Prevalence Of Atrial Fibrillation In Patients Research Articles

Prevalence of Atrial Fibrillation in Patients with Retinal Vessel Occlusion and Its Association: A Systematic Review and Meta-Analysis

ABSTRACTObjective: Recent studies have shown that atrial fibrillation (AF) is more prevalent in patients with retinal vessel occlusion and may be associated with both central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO). However, there is no systematic review and meta-analysis to confirm this finding.Methods: We searched the databases of MEDLINE and EMBASE from inception to January 2019. Included studies were published cohort, case-control or cross-sectional studies, and randomized control trials reporting the prevalence of AF in patients with CRAO or CRVO. Data from each study were combined using the random-effects model.Results: Eleven studies were included in our meta-analysis, involving a total population of 12,305 subjects with retinal vessel occlusion. The prevalence of AF ranged from 4.1% to 21.4% (pooled prevalence = 11.5%, 95% CI: 7.0–16.1, I2 = 96.3%). Five studies reported a control group of patients without retinal vessel occlusion. We found that AF is significantly associated with retinal vessel occlusion (pooled OR = 2.24, 95% CI:2.07–2.43, I2 = 0.0%).Conclusion: Our study showed that AF is significantly associated with retinal vessel occlusion. Further studies are needed to fully elucidate the exact mechanism linking AF with CRAO and CRVO.

ASSOCIATION OF LOW SODIUM-POTASSIUM RATIO WITH ATRIAL FIBRILLATION IN PATIENTS WITH PRIMARY ALDOSTERONISM

Objective: Atrial fibrillation (AF) is the most common cardiac arrhythmia with an increasing incidence and prevalence. Mechanisms of AF in patients with RHTN are not well studied. Obesity, high dietary salt intake and primary aldosteronism (PA) are commonly found. We have previously shown that AF is more common in patients with PA. Epidemiological studies suggest that the urinary sodium-to-potassium ratio may be a superior metric as compared to separate sodium and potassium values for determining the relation to blood pressure and cardiovascular disease risks. In this cross-sectional study we investigated the role of 24 h urinary sodium-to-potassium (24hUNaK) ratio in patients with AF and PA versus AF and non-PA. Design and method: This cross-sectional study of a large cohort of 2,375 black and white resistant hypertensive patients seen at the University of Alabama at Birmingham investigated the association of 24hUNaK ratio in patients with AF and PA vs AF and non-PA. PA was defined as renin activity <1ng/mL/h, aldosterone-renin-ratio >20, and 24 h UAldo >12mcg. Resistant hypertension was defined as blood pressure (BP) > 130/80 mmHg while taking 3 or more different antihypertensive medications, including a diuretic, if tolerated Results: Prevalence of AF in patients with PA vs non-PA was higher(18.5 vs 6.9%, p = 0.009). Patients with AF and PA were younger and more often male while rates of obesity, dyslipidemia, heart failure, obstructive sleep apnoea, diabetes, and coronary artery disease. There was no difference in clinic BP levels, duration of hypertension, and number of antihypertensive medications. Patients with AF and PA had a significant lower serum potassium (3.8+/−0.4 vs 4.2+/−0.5 mEq/dL, p < 0.001), higher 24 h urinary potassium levels (82.8+/−34.2 vs 53.1+/−22.8 mEq), higher 24 h urinary sodium levels (179.6+/−77.5 vs 149.1+/−69.2 mEq, p = 0.007), and lower 24 h UNaK ratio compared to patients with AF and non-PA (2.35+/−1.1 vs 3.05+/−1.3, p = 0.0003). Conclusions: A significant lower 24 h UNaK ratio was associated with AF in PA patients. Benefits for a reduction in sodium and an increase in potassium have been shown in patients with hypertension. Using the UNaK ratio as tool and improvement through diet and medical therapy, i.e. mineralocorticoid receptor antagonism may be key to prevent AF.

