary endpoint was all-cause mortality and systemic embolism. ResultsA total of 2016 patients were selected from September 2008 and April 2011. All-cause mortality was significantly higher in male AF patients with DM than those without (21.8 % & 13.6 %, P = 0.014). Cox regression analysis showed that there was an interaction between gender and DM for one-year all-cause mortality (P = 0.049). DM was significantly associated with one-year all-cause mortality regardless of univariate analysis (HR = 1.436, 95%CI:1.079–1.911, P = 0.013) or multivariate analysis (HR = 1.418, 95%CI: 1.059–1.899, P = 0.019). For male patients with AF, DM was significantly associated with one-year all-cause mortality (P = 0.048), but not for female patients with AF (P = 0.362). ConclusionDM was independently associated with one-year all-cause mortality in the entire cohort of AF patients. This association was found mainly in male patients with AF, but not in female patients. DM management programs may need to reflect gender difference.

Role of circulating long non-coding RNA for the improvement of the predictive ability of the CHA2DS2–VASc score in patients with atrial fibrillation

Background:The CHA2DS2–VASc score was initially applied to stratify stroke risk in patients with atrial fibrillation (AF) and was found to be effective in predicting all-cause mortality outcomes. To date, it is still unclear whether circulating long non-coding RNAs (lncRNAs) as emerging biomarkers, can improve the predictive power of the CHA2DS2–VASc score in stroke and all-cause mortality.Methods:Candidate lncRNAs were screened by searching the literature and analyzing previous RNA sequencing results. After preliminary verification in 29 patients with AF, the final selected lncRNAs were evaluated by Cox proportional hazards regression in 192 patients to determine whether their relative expression levels were associated with stroke and all-cause mortality. The c-statistic, net reclassification improvement (NRI), and integrated discrimination improvement of the patients were calculated to evaluate the discrimination and reclassification power for stroke and all-cause mortality when adding lncRNA expression levels to the CHA2DS2–VASc score model.Results:Five plasma lncRNAs associated with stroke and all-cause mortality in AF patients were selected in our screening process. Patients with elevated H19 levels were found to have a higher risk of stroke (hazard ratio [HR] 3.264, 95% confidence interval [CI]: 1.364–7.813, P = 0.008). Adding the H19 expression level to the CHA2DS2–VASc score significantly improved the discrimination and reclassification power of the CHA2DS2–VASc score for stroke in AF patients. In addition, the H19 level showed a marginally significant association with all-cause mortality (HR 2.263, 95% CI: 0.889–5.760, P = 0.087), although it appeared to have no significant improvement for the CHA2DS2–VASc model for predicting all-cause mortality.Conclusions:Plasma expression of H19 was associated with stroke risk in AF patients and improved the discriminatory power of the CHA2DS2–VASc score. Therefore, lncRNA H19 served as an emerging non-invasive biomarker for stroke risk prediction in patients with AF.

Dysnatremia Predicts All-Cause Mortality in Atrial Fibrillation Patients Without Heart Failure: A Prospective Cohort Study

Dysnatremia Predicts All-Cause Mortality in Atrial Fibrillation Patients Without Heart Failure: A Prospective Cohort Study

Dysnatremia Predicts All-Cause Mortality in Atrial Fibrillation Patients Without Heart Failure: A Prospective Cohort Study

Dysnatremia Predicts All-Cause Mortality in Atrial Fibrillation Patients Without Heart Failure: A Prospective Cohort Study

U-Shaped Association of the Heart Rate Variability Triangular Index and Mortality in Hemodialysis Patients With Atrial Fibrillation.

