scholarly journals 261 The Impact of Non-Valvular Atrial Fibrillation on Cardiovascular Outcomes in Patients with Chronic Kidney Disease

2020 ◽  
Vol 29 ◽  
pp. S150-S151
Author(s):  
A. Bhat ◽  
S. Karthikeyan ◽  
M. Denniss ◽  
M. Kayes ◽  
A. Gupta ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cardiovascular Outcomes ◽  
The Impact

Effect of prevalent atrial fibrillation on cardiovascular outcomes in patients with chronic kidney disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Bhat ◽  
G Gan ◽  
H.H.L Chen ◽  
K Gu ◽  
M Denniss ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Independent Predictor ◽  
Cardiovascular Outcomes ◽  
Composite Outcome ◽  
Obstructive Sleep ◽  
Co Morbidity ◽  
The Mean ◽  
The Impact

Abstract Background The global increase in incidence and prevalence of chronic kidney disease (CKD) is associated with a parallel rise in co-morbid atrial fibrillation (AF). Concurrent presence of both conditions increases clinical complexity and may portend poor outcomes in this population. Purpose The aim of our study was to assess the impact of prevalent AF on mortality and cardiovascular outcomes in patients with CKD. Methods Consecutive patients with CKD (Stages 2 to 5) attending the Nephrology outpatient clinics in our health district between Jan 2007-Dec 2017 were retrospectively evaluated. Detailed appraisal of patient demographics, anthropometrics, clinical co-morbidities (including aetiology, stage and management of CKD) and pharmacotherapeutics was undertaken. These patients were followed for up to ten years for the composite outcomes of all-cause death and major adverse cardiovascular events (MACE). We excluded patients with incomplete clinical data and patients with concomitant medical co-morbidity limiting lifespan to <6 months. Results 2008 patients (63.61±17.17 yrs; 55.7% men) were assessed. The mean eGFR was 37.53±21.88 mL/min/m2. Patients with prevalent AF (n=440, 22%) were older (p<0.01), with lower eGFR (p<0.01) and higher rates of renal replacement therapy (p<0.01). They also had a greater burden of coronary disease (p<0.01), heart failure (p<0.01), stroke (p<0.01), obstructive sleep apnoea (p<0.01), chronic obstructive pulmonary disease (p<0.01), anaemia (p<0.01) and obesity (p<0.01). Over the mean follow-up period of 44.04±34.96 months, 832 patients met the composite outcome (410 all-cause death, 422 MACE). On log rank tests, prevalent AF was a predictor of the composite outcome (Figure 1; p<0.01) and remained an independent predictor of all-cause death and MACE on multivariate analysis (HR 1.65; 95% CI 1.24–2.21, p<0.01). Conclusions Prevalent AF is an independent predictor of all-cause death and MACE in patients with CKD. Figure 1. Kaplan Meier Curve Funding Acknowledgement Type of funding source: None

scholarly journals Insight into the impact of vitamin D on cardiovascular outcomes in chronic kidney disease

Nephrology ◽  
2019 ◽  
Vol 24 (8) ◽  
pp. 781-790 ◽  
Author(s):  
Joey Junarta ◽  
Vivekanand Jha ◽  
Debasish Banerjee
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Kidney Disease ◽  
Cardiovascular Outcomes ◽  
The Impact ◽  
Insight Into

scholarly journals Factors Predicting Hospital Readmission among Thais with Post Myocardial Infarction

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 415
Author(s):  
Chuthaporn Phemphul ◽  
Wirat Pansila ◽  
Nisakorn Vibulchai ◽  
Chaiyasith Wongvipaporn
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Hospital Readmission ◽  
Screening Tools ◽  
Post Myocardial Infarction ◽  
Readmission Rates ◽  
One Year ◽  
The Impact