Association between atrial fibrillation and heart failure with different ejection fraction categories and its influence on outcomes

Background: The important role of atrial fibrillation (AF) in different types of heart failure (HF) according to ejection fraction (EF) is much less explored. In this study, we compared AF in HF with preserved (HFpEF), mid-range (HFmrEF) and reduced (HFrEF) EF with regard to prevalence, association, and prognostic role.Methods and results: A total of 405 inpatients with HF between February 2014 and June 2016 were prospectively analysed in this study. Patients were divided into three groups: HFrEF group (n = 109, 26.9%), HFmrEF group (n = 94, 23.2%), and HFpEF group (n = 202, 49.8%). There was a higher prevalence of AF in patients in the HFpEF and HFmrEF groups than in patients in the HFrEF. Several baseline variables were found to be independently associated with AF, including age, coronary heart disease, heart rate, left atrial diameter, and left ventricular (LV) end-diastolic diameter, regardless of EF category after multivariable adjustment. In addition, AF was found to be a more powerful predictor of all-cause mortality, HF rehospitalisation, and the composite event of all-cause mortality or rehospitalisation in HFpEF and HFmrEF patients, but not in HFrEF patients.Conclusions: HFmrEF resembled HFpEF rather than HFrEF with regard to both a higher prevalence of AF and a greater risk of all-cause mortality, HF rehospitalisation, and the composite event of all-cause mortality or rehospitalisation.

Meta-analysis of Atrial Fibrillation in Patients With Various Cardiomyopathies

Patients with cardiomyopathy are at risk of developing atrial fibrillation (AF) which is a strong risk factor for thromboembolic events, progression to heart failure, and mortality or heart transplantation. This systematic review and meta-analysis sought to estimate the prevalence of AF in a global population with cardiomyopathy. PubMed and EMBASE were searched from inception until June 30, 2017 for published articles on AF and major cardiomyopathies without language restrictions. Eligible papers were independently assessed for methodological qualities. The prevalence of AF in patients with cardiomyopathy was estimated using a random-effect model. The chi-square test on Cochrane's Q statistics was used to evaluate heterogeneity across studies. In total 220 full texts representing a population of 118,668 participants were included in the meta-analysis. The ages of the participants ranged from a median of 31 to 72 years. The proportion of males ranged from 3% to 97%. Considering only cardiomyopathies with more than one contributing study, the prevalence of AF was highest in participants with dilated (24% [95% confidence interval: 21 to 28]), ischemic (20% [8 to 35]), and hypertrophic (19% [17 to 21]) cardiomyopathies, and lowest in patients with peripartum cardiomyopathies (5% [1 to 11]). In conclusion, with the exception of peripartum cardiomyopathy, an average of 1 to 2 in every 10 patients with a cardiomyopathy had AF, with no gender difference. Future guidelines need to take into consideration the management of AF in all the forms of cardiomyopathy.

Epidemiology of atrial fibrillation in patients with cirrhosis and clinical significance: a meta-analysis.

The epidemiology of atrial fibrillation (AF) in patients with cirrhosis and its clinical significance remain unclear. This study aimed (i) to investigate the pooled prevalence and/or incidence of AF in patients with cirrhosis and (ii) to assess the mortality risk of AF in patients with cirrhosis. A literature search for studies that reported incidence of AF in patients with cirrhosis was carried out using Medline, Embase, and Cochrane Database from inception through July 2018. Pooled incidence with 95% confidence interval (CI) was calculated using a random-effect model. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42018102664). Seven cohort studies including 385 866 patients with cirrhosis were identified. The pooled estimated prevalence of AF in patients with cirrhosis was 5.0% (95% CI: 2.8-8.6%). When studies that solely assessed patients undergoing transplant evaluation or on transplant waiting list were excluded, the pooled estimated prevalence of AF in patients with cirrhosis was 7.4% (95% CI: 3.5-15.2%). There was a significant association between AF and increased mortality risk in cirrhotic patients with a pooled odds ratio of 1.44 (95% CI: 1.36-1.53). The overall estimated prevalence of AF among patients with cirrhosis is 5.0%. Our study demonstrates a statistically significant increased mortality risk in cirrhotic patients with AF.

Atrial Fibrillation: An Underestimated Cause of Ischemic Monocular Visual Loss?

