Cardioversion and subsequent quality of life and natural history of atrial fibrillation

Background Diabetes is a major risk factor for atrial fibrillation (AF). However, it remains unclear whether individual AF phenotype and related comorbidities differ between patients who have AF with and without diabetes. This study investigated the association of diabetes with AF phenotype and cardiac and neurological comorbidities in patients with documented AF. Methods and Results Participants in the multicenter Swiss‐AF (Swiss Atrial Fibrillation) study with data on diabetes and AF phenotype were eligible. Primary outcomes were parameters of AF phenotype, including AF type, AF symptoms, and quality of life (assessed by the European Quality of Life‐5 Dimensions Questionnaire [EQ‐5D]). Secondary outcomes were cardiac (ie, history of hypertension, myocardial infarction, and heart failure) and neurological (ie, history of stroke and cognitive impairment) comorbidities. The cross‐sectional association of diabetes with these outcomes was assessed using logistic and linear regression, adjusted for age, sex, and cardiovascular risk factors. We included 2411 patients with AF (27.4% women; median age, 73.6 years). Diabetes was not associated with nonparoxysmal AF (odds ratio [OR], 1.01; 95% CI, 0.81–1.27). Patients with diabetes less often perceived AF symptoms (OR, 0.74; 95% CI, 0.59–0.92) but had worse quality of life (β=−4.54; 95% CI, −6.40 to −2.68) than those without diabetes. Patients with diabetes were more likely to have cardiac (hypertension [OR, 3.04; 95% CI, 2.19–4.22], myocardial infarction [OR, 1.55; 95% CI, 1.18–2.03], heart failure [OR, 1.99; 95% CI, 1.57–2.51]) and neurological (stroke [OR, 1.39, 95% CI, 1.03–1.87], cognitive impairment [OR, 1.75, 95% CI, 1.39–2.21]) comorbidities. Conclusions Patients who have AF with diabetes less often perceive AF symptoms but have worse quality of life and more cardiac and neurological comorbidities than those without diabetes. This raises the question of whether patients with diabetes should be systematically screened for silent AF. Registration URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT02105844.

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Improving the understanding of how patients with non-dystrophic myotonia are selected for myotonia treatment with mexiletine (NaMuscla): outcomes of treatment impact using a European Delphi panel

BMC Neurology ◽

10.1186/s12883-021-02491-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ann-Marie Chapman ◽

Marieke Schurer ◽

Laure Weijers ◽

Amer Omar ◽

Hiba Lee ◽

...

Keyword(s):

Quality Of Life ◽

Natural History ◽

Negative Impact ◽

Phase Iii ◽

Future Research ◽

Delphi Panel ◽

Economic Modelling ◽

Patient Access ◽

History Of

Abstract Background Non-dystrophic myotonias (NDMs) comprise muscle chloride and sodium channelopathies due to genetic defects of the CLCN1- and SCN4A-channels. No licensed antimyotonic treatment has been available until approval of mexiletine (NaMuscla®) for adult patients by the EMA in December 2018. This Delphi panel aimed to understand how outcomes of the pivotal phase III Mexiletine study (MYOMEX) translate to real world practice and investigate health resource use, quality of life and the natural history of NDM to support economic modelling and facilitate patient access. Methods Nine clinical experts in treating NDM took part in a two-round Delphi panel. Their knowledge of NDM and previous use of mexiletine as an off-label treatment prior to NaMuscla’s approval ensured they could provide both qualitative context and quantitative estimates to support economic modelling comparing mexiletine (NaMuscla) to best supportive care. Consensus in four key areas was sought: healthcare resource utilization (HRU), treatment with mexiletine (NaMuscla), patient quality of life (QoL), and the natural history of disease. Concept questions were also asked, considering perceptions on the feasibility of mapping the validated Individualized Neuromuscular Quality of Life (INQoL) instrument to the generic EQ-5D™, and the potential impact on caregiver QoL. Results Consensus was achieved for key questions including the average long-term dosage of mexiletine (NaMuscla) in practice, the criteria for eligibility of myotonia treatment, the clinical importance of QoL outcomes in MYOMEX, the higher proportion of patients with increased QoL, and the reduction in the need for mental health resources for patients receiving mexiletine (NaMuscla). While consensus was not achieved for other questions, the results demonstrated that most experts felt mexiletine (NaMuscla) reduced the need for HRU and was expected to improve QoL. The QoL mapping exercise suggested that it is feasible to map domains of INQoL to EQ-5D. Points of interest for future research were identified, including that mexiletine (NaMuscla) may slow the annual decrease in QoL of patients over their lifetime, and a significant negative impact on QoL for some caregivers. Conclusions This project successfully provided data from an informed group of clinical experts, complementing the currently available clinical trial data for mexiletine (NaMuscla) to support patient access decisions.

