The nutritional risk and short-, medium- and long-term mortality of hospitalized patients with atrial fibrillation

Background: Cerebral microbleeds (CMBs) were predictive of mortality in elderly and considered as a putative marker for risk of intracranial hemorrhage. Stroke patients with non valvular atrial fibrillation (NVAF) require anticoagulation, which increases the risk of hemorrhages. We investigated association of CMBs with the long term mortality in acute ischemic stroke patients with NVAF. Methods: During 6 years , consecutive ischemic stroke patients who had NVAF and who had undergone brain MRI with a gradient-recalled echo sequence were enrolled. Long-term mortality and causes of death were identified using data from Korean National Statistical Office. Survival analysis was performed whether the presence, number and location of CMBs were related with all causes, cardiovascular, and cerebrovascular mortality during follow-up. Results: Total 506 patients were enrolled during the study period and were followed up for median 2.5 years. CMBs were found in 30.8% of patients (156/506). Oral anticoagulation with warfarin was prescribed at discharge in 477 (82.7%) patients. During follow up, 177 (35%) patients died and cerebrovascular death was noted in 93 patients (81 ischemic stroke and 12 hemorrhagic stroke). After adjusting age, sex and significant variables in univariate analysis (p<0.1), multiple CMBs (≥5) were the independent predictor for all-cause, cardiovascular and ischemic stroke mortalities. The strictly lobar CMBs were associated with hemorrhagic stroke mortality in multivariate Cox regression analysis (HR 4.776, p=0.032) (Figure 1). Conclusions: Multiple CMBs were the independent predictor for the long term mortality in stroke patients with NVAF. Among them, patients with strictly lobar CMBs had a high risk of death due to hemorrhagic stroke. Our findings suggest that detection of CMBs in stroke patients with NVAF are of clinical relevance for predicting long term outcome and that particular concern is necessary in those with strictly lobar CMBs for their increased risk of death due to hemorrhagic stroke. Figure 1.

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Commentary on : New-Onset Atrial Fibrillation Predicts Long-Term Mortality After Coronary Artery Bypass Graft by El-chami et.al

Journal of Atrial Fibrillation ◽

10.4022/jafib.v2i1.576 ◽

2010 ◽

Vol 2 (1) ◽

Author(s):

Giovanni Filardo

Keyword(s):

Atrial Fibrillation ◽

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft ◽

Onset Atrial Fibrillation ◽

Long Term Mortality ◽

New Onset

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Short- and long-term mortality associated with new-onset atrial fibrillation after coronary artery bypass grafting: A systematic review and meta-analysis

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2010.10.040 ◽

2011 ◽

Vol 141 (5) ◽

pp. 1305-1312 ◽

Cited By ~ 78

Author(s):

Roop Kaw ◽

Adrian V. Hernandez ◽

Iqbal Masood ◽

A. Marc Gillinov ◽

Walid Saliba ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Meta Analysis ◽

Artery Bypass ◽

Bypass Grafting ◽

Short And Long Term ◽

Onset Atrial Fibrillation ◽

Long Term Mortality ◽

New Onset

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Abstract WP379: Sex-specific Effects of Comorbid Diabetes and Depression on Post-stroke Mortality in Individuals With Atrial Fibrillation

Stroke ◽

10.1161/str.51.suppl_1.wp379 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Jodi Edwards ◽

Jessica Colby-Milley ◽

Jiming Fang ◽

Limei Zhou ◽

Baiju R Shah ◽

...

Keyword(s):