Introduction: Atrial fibrillation (AF) is a major cause of ischemic stroke and Transient Ischemic Attack (TIA) and investigation for paroxysmal AF is recommended following an embolic brain event. In contrast, retinal ischemic monocular blindness is traditionally considered most linked to carotid artery disease (CAS) and investigating for AF is less vigilant. We aimed to determine the prevalence of AF in patients with ischemic monocular blindness. Methods: Consecutive records of all patients presenting to a daily TIA clinic with transient or permanent ischemic monocular blindness were reviewed, January 2014-October 2016. Results: Of 400 patients, 224 (56.0%) were male, mean age 64.5 years (SD 15.1). A total of 263 (66%) presented with transient and 137 (34%) with permanent ischemic monocular blindness. ECG was performed in 364 patients (91%) but only 211 (52%) had further cardiac monitoring. The vast majority (97.3%) had carotid imaging. Thirty-six patients (9%) were found to have AF while 53 (14%) had ipsilateral CAS. Median ABCD2 score was 1 in AF and non-AF groups. Only 55% of known AF patients were anticoagulated at presentation, despite all having CHADVASC2 score greater than or equal to 1. Patients with AF had more hypertension (P = .004), previous TIA (P = .002), previous stroke (P = .044) and ischemic heart disease (P = .022) with no difference in age (P = .791), diabetes (P = .563), smoking (P = .460) nor hypercholesterolaemia (P = .083). Conclusions: A total of 9% of patients with ischemic monocular blindness had AF. This is an underestimate, as only 53% of patients had prolonged cardiac monitoring. Known AF was suboptimally managed with only 55% receiving anticoagulation despite being eligible.

EPIDEMIOLOGY AND CLINICAL SIGNIFICANCE OF ATRIAL FIBRILLATION IN PATIENTS CIRRHOSIS: A META-ANALYSIS

Epidemiology of atrial fibrillation (AF) in patients with cirrhosis and its clinical significance remain unclear. This study's aims were 1) to investigate the pooled prevalence of AF in patients with cirrhosis and 2) to assess mortality risk of AF in patients with cirrhosis. A literature search for

Relationship between the CHA2DS2-VASc score and atrial fibrillation in patients hospitalised due to heart failure.

Heart failure (HF) has become an epidemic. A similar situation is also observed for atrial fibrillation (AF). The CHA2DS2-VASc score is one of the most useful tools for thromboembolic risk assessment. The aim of the study was to assess the prevalence of AF in patients with decompensated HF, who were divided into subgroups according to the CHA2DS2-VASc score. We analysed the prevalence of AF in a group of 1108 patients (327 women) hospitalised due to HF decompensa- tion in medical centres of different referral levels. Twenty-one patients refused to participate in the registry. The data were collected from Polish centres included in the European Society of Cardiology Heart Failure Long-Term Registry. The recruit- ment period was from 2011 to 2014. The data were analysed retrospectively. Patients were divided into groups according to the CHA2DS2-VASC score. The study sample was characterised by a high occurrence of AF (44.3%), with the highest prevalence in patients with a CHA2DS2-VASC score ≥ 6 (61.3%, p = 0.01). The CHA2DS2-VASc score may be a useful tool for detecting patients with HF characterised by the highest risk of AF.

Prevalence of Atrial Fibrillation and use of Oral Antithrombotic Therapy in Patients with Acute Coronary Syndrome

To assess the prevalence of atrial fibrillation (AF) and use of antithrombotic agents in adult patients with acute coronary syndrome (ACS). We consecutively enrolled all ACS patients (n=1155) who were hospitalized in two Moscowbased percutaneous coronary intervention centers (each center performs over 500 PCIs a year) between October 2017 and February 2018. AF was diagnosed in 204 patients (17.7%). The risk of thromboembolic complications was assessed using the CHA2DS2-VASc Score. The risk of hemorrhagic complications was assessed using the HAS-BLED Score. The data were processed using StatSoft Statistica 10.0 and IBM SPSS Statistics v.23 software. The prevalence of diagnosed AF was 13.6%, while the prevalence of undiagnosed AF was 4.1%. Of the 179 discharged patients with AF, only 2 had a low risk of ischemic stroke (IS). One hundred and fifty patients (83.8%) eligible for oral anticoagulant therapy received oral anticoagulants. Patients with diagnosed AF were administered oral anticoagulants (OACs) significantly more often than patients with undiagnosed AF [125 (91.9%) vs. 25 (58.1%), р&lt;0.001]. Novel oral anticoagulants (NOACs) were administered four times more often than vitamin K antagonists [120 (80.0%) vs. 29 (19.3%), р&lt;0.001]. Rivaroxaban was used in 51.3% of cases. Of the 29 patients treated with warfarin, only 3 (10.3%) achieved the target international normalized ratio (INR) at discharge. Of the 107 patients who underwent percutaneous coronary intervention (PCI), 77 patients (80%) received an OAC and two antiplatelet agents (with 74% receiving this three-agent therapy for one month), 11 patients (10.3%) received an OAC and an antiplatelet agent, and 18 patients (16.8%) received two antiplatelet agents. The only antiplatelet agent used as part of the three-agent therapy was clopidogrel. The three-agent therapy without PCI was administered in 43.1% of cases. We found that the prevalence of AF in patients with ACS was high. The fact that doctors administered NOACs suggests that they are aware of the need to use these agents to prevent thromboembolic complications in AF patients.