Background: Atrial fibrillation (AF) is common in hemodialysis patients and contributes to increased mortality. We aimed to examine heart rate variability triangular index (HRVI) in hemodialysis patients with AF as it has recently been reported to predict mortality in AF patients without kidney disease.Methods: A total of 88 patients on hemodialysis with a medical history of AF or newly diagnosed AF underwent 24-h electrocardiography recordings. The primary endpoint of cardiovascular mortality was recorded during a median follow up of 3.0 years. Risk prediction was assessed by Cox regression, both unadjusted and adjusted for the Charlson Comorbidity Index and the Cardiovascular Mortality Risk Score.Results: Median age was 76 years, median dialysis vintage was 27 months. Altogether, 22 and 44 patients died due to cardiovascular and non-cardiovascular causes. In 55% of patients AF was present during the recording. Kaplan-Meier plots of HRVI quartiles suggested a non-linear association between HRVI, cardiovascular, and all-cause mortality which was confirmed in non-linear Cox regression analysis. Adjusted linear Cox regression revealed a hazard ratio of 6.2 (95% CI: 2.1–17.7, p = 0.001) and 2.2 (95% CI: 1.3–3.8, p = 0.002) for the outer quartiles (combined first and fourth quartile) for cardiovascular and all-cause mortality, respectively. Patients in the first quartile were more likely to have sinus rhythm whereas patients in the fourth quartile were more likely to have AF.Conclusions: We found a U-shaped association between HRVI and mortality in hemodialysis AF patients. The results might contribute to risk stratification independent of known risk scores in hemodialysis AF patients.

Abstract 13638: Protein Calorie Malnutrition is an Adverse Prognostic Marker in Atrial Fibrillation Patients: An Analysis of the National Inpatient Sample Registry

Introduction: Protein Calorie Malnutrition (PCM) is not thought to be associated with atrial fibrillation (AF). Some research has stipulated that overweight AF patients may have a better prognosis than those with normal weight, however, the interaction between poor nutritional status and AF has not been well explored. Dyselectrolytemias secondary to malnutrition could confer a poor prognosis in AF patients. We aimed to assess the impact of PCM on outcomes in patients admitted with AF. Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2017. About 412,159 hospitalizations who had AF as their primary diagnosis were identified and stratified based on the presence of PCM using ICD-10 codes. Multivariate regression analysis was used to adjust for confounders and to analyze the variables. The selection of covariates was done with a univariate screen and literature review. Results: Out of the 412,159 hospitalized patients with AF, 11,590 individuals had PCM. In-hospital mortality in AF patients with PCM were significantly higher than those without (4.62% vs 0.77%); p&lt;0.0001. When adjusted for patient demographics, comorbidities, and hospital characteristics, AF patients with PCM had a higher risk of mortality (aOR=3.45, p&lt;0.0001), cardiac arrest (aOR=2.41, p&lt;0.0001), PE (aOR=2.06, p&lt;0.0001), sepsis (aOR=4.72, p&lt;0.0001), pneumonia (aOR=2.25, p&lt;0.0001), AKI (aOR=1.41, p&lt;0.0001), acute respiratory failure (ARF) (aOR=1.81, p=0.011), and being intubated (aOR=1.45, p=0.019). When adjusted similarly, AF patients with PCM had longer length of stay (LOS) by 2.76 days (mean LOS: 6.61 vs 3.25 days) (p&lt;0.0001) and an additional hospital cost (HC) of $18,373 (mean HC: $62,093 vs $39,934) (p&lt;0.0001). However, there was no difference in the risk of developing stroke (aOR=1.23, p=0.26) in AF patients with PCM. Conclusions: AF patients with PCM had worse outcomes in terms of in-hospital mortality, LOS, HC, cardiac arrest, PE, sepsis, pneumonia, AKI, ARF, and being intubated compared to those without PCM. This suggests that PCM is an adverse prognostic marker in this population. Current limitations include the underrepresentation of metabolic derangements due to inadequate coding within this administrative database.

Impact of malnutrition on the relationship between obesity and mortality in patients with atrial fibrillation