Atrial Fibrillation ◽

Hospital Mortality ◽

Recurrent Stroke ◽

Stroke Patients ◽

Comorbid Depression ◽

Term Care ◽

Post Stroke ◽

Specific Effects ◽

Long Term Mortality

Background: Comorbid diabetes and depression are highly prevalent in atrial fibrillation (AF) and increase the risk of stroke. Women with AF show higher mortality rates and have worse functional outcomes post-stroke. However, the sex-specific effects of comorbid diabetes and depression on mortality and other adverse outcomes in stroke patients with a history of AF is unclear. Methods: Prospectively collected consecutive patients with ischemic stroke and known AF presenting to designated stroke centres in Ontario (2003-2013). Multinomial regression was used to determine sex-specific associations between diabetes and depression and in-hospital mortality post-stroke in individuals with AF. Cox proportional hazards regression was used to estimate the adjusted hazard of long-term mortality post-stroke and competing risks models to estimate hazards of recurrent stroke/TIA, admission to long-term care, and incident dementia post-discharge. Results: Among 5082 stroke patients with known AF (median age=80, IQR:73-85), female patients were more likely to have comorbid depression than males (63.5% vs. 36.5%) and those with comorbid diabetes and depression were younger (77 yrs) and had more vascular history (HTN, CAD, hyperlipidemia) than those with AF only. For males, comorbid diabetes increased the likelihood of in-hospital mortality post-stroke by 53% (OR=1.53, 95% CI=1.16-2.02), after adjustment for stroke severity, demographic and clinical factors, while comorbid depression did not significantly impact in-hospital mortality and neither diabetes or depression affected in-hospital mortality post-stroke for females. However, diabetes was independently associated with increased hazard of long-term mortality for both female (HR=1.15, 95%CI=1.02-1.29) and male AF stroke patients (HR=1.35, 95%CI=1.19-1.53). No associations with recurrent stroke/TIA, institutionalization or dementia post-stroke were observed for either females or males. Conclusion: In stroke patients with known AF, comorbid diabetes but not depression was independently associated with increased in-hospital mortality for males and increased long-term mortality post-stroke for both females and males.

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Surgical factors associated with new-onset postoperative atrial fibrillation after lung resection: the EPAFT multicentre study

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2020-138904 ◽

2020 ◽

pp. postgradmedj-2020-138904

Author(s):

Vassili Crispi ◽

Emmanuel Isaac ◽

Udo Abah ◽

Michael Shackcloth ◽

Eileen Lopez ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cerebrovascular Accident ◽

Thoracoscopic Surgery ◽

Lung Resection ◽

Extent Of Resection ◽

Postoperative Atrial Fibrillation ◽

Preoperative Treatment ◽

Lung Resections ◽

Long Term Mortality

Purpose of the studyPostoperative atrial fibrillation (POAF) is a recognised complication in approximately 10% of major lung resections. In order to best target preoperative treatment, this study aimed at determining the association of incidence of POAF in patients undergoing lung resection to surgical and anatomical factors, such as surgical approach, extent of resection and laterality.Study designEvaluation of Post-operative Atrial Fibrillation in Thoracic surgery (EPAFT): a multicentre, population-based, retrospective, cross-sectional, observational study including 1367 patients undergoing lung resections between April 2016 and March 2017. The primary outcome was the presence of POAF following resection. POAF was defined as at least one episode of symptomatic or asymptomatic AF confirmed by ECG within 7 days from the thoracic procedure or prior to discharge from the hospital.ResultsPOAF was observed in 7.4% of patients: 3.1% in minor resection (video-assisted thoracoscopic surgery (VATS): 2.5%; thoracotomy: 3.8%), 9.0% in simple lobectomy (VATS: 7.3%, thoracotomy: 9.9%), 6.0% in complex resection (thoracotomy: 6.3%) and 11.4% in pneumonectomy. POAF was higher in left (4.0%) vs right (2.4%) minor resections, and in left (9.9%) vs right (8.3%) lobectomy, but higher in right (7.5%) complex resections, and the highest in right pneumonectomy (17.6%). No significant variations were observed as per sex, laterality or resected lobes. A positive univariable and multivariable association was observed for increasing age and increasing extent of resection, but not thoracotomy. Median (Q1–Q3) hospital stay was 9 (7–14) days in POAF and 5 (4–7) days in non-AF patients (p<0.001), with an increased cerebrovascular accident burden (p<0.001) and long-term mortality (p<0.001).ConclusionsAmong patients undergoing lung resection, POAF was significantly associated with age, increasing invasiveness of approach and increasing extent of resection. In addition, POAF carried a significant long-term mortality rate and burden of cerebrovascular accident. Appropriate prophylaxis should be targeted at these groups.

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