Ocorrência de Fibrilação Atrial Subclínica no Acompanhamento de Pacientes Portadores de Marcapasso Cardíaco

Objetivo: O marcapasso cardíaco registra a fi brilação atrial (FA). Essa condição pode causar graves consequências hemodinâmicas aos pacientes, que devem ser assistidos por médico cardiologista. Este estudo objetivou documentar e investigar, em um hospital terciário, a prevalência de FA subclínica em portadores de marcapasso cardíaco. Métodos: Entre julho de 2015 e abril de 2016, foram atendidos 196 pacientes portadores de marcapasso em caráter ambulatorial. Desses, 60 apresentaram arritmias cardíacas registradas pelo marcapasso e foram convidados a participar do estudo. A coleta de dados foi feita por meio de entrevista estruturada contendo quatro questões: sexo, idade, acompanhamento com cardiologista e uso de anticoagulantes. Resultados:Foi registrada FA subclínica em 35 (17,8%) do total de 196 pacientes. Desses 35, 16 (45,7%) não realizavam acompanhamento regular em serviço de cardiologia e 29 (82,8%) não faziam uso de medicamento anticoagulante. Não foram encontradas relações estatisticamente signifi cativas entre idade, acompanhamento com cardiologista e presença ou ausência da FA subclínica nos pacientes estudados. Conclusão: Uma parcela signifi cativa dos pacientes portadores de marcapasso atendidos ambulatorialmente tem FA registrada pelo dispositivo. No entanto, ainda que essencial, quase metade desses não faz acompanhamento clínico com cardiologista e menos de um quinto com FA faz uso de terapia anticoagulante.

Occurrence of Subclinical Atrial Fibrillation in the Follow-up of Patients with Cardiac Pacemakers

Objective: Cardiac pacemaker records atrial fibrillation (AF). This condition can cause serious hemodynamic consequences to patients, who should be assisted by a cardiologist. This study aimed to document and investigate, in a tertiary hospital, the prevalence of subclinical AF in patients with a cardiac pacemaker. Methods: Between July 2015 and April 2016, 196 patients with pacemakers were attended on an outpatient basis. Of these, 60 had cardiac arrhythmias recorded by the pacemaker and were invited to participate in the study. Data collection was done through a structured interview containing four questions: gender, age, follow-up with cardiologist and use of anticoagulants. Results: Subclinical AF was recorded in 35 (17.8%) of the total of 196 patients. Of these 35, 16 (45.7%) did not follow a regular cardiology service and 29 (82.8%) did not use anticoagulant medication. No statistically significant relationships were found between age, follow up with a cardiologist, and presence or absence of subclinical AF in the patients studied. Conclusion: A significant portion of outpatient patients with pacemakers have AF recorded by the device. However, although essential, almost half of these do not proceed with the clinical follow-up with cardiologist and less than a fifth with AF makes use of anticoagulant therapy.

Atrial fibrillation with flutter episode in patient with mitral stenosis

Mitral stenosis (MS) is a condition which happened because of congenital or acquired event. The most common etiology of MS in Indonesia is Rheumatic Heart Disease (RHD). Chronic inflammation on the mitral valve could lead to stenosis from mild to severe degree. Mitral stenosis could lead to many complications such as pulmonary hypertension and atrial fibrillation (AF). The prevalence of AF in patients with MS is related to the severity of valve obstruction and patient age. AF event in patient with MS could be happen because of Left Atrial (LA) dilatation of the patient. The mechanism that responsible for AF in patient with MS is a complex one. AF even with or without atrial flutter episode could lead a deterioration of patient hemodynamic. In the other way, the patient also predisposes to left atrial thrombus formation and systemic embolic events. Good awareness in diagnosis and management of atrial fibrillation in patient with MS are mandatory to reduce the morbidity and mortality.