Abstract Introduction A protective effect of obesity has been previously reported in patients with atrial fibrillation (AF) – the so-called `obesity paradox”. Nutritional status could behave as a confounding factor, but there are no studies that analyze the interaction of malnutrition in the relationship between obesity and mortality in AF patients. Aim The objective of this study was to determine the impact of nutritional status on the relationship between body mass index (BMI) and mortality in AF patients. Methods A retrospective, multicenter, population-based cohort study of patients with diagnosis of AF from January 1, 2014 to December 31, 2017, in Vigo, Spain, was conducted. We created three separate groups according to BMI (normal-weight, overweight, and obesity) and three separate cohorts based on nutritional status according to CONUT score (good nutrition, mild malnutrition, and moderate-severe malnutrition). The primary outcome was all-cause mortality. Secondary outcomes included embolic events (systemic embolism and stroke) and major bleeding. A combined endpoint of mortality, embolic and haemorrhagic events was assessed (clinical net outcome). Results A total of 14,849 AF patients aged ≥75 years (75.6±10.3 years, 50.9% women) were followed-up during 44.4±1.8 years. Overweight and obesity was observed in 42.6% and 46.0%, respectively, whereas malnutrition was observed in 34.3%. Malnutrition rates were lower as BMI increased: from 48.1% in patients with underweight, to 36.8%, 35.1% and 33.0% in patients with normal weight, overweight, and obesity, respectively (p-value &amp;lt;0.001 for the trend). BMI was inversely associated with mortality (HR 0.96, 95% CI 0.95–0.97; p&amp;lt;0.001) in the univariate analysis; however, this association was lost when adjusted analysis by nutritional status was performed (HR 0.99, 95% CI 0.99–1.00; p=0.285). Thus, neither overweight nor obesity were predictors of mortality nor net outcome when we adjusted by nutritional status: after stratifying for presence of malnutrition, survival of patients with a BMI&amp;gt;25 kg/m2 was similar to that of patients with BMI ≤25 kg/m2. Regarding to nutritional status, both mild and moderate-severe malnutrition were associated with higher rates of mortality, stroke/systemic embolism and bleeding in all BMI groups (normal-weight, overweight and obesity). In this real-world observational study, we have assessed the interaction of nutritional status in the association between BMI and prognosis of AF patients. We concluded that 1) Malnutrition is common in AF patients, even among patients with overweight and obesity; 2) Malnutrition is a strong predictor of mortality in patients with AF; and 3) BMI was not associated with worse prognosis after adjusting for nutritional status. Conclusion The analysis of a large population of AF patients showed that the association between improved mortality and obesity/overweight is confounded by malnutrition status. Funding Acknowledgement Type of funding sources: None. Impact of nutrition status and weightClinical outcomes in different groups

The change of renal functions after nonvitamin K oral anticoagulants in patients with atrial fibrillation.

Oral anticoagulants decreased stroke and mortality in atrial fibrillation patients. There have been cumulative data suggesting that some oral anticoagulants may exert favorable renal outcomes.The aim of this study is to evaluate the renal outcomes in patients with atrial fibrillation who took oral anticoagulant.Methods:A Retrospective cohort study using hospital electronic database. Serum creatinine and GFR were collected at baseline and at 1 and 2 years.Results:Authors identified 734 patients with non-valvular AF who took oral anticoagulants. At the end of 2-year, the cumulative risk of significant GFR decline (eGFR drop > 30%) was 10.94% in warfarin group and 9.69% in NOACs group.The incidence rate of significant eGFR decline were comparable between NOACs and warfarin group which were 4.82 and 5.34 per 100-patient year respectively(HR 1.01 CI 0.62–1.66 , p- value 0.964).However, the adjusted mean eGFR change per year was significantly lower in NOAC group, especially rivaroxaban (coefficient 7.83 ,CI 4.44 11.22 , p-value < 0.001) and dabigatran (coefficient 6.22 ,CI 2.67–9.77 , p-value = 0.001) at 2 years.Conclusions:Significant GFR decline was not uncommon in non-valvular AF patients who received anticoagulant. Among these, the proportion of patients who had significant eGFR decline(>30%) were comparable between NOACs and warfarin at 2 years. However, there is a significantly less mean eGFR decline per year in patients who receive NOACs, notably with dabigatran and rivaroxaban, than those who receive warfarin.The findings of this study should be interpreted in the context of patients included in this study.

