Atrial Fibrillation is not Predictive of Mortality in the Dialysis Patient Cohort

The aim of the research is to determine frequency of atrial fi brillation; factors that lead to the formation of atrial fi brillation and the development of cardiovascular complications in dialysis patients. Material and methods. Analysis of current clinical practice in one out-patient hemodialysis center. Results. The incidence of atrial fi brillation in dialysis patients is 10.5 %. Most patients (72.4 %) had a paroxysmal form of atrial fi brillation. Th ere is clinical and laboratory characteristics of patients with atrial fi brillation. Atrial fi brillation occurred in 58.6 % of dialysis patients in average in 45 [15.4; 70.5] months after the beginning of regular hemodialysis, the rest got it in pre-dialysis period. Th e main factor associated with the development of atrial fi brillation on dialysis is the duration of dialysis therapy. Dialysis patients with atrial fi brillation are characterized by more pronounced systemic infl ammation and a higher incidence of hyperparathyroidism compared with patients without atrial fi brillation. Cardiovascular complications developed in 41.4 % dialysis patients with atrial fibrillation. Anuria is a factor associated with the development of myocardial infarction and stroke. Conclusion. Atrial fibrillation is found in every tenth dialysis patient. An increase in atrial fi brillation was noted along with an increase in hemodialysis duration. To optimize dialysis treatment of patients with atrial fibrillation further research is needed

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Detection of unknown atrial fibrillation by prolonged ECG monitoring in an all-comer patient cohort and association with clinical and Holter variables

Open Heart ◽

10.1136/openhrt-2019-001151 ◽

2020 ◽

Vol 7 (1) ◽

pp. e001151

Author(s):

Muhammad Jawad-Ul-Qamar ◽

Winnie Chua ◽

Yanish Purmah ◽

Mohammad Nawaz ◽

Chetan Varma ◽

...

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulation ◽

Diagnostic Yield ◽

Clinical Parameters ◽

Ecg Monitoring ◽

Multivariate Logistic Regression ◽

Detection Rates ◽

Patient Cohort ◽

Ischaemic Attack ◽

Medical Specialities

ObjectivesProlonged ECG monitoring is clinically useful to detect unknown atrial fibrillation (AF) in stroke survivors. The diagnostic yield of prolonged ECG monitoring in other patient populations is less well characterised. We therefore studied the diagnostic yield of prolonged Holter ECG monitoring for AF in an unselected patient cohort referred from primary care or seen in a teaching hospital.MethodsWe analysed consecutive 7-day ECG recordings in unselected patients referred from different medical specialities and assessed AF detection rates by indication, age and comorbidities.ResultsSeven-day Holter ECGs (median monitoring 127.5 hours, IQR 116 to 152) were recorded in 476 patients (mean age 54.6 (SD 17.0) years, 55.9% female) without previously known AF, requested to evaluate palpitations (n=241), syncope (n=99), stroke or transient ischaemic attack (n=75), dizziness (n=29) or episodic chest pain (n=32). AF was newly detected in 42/476 (8.8%) patients. Oral anticoagulation was initiated in 40/42 (95.2%) patients with newly detected AF. Multivariate logistic regression, adjusted for age, sex and monitoring duration found four clinical parameters to be associated with newly detected AF: hypertension OR=2.54, (1.08 to 8.61) (adjusted OR (95% CI)), p=0.034; previous stroke or TIA OR=4.14 (1.81 to 13.01), p=0.001; left-sided valvular heart disease OR=5.07 (2.48 to 18.70), p<0.001 and palpitations OR=2.86, (1.33 to 10.44), p=0.015.ConclusionsOpen multispeciality access to prolonged ECG monitoring, for example, as part of integrated, cross-sector AF care, can accelerate diagnosis of AF and increase adequate use of oral anticoagulation, especially in older and symptomatic patients with comorbidities.

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