Clinical and echocardiographic parameters as risk factors for atrial fibrillation in patients with hypertrophic cardiomyopathy

Atrial fibrillation (AF) is a common complication in patients with hypertrophic cardiomyopathy (HCM) and may contribute to high cardiovascular morbidity and mortality. Therefore, it is important to assess parameters associated with AF in HCM patients. The aim of the study was to evaluate AF prevalence in patients with HCM and to investigate risk factors for AF. Five hundred and forty-six HCM patients aged below 65 were included into analysis. Clinical and echocardiographic parameters were analyzed. In 141 patients (25.8%) AF episodes were recorded. The following factors were identified as risk factors for AF in patients with HCM: age ≥ 45 years (OR 2.38, CI 1.40-4.05, P = 0.001), past history of presyncope or syncope (OR 2.25, CI 1.35-3.74, P = 0.002), non-sustained ventricular tachycardia (nsVT) (OR 2.70, CI 1.60-4.57, P < 0.001), left atrium diameter during first assessment (OR 1.065, CI 1.03-1.11, P = 0.001), left atrium diameter at the last assessment before AF occurrence (OR 1.10, CI 1.06-1.14, P < 0.001) and left ventricular ejection fraction at the last assessment before AF occurrence (CI 0.96, CI 0.94-0.98, P = 0.001). We confirm that AF is a common complication for patients with HCM. Identification of patients with high risk for AF and implementation of preventive strategies may reduce AF occurrence and its complications.

Burden of Atrial Fibrillation-Associated Ischemic Stroke in the United States.

This study aimed to investigate whether the excess morbidity and mortality of atrial fibrillation (AF)-related stroke persists in the contemporary era. Acute ischemic stroke (AIS) in patients with AF is associated with worse outcomes than in patients without AF. Stroke prevention strategies in patients with AF have improved over the last decade and AIS-related mortality overall has also declined. Patients≥18 years of age who were admitted with AIS between 2003 and 2014 were identified in the National Inpatient Sample. The study compared crude and propensity score-matched in-hospital morbidity and mortality, cost, length of stay, and discharge dispositions between patients with and without AF. A total of 930,010 patients were admitted with AIS, and 18.2% of these patients had AF. The prevalence of AF in these patients increased from 16.4% in 2003 to 20.4% in 2014, with the greatest increase observed in white and older patients. Propensity score matching attained 2 pairs of 125,203 patients with AIS with and without AF. In these matched cohorts, the mortality rate was higher in patients with AF (9.9% vs. 6.1%; p< 0.001). Ischemic stroke in patients with AF was also associated with higher incidences of acute kidney injury, bleeding and infectious complications, and severe disability. Hospital length of stay was significantly longer, and cost of care was 20% higher in patients with AF. The prevalence of AF in AIS patients continued to rise, particularly in white and older patients. Despitethe improvement in AIS-related morality overall, the differential negative impact of AF on the morbidity, mortality, and cost of AIS was steady over the study's 12-year period.

The association of QRS duration with atrial fibrillation in a heart failure with preserved ejection fraction population: a pilot study.

Heart failure is a significant cause of morbidity and mortality, yet patient risk stratification may be difficult. Prevention or treatment of atrial fibrillation (AF) may be an important strategy in these patients that could positively affect their outcome. It has been demonstrated that in patients with systolic dysfunction, prolonged QRS duration (QRSd), an easily measured electrocardiographic parameter, is associated with AF. Prolonged QRSd is associated with an increase in prevalence of AF in patients with heart failure with preserved ejection fraction(HFPEF). Between February 2006 and February 2009, 718 patients were discharged with a diagnosis of HF from the Dartmouth-Hitchcock Medical Center. Of these, 206 had EF ≥50% by echocardiography performed within 72 hours of admission. After exclusions, 82 patients remained, of which 25 had AF and 57 had sinus rhythm. Characteristics of the AF and sinus-rhythm patients were compared in this pilot study. After adjustment for age, prior diagnosis of HF, and left atrial area, there was a nonsignificant trend (odds ratio: 2.2, 95% CI of 0.3-17.2) for a QRSd >120 ms to be associated with AF. Similar to results in patients with systolic dysfunction, patients with preserved EF may have an association between a prolonged QRSd and AF.