All you want to know about the arrhythmia: A comprehensive, nationwide registry study of atrial fibrillation in Finland

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Helsinki and Uusimaa Hospital District Funding The Finnish Foundation for Cardiovascular Research OnBehalf FinACAF Introduction The number of atrial fibrillation (AF) patients is increasing, and thus, the socio-medico-economic impact of AF is exploding. Up-to-date, multifaceted data about the characteristics of AF patients, their treatments, and outcomes are urgently needed. Purpose The aim of the Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) study is to evaluate the incidence and prevalence of AF, risk of stroke, thromboembolic complications, myocardial infarction, major bleeding events, and mortality in AF patients using comprehensive nationwide registries regulated by law. Assessment of the socio-medico-economic aspects of AF and the effect of socio-economic factors on the AF treatment play a central role in this study. Methods The FinACAF study collects data from 411 000 patients covering all Finnish AF patients from 1st January 2004 to 31st December 2018. Using national unique personal identification number, individual patient data from ten nationwide population registries and six regional laboratory databases (∼282000, 77 % of the patients) are linked together. All the register data were obtained during Q1-Q2/2020. The main results will be expected during Q1-2/2021. Results Since the introduction of the national primary care register in 2012, 9% of all AF patients were identified outside hospital care registers. The total number of AF patients on 31st December 2018 was 227 114, which translates to an AF prevalence of 4.1% in Finland (population of 5 517 900). The Table represents the registries used in the FinACAF study. Conclusions The FinACAF study records all patient contacts with the health care institutions and organizations, as well as incomes and places of domicile. Thus, the database allows a unique possibility to investigate the epidemiology and socio-medico-economic impact of AF as well as the cost effectiveness of different AF management strategies in a completely unselected, nationwide population. This data will markedly help "leading with data" when the increasing number of AF patients are treated. The registries used in the FinACAF study Register Registry Information obtained Finnish Care Register for Health Care: Primary, Hospital and Social care registries National Institute for Health and Welfare Diagnosis (ICD-10), procedure codes and date; non-hospital institutionalizations National Prescription Register, National Reimbursement Register The Social Insurance Institution of Finland Drug purchases (date, ATC codes, amount), Reimbursement decisions for chronic diseases (date, ICD-10) National Causes of Death Register, The Register of Completed Education and Degrees Statistics Finland Deaths and causes of deaths (ICD-10), Education and socio-economic status National Cancer Registry (1st Jan 1950 to 31st Dec 2018) Finnish Cancer Registry National registry of all cancer cases (e.g. date, ICD-O-3, TNM) Population Register, Tax register Population Register Center, Tax Administration Places of domicile, Income and taxes Laboratory databases (1st Jan 2010 to 31st Dec 2018) Six largest regional laboratory databases INR and other relevant laboratory measurements

Growth differentiation factor-15 predicts major adverse cardiac events and all-cause mortality in patients with atrial fibrillation

Background: Growth-differentiation factor-15 (GDF-15) has recently been described as a potential biomarker for predicting risk of mortality and cardiovascular events in patients with atrial fibrillation (AF) but requires validation in clinical practice.Methods: The study population consisted of 362 patients (mean age: 71 years, 37% women) with non-valvular AF included in a prospective cohort study. Relationship of GDF-15 with all-cause mortality and major adverse cardiac events (MACE) was analyzed using Cox regression. Survival analysis stratified by GDF-15 was based on national death records, while MACE was recorded at personal follow-up. Further, we evaluated the recently developed GDF-15 based prognostic score towards prediction of all-cause mortality (ABC-death score).Results: Over a median observation period of 4.3 years, 81 (23.3%) patients died, and over a median personal follow-up of 316 days 47 MACE occurred. GDF-15 was independently associated with all-cause mortality (adjusted HR per double increase 2.33, 95%CI 1.74-3.13) and MACE (adjusted HR per double increase 2.33, 95%CI 1.60-3.39). GDF-15 levels, measured at follow-up, were similarly associated with mortality, and longitudinal measurements of GDF-15 did not significantly differ. Six-year survival probability of patients above vs. below the median GDF-15 level was 44% (95%CI 34-57) and 84% (95%CI 76-93), respectively. The ABC-death score revealed a C-statistic of 0.80.Conclusion: GDF-15 predicts risk of all-cause mortality and MACE in patients with non-valvular AF. Further, the ABC-death score showed good predictive accuracy in a “real-world” cohort. Therefore, introduction of GDF-15 into clinical practice would enhance risk prediction of morbidity and mortality in AF patients.