Background: Readmission after an acute myocardial infarction is not only common and costly but can also impact patients’ quality of life and mortality. This retrospective observational study was conducted to determine the impact of sociodemographic variables, clinical variables, and hospital readmission among post-myocardial infarction patients in Thailand.  Few, if any, previous studies have investigated the factors predicting readmission rates over variable time periods. We aimed to provide such information to prevent readmission in the future.  Methods: Between October 1, 2014, to September 30, 2018 a total of 376 post-myocardial infarction patients of Roi-Et hospital were recruited for this study. The criteria of data collection concerned the rate of readmission, gender, comorbidities, anaemia, chronic kidney disease, complication, smoking, and type of myocardial infarction. A measurement period was seven-day, 30-day, six-month, and one-year of readmission. Data were analyzed using percentage, mean, standard deviation, and logistic regression analysis.   Results: The highest readmission rate at six-month, 30-day, seven-day, and one-year was 52.2%, 30.4%, 10.6%, and 6.8%, respectively. None of the predictors were significant for seven-day and one-year of readmissions. Meanwhile, hypertension comorbidity and anaemia were identified as the significant predictors for early 30-day readmission whereas atrial fibrillation complication, chronic kidney disease, and smoking were the significant predictors for late six-month readmission.   Conclusions: Multiple factors including HT comorbidity, anaemia, atrial fibrillation, chronic kidney disease, and smoking predict readmission among Thais with post myocardial infarction. This study demonstrated that rates and predictors of readmissions in short-term and long-term periods are different. Therefore, various screening tools and interventions are required.

Percutaneous Coronary Intervention Does Not Lower Cardiovascular Outcomes in Patients with Chronic Kidney Disease

2019 ◽  
Vol 50 (6) ◽  
pp. 465-472 ◽  
Author(s):  
Gil Chernin ◽  
Shmuel Chen ◽  
Ozgu Ozan ◽  
Mengdan Liu ◽  
Dan Haberman ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Percutaneous Coronary Intervention ◽  
Kidney Disease ◽  
Coronary Intervention ◽  
Cardiovascular Outcomes ◽  
Metal Stents ◽  
Cardiovascular Adverse Event ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
The Impact

Background: Chronic kidney disease (CKD) is associated with an increased risk of adverse cardiovascular outcomes, in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). However, most studies used bare-metal stents or first-generation drug-eluting stents, and less guideline-directed therapy to reduce cardiovascular risk was reported in CKD patients. This study investigates the impact of moderate-CKD on patients undergoing PCI in the current era. Methods: Patient level data were pooled from 2 multicenter randomized trials (BIONICS and NIREUS trials) with a near “all-comers” design, comparing PCI with ridaforolimus-eluting stents vs. zotarolimus-eluting stents in patients with CAD. Patients were classified according to the presence or absence of moderate-CKD, defined as creatinine clearance (CrCl) <60 mL/min. We compared baseline characteristics, angiographic findings, and clinical outcomes 1-year post-PCI. Results: 236/2,201 (10.7%) patients had CKD, mean CrCl of 50.3 + 7.8 mL/min. These patients were generally older and more often with hypertension than non-CKD patients, but the use of guideline-directed therapy was similar between the groups. CKD was associated with an increased risk of cardiovascular death (hazard ratio [HR] 6.08; 95% CI 2.11–17.51; p < 0.001), but with a reduced occurrence of repeated revascularization, including ischemia-driven revascularization (HR 0.47; 95% CI 0.24–0.92; p < 0.05). The rate of repeated angiography per severe cardiovascular adverse event was significantly lower in the CKD than the non-CKD group (23/38 [61%] vs. 253/334 [76%], p < 0.05). Conclusions: Moderate-CKD in patients with CAD was associated with higher rates of all-cause and cardiovascular mortality, yet with a lower risk of revascularization 1-year following PCI. Lack of guideline-directed medical therapy does not explain the adverse outcome of CKD patients.

The Problem of Atrial Fibrillation in Patients with Chronic Kidney Disease

2016 ◽  
Vol 14 (3) ◽  
pp. 260-265 ◽  
Author(s):  
Beata Franczyk ◽  
Anna Gluba-Brzózka ◽  
Aleksandra Cia|kowska-Rysz ◽  
Maciej Banach ◽  
Jacek Rysz
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease

scholarly journals Impact of antithrombotic therapy in the prognosis of atrial fibrillation patients with advanced chronic kidney disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.M Andreu Cayuelas ◽  
S Raposeiras-Roubin ◽  
E Fortuny Frau ◽  
A Garcia Del Egido ◽  
J Seller-Moya ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Antithrombotic Therapy ◽  
Anticoagulation Therapy ◽  
Bleeding Event ◽  
Funding Source ◽  
Newly Diagnosed ◽  
Bleeding Events ◽  
Cox Regression Analysis