Periodic limb movements of sleep are associated with an increased prevalence of atrial fibrillation in patients with mild sleep-disordered breathing

BackgroundGrowing evidence indicates that periodic limb movements of sleep (PLMS) may be related to increased risk of developing cardiovascular disease. However, the association of PLMS with atrial fibrillation (AF) is unclear, especially in patients with sleep-disordered breathing (SDB). This study sought to investigate whether PLMS were associated with increased AF prevalence, independent of established risk factors. MethodsWe performed a cross-sectional study of patients who underwent attended polysomnography at Mayo Clinic from 2011 to 2014. The association of PLMS with AF prevalence was estimated by using logistic regression models. Results15,414 patients were studied, 76.3% of individuals with SDB defined by apnea-hypopnea index (AHI) ≥5/h, and 15.3% with a diagnosis of AF. In univariate logistic modelling, individuals with periodic limb movement index (PLMI) ≥30/h had higher odds of AF (odds ratio [OR] 1.96, 95% confidence interval [CI]1.79–2.16, p<0.001) when compared to patients with PLMI <15/h. After multivariate adjustment (for age, race, sex, history of smoking, hypertension, diabetes, coronary artery disease, heart failure, cerebrovascular disease, renal disease, iron deficiency anemia, chronic obstructive pulmonary disease, AHI, arousal index), in mild SDB patients, a PLMI ≥30/h or periodic limb movement arousal index (PLMAI) ≥5/h had significantly higher odds of AF than those with PLMI <15/h (OR 1.21, 95% CI 1.00–1.47, p=0.048) or PLMAI <1/h (OR 1.27, 95% CI 1.03–1.56, p=0.024). ConclusionsFrequent PLMS are independently associated with AF prevalence in patients with mild SDB. Further studies are needed to better understand the relationship with incident AF.

Diabetes mellitus and atrial fibrillation: evidence of a pathophysiological, clinical and epidemiological association beyond the thromboembolic risk

A large number of studies have linked diabetes mellitus (DM) to the development of cardiovascular disease. However, the association between DM and arrhythmic disease of the heart is less well recognized by the cardiology community. Mostly, the focus is the increased thromboembolic risk that the presence of DM confers to patients with atrial fibrillation (AF). However, recent evidence points toward an increased prevalence of AF in patients with diabetes. This association seems to be reinforced by the presence of additional comorbidities such as hypertension and insulin-resistance. Moreover, different pathophysiological mechanisms support this association. Notably the link between AF and DM is bidirectional: not only patients with DM are more vulnerable to develop AF but also patients with new-onset AF have an increased risk of DM. Herein, the epidemiological findings and pathophysiological mechanisms linking AF and DM will be reviewed in order to increase the knowledge on this association and improve the clinical and therapeutic approach.

Abstract 071: The Association Between Comorbid Atrial Fibrillation and the Type of Coronary Stent Implanted in Acute Coronary Syndrome Patients