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Natural history of Charcot–Marie-Tooth 2: 2-year follow-up of muscle strength, walking ability and quality of life

Neurological Sciences ◽

10.1007/s10072-009-0202-z ◽

2009 ◽

Vol 31 (2) ◽

pp. 175-178 ◽

Cited By ~ 10

Author(s):

Luca Padua ◽

D. Pareyson ◽

I. Aprile ◽

T. Cavallaro ◽

D. A. Quattrone ◽

...

Keyword(s):

Quality Of Life ◽

Muscle Strength ◽

Natural History ◽

Walking Ability ◽

Charcot Marie Tooth ◽

History Of

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Natural history of reflux oesophagitis: a 10 year follow up of its effect on patient symptomatology and quality of life.

Gut ◽

10.1136/gut.38.4.481 ◽

1996 ◽

Vol 38 (4) ◽

pp. 481-486 ◽

Cited By ~ 146

Author(s):

N I McDougall ◽

B T Johnston ◽

F Kee ◽

J S Collins ◽

R J McFarland ◽

...

Keyword(s):

Quality Of Life ◽

Natural History ◽

Reflux Oesophagitis ◽

History Of ◽

Reflux Œsophagitis

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Atrial fibrillation and clinical outcomes 1 to 3 years after myocardial infarction

Open Heart ◽

10.1136/openhrt-2021-001726 ◽

2021 ◽

Vol 8 (2) ◽

pp. e001726

Author(s):

Anthony P Carnicelli ◽

Ruth Owen ◽

Stuart J Pocock ◽

David B Brieger ◽

Satoshi Yasuda ◽

...

Keyword(s):

Quality Of Life ◽

Myocardial Infarction ◽

Atrial Fibrillation ◽

Clinical Outcomes ◽

Oral Anticoagulants ◽

Adverse Outcomes ◽

Increased Risk ◽

History Of ◽

The Impact

ObjectiveAtrial fibrillation (AF) and myocardial infarction (MI) are commonly comorbid and associated with adverse outcomes. Little is known about the impact of AF on quality of life and outcomes post-MI. We compared characteristics, quality of life and clinical outcomes in stable patients post-MI with/without AF.Methods/resultsThe prospective, international, observational TIGRIS (long Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease) registry included 8406 patients aged ≥50 years with ≥1 atherothrombotic risk factor who were 1–3 years post-MI. Patient characteristics were summarised by history of AF. Quality of life was assessed at baseline using EQ-5D. Clinical outcomes over 2 years of follow-up were compared. History of AF was present in 702/8277 (8.5%) registry patients and incident AF was diagnosed in 244/7575 (3.2%) over 2 years. Those with AF were older and had more comorbidities than those without AF. After multivariable adjustment, patients with AF had lower self-reported quality-of-life scores (EQ-5D UK-weighted index, visual analogue scale, usual activities and pain/discomfort) than those without AF. CHA2DS2-VASc score ≥2 was present in 686/702 (97.7%) patients with AF, although only 348/702 (49.6%) were on oral anticoagulants at enrolment. Patients with AF had higher rates of all-cause hospitalisation (adjusted rate ratio 1.25 [1.06–1.46], p=0.008) over 2 years than those without AF, but similar rates of mortality.ConclusionsIn stable patients post-MI, those with AF were commonly undertreated with oral anticoagulants, had poorer quality of life and had increased risk of clinical outcomes than those without AF.Trial registration numberClinicalTrials: NCT01866904.