Abstract P12: Alteplase Reduces Mortality in Patients With Ischemic Stroke and Atrial Fibrillation: Analysis of the IAC Study

Background and Purpose: Multiple studies have established that intravenous thrombolysis with alteplase improves outcome after acute ischemic stroke. However, assessment of thrombolysis’ efficacy in stroke patients with atrial fibrillation (AF) has yielded mixed results. We sought to determine the association of alteplase with mortality, hemorrhagic transformation (HT), infarct volume, and mortality in patients with AF and acute ischemic stroke. Methods: We retrospectively analyzed consecutive acute ischemic stroke patients with AF included in the Initiation of Anticoagulation after Cardioembolic stroke (IAC) study, which pooled data from 8 comprehensive stroke centers in the United States. 1889 (90.6%) had available 90-day follow up data and were included. For our primary analysis we used a cohort of 1367/1889 (72.4%) patients who did not undergo mechanical thrombectomy (MT). Secondary analyses were repeated in the patients that underwent MT (n=522). Binary logistic regression was used to determine whether alteplase use was independently associated with risk of HT, final infarct volume, and 90-day mortality, respectively, adjusting for potential confounders. Results: In our primary analyses we found that alteplase use was independently associated with an increased risk for HT (adjusted OR 2.14, 95% CI 1.49 - 3.07, p &lt;0.001) but overall reduced risk of 90-day mortality (adjusted OR 0.58, 95% CI 0.39 - 0.87, p = 0.009). Among patients undergoing MT, alteplase use was associated with a trend towards a reduction in 90-day mortality (adjusted OR 0.68 95% CI 0.45 - 1.04, p = 0.077). In the subgroup of patients prescribed DOAC treatment (n = 327; 24 received alteplase), alteplase treatment was associated with a trend towards smaller infarct size (&lt; 10 mL), (adjusted OR 0.40, 95% CI 0.15 - 1.12, p = 0.082) without a significant difference in the odds of 90-day mortality (adjusted OR 0.51, 95% CI 0.12 - 2.13, p = 0.357) or hemorrhagic transformation (adjusted OR 0.27, 95% CI 0.03 - 2.07, p = 0.206). Conclusion: Thrombolysis with intravenous alteplase was associated with reduced 90-day mortality in AF patients with acute ischemic stroke not undergoing MT. Further study is required to assess the safety and efficacy of alteplase in AF patients undergoing MT and those on DOACs.

Efficacy and safety of thrombolysis for acute ischemic stroke with atrial fibrillation: a meta-analysis

BackgroundThe efficacy and safety of intravenous thrombolysis (IVT) for acute ischemic stroke with atrial fibrillation (AF) is still controversial.MethodsWe conducted a meta-analysis of all relevant studies, retrieved through systematic search of PubMed, Embase, and Cochrane databases up to December 31, 2019. Modified Rankin Scale (mRS) scores of 0–1 at 90 days, mRS of 0–2 at 90 days, overall mortality, and incidence of symptomatic intracranial hemorrhage (sICH) were collected as outcome measures. Fixed- and random-effects meta-analytical models were applied, and between-study heterogeneity was assessed.ResultsA total of 8509 patients were enrolled in 18 studies. A comparison of IVT treatment in AF versus non-AF patients showed that AF was associated with a significantly lower proportion of patients with mRS of 0–1 (24.1% vs. 34.5%; OR 0.59; 95% CI 0.43–0.81; P < 0.001), mRS of 0–2 (33.6% vs. 47.8%; OR 0.55; 95% CI 0.43–0.70; P < 0.001), as well as significantly higher mortality (19.4% vs. 11.5%; OR 2.05; 95% CI 1.79–2.36; P < 0.001) and higher incidence of sICH (6.4% vs. 4.1%; OR 1.60; 95% CI 1.27–2.01; P < 0.001). A comparison of AF patients who were subjected or not to IVT showed that thrombolysis carried a higher risk of sICH (5.7% vs. 1.6%; OR 3.44; 95% CI 2.04–5.82; P < 0.001) and was not associated with a better prognosis. Subgroup analysis in prospective studies also suggested a poorer functional prognosis and higher mortality in AF patients treated with IVT compared with those who did not receive IVT. Some heterogeneity was present in this meta-analysis.ConclusionsAcute IS patients with AF had worse outcomes than those without AF after thrombolytic therapy, and had a higher incidence of sICH after thrombolysis than those without thrombolysis. Thrombolysis in ischemic stroke patients with AF should be carefully considered based on clinical factors such as NIHSS score, age, and the type of AF.