Background: The presence of comorbid atrial fibrillation (AF) in patients hospitalized for acute coronary syndrome (ACS) and undergoing stent placement may necessitate the need for triple anti- thrombotic therapy including an anticoagulant plus dual antiplatelet therapy. We sought to determine the prevalence of comorbid AF in patients hospitalized for ACS and receiving a coronary stent and comorbid AF’s association with the type of stent implanted. Methods: We performed a retrospective analysis in the 2012 United States Agency for Healthcare Research and Quality National Inpatient Sample dataset. We included adult patients (age ≥18 years) hospitalized for ACS (International Classification of Diseases-Ninth Revision [ICD-9] diagnostic codes=410.x or 411.x in the primary position) who received either a bare-metal stent (BMS)(ICD-9 procedure code=36.06) or drug-eluting stent (DES)(ICD-9 procedure code=36.07). Patients were stratified into 2 cohorts based on the presence or absence of an ICD-9 diagnosis code in any position signifying comorbid AF (427.31 or 427.32). Multivariable logistic regression was performed to determine the association between comorbid AF and the odds of receiving a DES after adjustment for patient- and hospital-level covariates. Results are reported as adjusted odds ratios with accompanying 95% confidence intervals. Results: During the year 2012, there were 66,287 ACS patient admissions, of which, 24.7% received a BMS and 75.3% a DES. Of these admissions, 7,109 (10.9%) were for patients with comorbid AF (median [25%, 75% range] for CHA2DS2-VASc and ATRIA scores =3 [2, 4] and 1 [1, 3]). Following multivariable adjustment, the odds of receiving a DES were lower for ACS patients with comorbid AF (adjusted odds ratio=0.63, 95% confidence interval=0.59-0.67). Conclusions: Comorbid AF is not an uncommon condition in patients hospitalized for ACS and receiving a coronary stent. Our study suggests comorbid AF is associated with a significant 27% decreased odds of receiving a DES versus a BMS. This decreased utilization of DES may be secondary to concerns of increased bleeding from prolonged triple therapy and is not inconsistent with current guidelines.

Prognostic Significance of Atrial Fibrillation in Lower Limb Amputee Patients

In patients with risk factors or established atherothrombosis, atrial fibrillation (AF) is associated with a poor prognosis compared with patients without AF. The aim of this study was to evaluate the prevalence of AF in patients with lower limb amputation (LLA) and its association with cardiovascular death and adverse cardiovascular events in long-term follow-up. Observational prospective study of consecutive patients after index major (transfemoral and transtibial) LLA. The primary endpoint was cardiovascular death and secondary endpoint was a composite of adverse cardiovascular events at follow-up (acute myocardial infarction, contralateral lower limb amputation, and ischaemic stroke). Of 282 patients with LLA, 46 (16.3%) patients had AF. AF patients were significantly older compared with patients without AF (median 74.0, IQR 13.0 vs. median 67.0, IQR 14.8 years, p< .001). Diabetes and smoking on the other hand were significantly less prevalent in patients with AF compared with those without AF (41.3% vs. 72.0%, p< .001 and 56.5% vs. 76.3%, p=.01, respectively). 54.3% of patients with AF were on oral anticoagulation therapy. At a median follow-up of 24.0 months (IQR 19.0-32.0), 28.3% patients with AF died of cardiovascular causes versus 17.8% without AF (HRR 1.8, 95% CI 1.0-3.4, p=.06). Adverse cardiovascular events occurred in 32.6% of patients with AF during follow-up versus 22.0% without AF (HRR 1.9, 95% CI 1.0-3.3, p=.03). In multivariate Cox regression analysis, AF (HRR 2.3, 95% CI 1.3-4.2, p=.01) and diabetes (HRR 2.1, 95% CI 1.1-3.9, p=.02) were identified as independent predictors of adverse cardiovascular events during the follow-up. AF is common in patients with LLA and associated with higher risk of adverse cardiovascular events during long-term follow-up.

Prevalencia de fibrilación auricular y factores predictores de su aparición en pacientes portadores de marcapasos bicamerales

To assess the prevalence of atrial fibrillation (AF) in patients with dual-chamber pacemakers (DP), determine the variables associated with development of AF and evaluate the changes in AF's management by physicians. Five hundred patients with DP were prospectively included and interrogated. When AF was detected physicians in charge of the patient were warned. Changes in AF's management were evaluated. Mean age of the study population was 77 years, with 51% of men. AF was detected in 13.2% of patients. These findings led treatment changes in 64.7%. The variables analyzed by logistic regression model which were associated with the occurrence of AF were: arterial hypertension (OR=2.62; CI 95% 1.01-6.8; P<.048), history of AF (OR=4.30; CI 95% 2.26-8.32; P<.001), sick sinus syndrome as cause of device implantation (OR=2.09; CI 95% 1.09-3.97; P<.025) and burden of supraventricular extrasystoles series(OR= 1.000033 per serie; CI 95% 0.000011-0.000055; P<.003.). We have detected a high prevalence of AF in patients with DP. The diagnose of AF led to change in treatment. Four clinical variables increase the likelihood of developing this arrhythmia.