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Diabetes is associated with atrial fibrillation phenotype, cardiac and neurological comorbidities: insights from the Swiss-AF study

European Heart Journal ◽

10.1093/eurheartj/ehab724.0442 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

A Bano ◽

N Rodondi ◽

J Beer ◽

G Moschovitis ◽

R Kobza ◽

...

Keyword(s):

Quality Of Life ◽

Myocardial Infarction ◽

Heart Failure ◽

Atrial Fibrillation ◽

Cognitive Impairment ◽

Cross Sectional ◽

Funding Sources ◽

Patients With Diabetes ◽

History Of

Abstract Background Diabetes mellitus is a major risk factor for atrial fibrillation (AF). However, it remains unclear whether individual AF phenotype and related comorbidities differ between AF patients with and without diabetes. Purpose To investigate the association of diabetes with AF phenotype, cardiac and neurological comorbidities in patients with documented AF. Methods Participants of the multicenter Swiss-AF study with available data on diabetes and AF phenotype were eligible. The primary outcomes were parameters of AF phenotype, including AF type (paroxysmal vs non-paroxysmal), AF symptoms (yes vs no), and quality of life (assessed by EQ-5D score). The secondary outcomes were cardiac (ie, history of hypertension, myocardial infarction, heart failure) and neurological comorbidities (ie, history of stroke, cognitive impairment). The cross-sectional association of diabetes with these outcomes was assessed using logistic and linear regression. Results were adjusted for age, sex, and cardiovascular risk factors. Results We included 2411 AF patients (27.4% women; median age, 73.6 years). Diabetes was not associated with non-paroxysmal AF (odds ratio [OR]=1.01; 95% confidence interval [CI]=0.81 to 1.27). Patients with diabetes less often perceived AF symptoms (OR=0.73; CI=0.59 to 0.91), but had worse quality of life (predicted mean difference in EQ-5D score: β=−4.54; CI=−6.40 to −2.68) than those without diabetes. Patients with diabetes were more likely to have cardiac comorbidities [history of hypertension (OR=3.04; CI=2.19 to 4.22), myocardial infarction (OR=1.55; CI=1.18 to 2.03), heart failure (OR=1.99; CI=1.57 to 2.51)] and neurological comorbidities [history of stroke (OR=1.39; CI=1.03 to 1.87), cognitive impairment (OR=1.75; CI=1.39 to 2.21)]. Conclusions In the Swiss-AF cohort population, patients with diabetes less often perceived AF symptoms, but had worse quality of life, more cardiac and neurological comorbidities than those without diabetes. These findings have significant clinical implications. The reduced perception of AF symptoms in patients with diabetes might result in a delayed AF diagnosis and consequently more adverse events, especially cardioembolic stroke. This raises the question whether patients with diabetes should be systematically screened for silent AF. Moreover, patients with concomitant AF and diabetes have increased likelihood of comorbidities and therefore deserve more attentive care. FUNDunding Acknowledgement Type of funding sources: None.

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Natural history of prostatism: Impact of urinary symptoms on quality of life in 2115 randomly selected community men

Urology ◽

10.1016/s0090-4295(94)80165-7 ◽

1994 ◽

Vol 44 (6) ◽

pp. 825-831 ◽

Cited By ~ 102

Author(s):

Cynthia J. Girman ◽

Robert S. Epstein ◽

Steven J. Jacobsen ◽

Harry A. Guess ◽

Laurel A. Panser ◽

...