Mortality Prediction of the CHA2DS2-VASc Score, the HAS-BLED Score, and Their Combination in Anticoagulated Patients with Atrial Fibrillation.

Background and Objectives: Atrial fibrillation (AF) is associated with increased mortality, predictors of which are poorly characterized. We investigated the predictive power of the commonly used CHA2DS2-VASc score (congestive heart failure, hypertension, age ≥ 75 years [doubled], diabetes, stroke/transient ischemic attack/thromboembolism [doubled], vascular disease [prior myocardial infarction, peripheral artery disease, or aortic plaque], age 65–75 years, sex category [female]), the HAS-BLED score (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio [INR], elderly [age ≥ 65 years], drugs/alcohol concomitantly), and their combination for mortality in AF patients. Methods: The PREvention oF thromboembolic events—European Registry in Atrial Fibrillation (PREFER in AF) was a prospective registry including AF patients across seven European countries. We used logistic regression to analyze the relationship between the CHA2DS2-VASc and HAS-BLED scores and outcomes, including mortality, at one year. We evaluated the performance of logistic regression models by discrimination measures (C-index and DeLong test) and calibration measures (Hosmer and Lemeshow goodness-of-fit and integrated discrimination improvement (IDI), with bootstrap techniques for internal validation. Results: In 5209 AF patients with complete information on both scores, average one-year mortality was 3.1%. We found strong gradients between stroke/systemic embolic events (SSE), major bleeding and—specifically—mortality for both CHA2DS2-VASc and HAS-BLED scores, with a similar C-statistic for event prediction. The predictive power of the models with both scores combined, removing overlapping components, was significantly enhanced (p < 0.01) compared to models including either CHA2DS2-VASc or HAS-BLED alone: for mortality, C-statistic: 0.740, compared to 0.707 for CHA2DS2-VASc or 0.646 for HAS-BLED alone. IDI analyses supported the significant improvement for the combined score model compared to separate score models for all outcomes. Conclusions: Both the CHA2DS2-VASc and the HAS-BLED scores predict mortality similarly in patients with AF, and a combination of their components increases prediction significantly. Such combination may be useful for investigational and—possibly—also clinical purposes.

Association between body mass index and mortality in atrial fibrillation patients with and without diabetes mellitus: Insights from a multicenter registry study in China

Background and aimsThe aim of this study was to evaluate the association between body mass index (BMI) and mortality in atrial fibrillation (AF) patients with and without diabetes mellitus (DM). Methods and resultsA total of 1991 AF patients were enrolled and divided into two groups according to whether they have DM at recruitment. Baseline information was collected and a mean follow-up of 1 year was carried out. The primary outcome was defined as all-cause mortality with the secondary outcomes including cardiovascular mortality, stroke and major adverse events (MAEs). Univariable and multivariable Cox regression were performed to estimate the association between BMI and 1-year outcomes in AF patients with and without DM. 309 patients with AF (15.5%) had comorbid DM at baseline. Patients with DM were more likely to have cardiovascular comorbidities, receive relevant medications but carry worse 1-year outcomes. Multivariable Cox regressions indicated that elevated BMI was related with reduced risk of all-cause mortality, cardiovascular mortality and major adverse events. Compared to normal weight, overweight [HR (95% CI): 0.548 (0.405–0.741), p < 0.001] and obesity [HR (95% CI): 0.541 (0.326–0.898), p = 0.018] were significantly related with decreased all-cause mortality for the entire cohort. Remarkably reduced all-cause mortality in the overweight [HR (95% CI): 0.497 (0.347–0.711), p < 0.001] and obesity groups [HR (95% CI): 0.405 (0.205–0.800), p = 0.009] could also be detected in AF patients without DM, but not in those with DM. ConclusionElevated BMI was associated with reduced mortality in patients with AF. This association was modified by DM. The obesity paradox confined to AF patients without DM, but could not be generalized to those with DM.