Abstract Introduction Chronic kidney disease (CKD) is associated with an elevated thromboembolic and bleeding risk in atrial fibrillation (AF) patients, so the decision of antithrombotic therapy is a challenge. Purpose To analyze mortality, embolic and bleeding events in patients with advanced CKD and AF. Methods Multicentric retrospective registry on patients with AF and advanced CKD (CKD-EPI &lt;30 mL/min/1.73 m2). For death, multivariable Cox regression analysis was developed. For embolic and bleeding events, competing-risks regression based on Fine and Gray's proportional subhazards model was performed, being death the competing event Results We analysed 405 patients with advanced CKD and newly diagnosed AF. 57 patients were not treated with antithrombotic therapy (14.1%), 80 only with antiplatelet/s (19.8%), 211 only with anticoagulation (52.1%), and 57 with anticoagulant plus antiplatelet/s (14.1%). During a follow-up of 4.6±2.5 years, 205 died (50.6%), 34 had embolic events (8.4%) and 85 had bleeding outcomes (21.0%). Bleeding event rate was significantly lower in patients without antithrombotic therapy (Figure). After multivariate analysis, anticoagulant treatment was associated with higher bleeding rates, without differences in mortality or embolic events (Table). Conclusion Anticoagulation therapy was associated with a significant increase in bleeding events in patients with advanced CKD and newly diagnosed AF. None of the antithrombotic therapy regimens resulted in lower embolic events rate neither benefit in mortality. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): This study was supported by an unconditional grant from BMS-Pfizer

scholarly journals Plasma natriuretic peptide level is an independent determinant of major clinical outcomes in atrial fibrillation patients without heart failure: the Fushimi AF Registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Hamatani ◽  
M Iguchi ◽  
Y Aono ◽  
K Ishigami ◽  
S Ikeda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Outcomes ◽  
Prognostic Marker ◽  
Oral Anticoagulants ◽  
Systemic Embolism ◽  
The Mean

Abstract Background Atrial fibrillation (AF) increases the risk of death, stroke/systemic embolism and heart failure (HF). Plasma natriuretic peptide (NP) level is an important prognostic marker in HF patients. However, little is known regarding the prognostic significance of plasma NP level in AF patients without HF. Purpose The aim of this study is to investigate the relationship between plasma NP level and clinical outcomes such as all-cause death, stroke/systemic embolism and HF hospitalization during follow-up period in AF patients without HF. Methods The Fushimi AF Registry is a community-based prospective survey of AF patients in our city. The inclusion criterion of the registry is the documentation of AF at 12-lead electrocardiogram or Holter monitoring at any time, and there are no exclusion criteria. We started to enroll patients from March 2011, and follow-up data were available for 4,466 patients by the end of November 2019. From the registry, we excluded 1,220 patients without a pre-existing HF (defined as having one of the following; prior hospitalization for HF, New York Heart Association class ≥2, or left ventricular ejection fraction &lt;40%). Among 3,246 AF patients without HF, we investigated 1,189 patients with the data of plasma BNP (n=401) or N-terminal pro-BNP (n=788) level at the enrollment. We divided the patients according to the quartile of each plasma BNP or NT-pro BNP level and compared the backgrounds and outcomes between these 4 groups stratified by plasma NP level. Results Of 1,189 patients, the mean age was 72.1±10.2 years, 454 (38%) were female and 684 (58%) were paroxysmal AF. The mean CHADS2 and CHA2DS2-VASc score were 1.6±1.1 and 2.9±1.5, respectively. Oral anticoagulants were prescribed in 671 (56%) at baseline. The median (interquartile range) BNP and N-terminal pro-BNP level were 84 (38, 176) and 500 (155, 984) pg/ml, respectively. Patients with high plasma NP level were older, and demonstrated lower prevalence of paroxysmal AF, higher CHADS2 and CHA2DS2-VASc scores and higher prevalence of chronic kidney disease and oral anticoagulants prescription (all P&lt;0.01). A total of 165 all-cause death, 114 stroke/systemic embolism and 103 HF hospitalization occurred during the median follow-up period of 5.0 years. Kaplan-Meier curves demonstrated that higher plasma NP level was significantly associated with the incidences of all-cause death, stroke/systemic embolism and HF hospitalization in AF patients without HF (Figure 1A). Multivariable Cox regression analysis revealed that plasma NP level could stratify the risk of clinical outcomes even after adjustment by type of AF, CHA2DS2-VASc score, chronic kidney disease and oral anticoagulant prescription (Figure 1B). Conclusion Plasma NP level is a significant prognostic marker for all-cause death, stroke/systemic embolism and HF hospitalization in AF patients without HF, suggesting the importance of measuring plasma NP level in AF patients even without HF. Figure 1 Funding Acknowledgement Type of funding source: None

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