Keyword(s):

Quality Of Life ◽

Natural History ◽

Urinary Symptoms ◽

History Of

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Natural History of Arteriovenous Malformations

Otolaryngology ◽

10.1016/j.otohns.2008.05.136 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P41-P42

Author(s):

James Y Suen ◽

Lisa M Buckmiller ◽

Chun-Yang Fan ◽

Gal Shafirstein ◽

Robert Glade

Keyword(s):

Quality Of Life ◽

Natural History ◽

Surgical Resection ◽

Healthcare Providers ◽

Previous Treatment ◽

Insurance Companies ◽

Preoperative Embolization ◽

Presenting Symptoms ◽

History Of

Objective 1) To demonstrate the natural history of arteriovenous malformation (AVMs) when left untreated or inadequately managed. 2) To demonstrate the need for major treatment to patients, families, healthcare providers, and insurance companies. Methods Records from 10 of 50 representative patients treated at University of Arkansas for Medical Sciences (UAMS) for advanced AVMs were reviewed for age at presentation, gender, presenting symptoms, previous treatment, disease course, and post-presentation management. Patients were asked if quality of life had improved after treatment at UAMS Facial photos from childhood were obtained and compared with photos taken at time of presentation. Results 10 patients (7 male, 3 female, range 21–46 years) received treatment. All patients presented with bleeding, pain and/or facial destruction. 6 of 10 patients received previous embolization. No patients had undergone previous surgical resection. All were informed by a previous physician that the disease was incurable or treatment options had been exhausted. All patients experienced subsequent worsening of symptoMS All patients were treated at UAMS with preoperative embolization followed by surgical resection and required multiple surgeries to remove persistent AVM. All patients indicated quality of life improved after embolization/surgical resection. Comparison of photos revealed progression of disease in all cases marked by facial destruction and deformity. Conclusions AVMs display a progressive and destructive nature when left untreated or inadequately managed. Natural history can be used to demonstrate to patients, families, and healthcare providers the seriousness of disease and convince insurance companies that radical treatment is typically necessary to obtain control or cure.

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Heart Rate Variability Reflects the Natural History of Physiological Development in Healthy Children and Is Not Associated with Quality of Life

PLoS ONE ◽

10.1371/journal.pone.0091036 ◽

2014 ◽

Vol 9 (3) ◽

pp. e91036 ◽

Cited By ~ 4

Author(s):

Georg Seifert ◽

Gabriele Calaminus ◽

Andreas Wiener ◽

Dirk Cysarz

Keyword(s):

Quality Of Life ◽

Heart Rate ◽

Heart Rate Variability ◽

Natural History ◽

Healthy Children ◽

History Of

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Corneal-Based Surgical Presbyopic Therapies and Their Application in Pseudophakic Patients

Journal of Ophthalmology ◽

10.1155/2016/5263870 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Grace L. Paley ◽

Roy S. Chuck ◽

Linda M. Tsai

Keyword(s):

Quality Of Life ◽

Laser Ablation ◽

Natural History ◽

Cataract Surgery ◽

Refractive Surgery ◽

Corneal Inlay ◽

History Of ◽

Surgical Options ◽

Laser Refractive Surgery

Purpose. The purpose of this review is to provide a summary of laser refractive surgery and corneal inlay approaches to treat presbyopia in patients after cataract surgery.Summary. The presbyopic population is growing rapidly along with increasing demands for spectacle independence. This review will focus on the corneal-based surgical options to address presbyopia including various types of corneal intrastromal inlays and laser ablation techniques to generate either a multifocal cornea (“PresbyLASIK”) or monovision. The natural history of presbyopia develops prior to cataracts, and these presbyopic surgeries have been largely studied in phakic patients. Nevertheless, pseudophakic patients may also undergo these presbyopia-compensating procedures for enhanced quality of life. This review examines the published reports that apply these technologies to patients after cataract surgery and discusses unique considerations for this population.

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