Evaluation of Mortality in Atrial Fibrillation: Clinical Outcomes in Digital Electrocardiography (CODE) Study.

Aims:Atrial fibrillation (AF) is a public health problem and its prevalence is increasing worldwide. Electronic cohorts, with large electrocardiogram (ECG) databases linked to mortality data, can be useful in determining prognostic value of ECG abnormalities. Our aim is to evaluate the risk of mortality in patients with AF from Brazil.Methods:This observational retrospective study of primary care patients was developed with the digital ECG database from the Telehealth Network of Minas Gerais, Brazil. ECGs performed from 2010 to 2017 were interpreted by cardiologists and the University of Glasgow automated analysis software. An electronic cohort was obtained linking data from ECG exams and those from a national mortality information system, using standard probabilistic linkage methods. We considered only the first ECG of each patient. Patients under 16 years were excluded. Hazard ratios (HR) for mortality were adjusted for demographic and self-reported clinical factors and estimated with Cox regression.Results:From a dataset of 1,773,689 patients, 1,558,421 were included, mean age 51.6 years; 40.2% male. There were 3.34% deaths from all causes in 3.68 years of median follow up. The prevalence of AF was 1.33%. AF was an independent risk factor for all-cause mortality (HR 2.10, 95%CI 2.03–2.17) and cardiovascular mortality (HR 2.06, 95%CI 1.86–2.29). Females with AF had a higher risk of overall and cardiovascular mortality compared with males (p < 0.001).Conclusions:AF was a strong predictor of cardiovascular and all-cause mortality in a primary care population, with increased risk in women.Condensed abstractTo assess risk of mortality in AF patients, an electronic cohort was obtained linking data from ECG exams of Brazilian primary care patients and a national mortality information system. From 1,558,421 patients, AF (prevalence 1.33%) carried a higher risk of overall and cardiovascular mortality, with increased risk in women.What’s NewThis is the first study with a large Brazilian electronic cohort to evaluate the risk of mortality linked to AF in primary care patients.AF patients from a Brazilian primary care population had a higher risk of death for all causes (HR 2.10, 95%CI 2.03–2.17) and cardiovascular mortality (HR 2.06, 95%CI 1.86–2.29).Female patients with AF had an increased risk of overall and cardiovascular mortality compared with male patients (p < 0.001).

Usefulness of the 2MACE score as a predictor of long-term all-cause mortality in patients with atrial fibrillation.

2MACE is a risk assessment score designed to stratify cardiovascular risk in patients with atrial fibrillation (AF). Early detection of increased cardiovascular risk is of vital importance in this population, as it helps reduce mortality and morbidity rates. This study aimed to assess the utility of the 2MACE score in predicting long‑term mortality in patients with AF. This was a post hoc analysis of a prospective observational cohort study including consecutive patients with nonvalvular AF, who were followed for a median duration of 81 months. The final analysis included 1351 patients (men, 53.1%; median [interquartile range] age, 71 [62-80] years). During the follow‑up, 142 patients (10.5%) died. Deceased patients were more often classified as high risk according to the 2MACE score than survivors (80.3% vs 53.2%; P <0.0001). The receiver operator characteristic curve analysis demonstrated that the 2MACE score had a good predictive value for long‑ term all cause mortality (area under the curve, 0.73; 95% CI, 0.69-0.78). The mortality rate was significantly increased in patients with a 2MACE score of 3 or higher (hazard ratio, 3.40; 95% CI, 2.33-5.49). The 2MACE score is a good predictor of long‑ term all cause mortality in patients with AF. A progressive increase in the mortality rate was observed with an increasing 2MACE score.