Association between body mass index and mortality in atrial fibrillation patients with and without diabetes mellitus: Insights from a multicenter registry study in China

Abstract Aims Older age is associated with inappropriate dose prescription of direct oral anticoagulants. The aim of our study was to describe the prevalence and the clinical predictors of inappropriate DOACs dosage among octogenarians in real-world setting. Methods Data for this study were sourced from the multicentre prospectively maintained Atrial Fibrillation (AF) Research Database (NCT03760874). AF patients aged ≥80 who received DOACs treatment 253 patients were selected. Participants were categorized as appropriate dosage, overdosage, or underdosage. Underdosage and overdosage were respectively defined as administration of a lower or higher DOAC dose than recommended in the EHRA consensus. Results A total of 178 patients (71%) received appropriate DOACs dose and 75 patients (29%) inappropriate DOACs dose; among them 19 patients (25.6%) were overdosed and 56 (74.4%) were underdosed. Subgroup analysis demonstrated that underdosage was independently associated with male gender [OR = 3.15 (95% IC 1.45–6.83); P < 0.01], coronary artery disease [OR = 3.6 (95% IC 1.41–9.1); P< 0.01] and body mass index [OR = 1.27 (1.14–1.41); P < 0.01]. Overdosage was independently associated with diabetes mellitus [OR = 18 (3.36–96); P < 0.01], with age [OR = 0.76 (95% IC; 0.61–0.96); P < 0.05], BMI [OR = 0.77 (0.11; 0.62–0.97); P < 0.05] and with previous bleedings [OR = 6.4 (0.7; 1.43–28) P < 0.05]. There wasn’t significant difference in thromboembolic, major bleeding events and mortality among different subgroups. Underdosage group showed a significatively lower survival compared with appropriate dose group (P < 0.001). Conclusion In our analysis, nearly one-third of octogenarians with AF received an inappropriate dose of DOAC. Several clinical factors increased the risk of DOACs’ overdosage (diabetes mellitus Type II) or underdosage (male gender, coronary artery disease and higher body mass index). Octogenarians with inappropriate DOACs underdosage showed less survival.

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Body mass index and all-cause mortality in patients with atrial fibrillation: insights from the China atrial fibrillation registry study

Clinical Research in Cardiology ◽

10.1007/s00392-019-01473-3 ◽

2019 ◽

Vol 108 (12) ◽

pp. 1371-1380 ◽

Cited By ~ 4

Author(s):

Lu Wang ◽

Xin Du ◽

Jian-Zeng Dong ◽

Wen-Na Liu ◽

Ying-Chun Zhou ◽

...

Keyword(s):

Atrial Fibrillation ◽

Body Mass Index ◽

Body Mass ◽

Registry Study ◽

All Cause Mortality

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Comparison of Cardiovascular Risk Factors in European Population Cohorts for Predicting Atrial Fibrillation and Heart Failure, Their Subsequent Onset, and Death

Journal of the American Heart Association ◽

10.1161/jaha.119.015218 ◽

2020 ◽

Vol 9 (9) ◽

Author(s):

Benedikt Schrage ◽

Bastiaan Geelhoed ◽

Teemu J. Niiranen ◽

Francesco Gianfagna ◽

Julie K. K. Vishram‐Nielsen ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Heart Failure ◽

Atrial Fibrillation ◽

Body Mass Index ◽

Body Mass ◽

High Sensitivity ◽

Population Based ◽

Male Sex ◽

Subsequent Onset

Background Differences in risk factors for atrial fibrillation (AF) and heart failure (HF) are incompletely understood. Aim of this study was to understand whether risk factors and biomarkers show different associations with incident AF and HF and to investigate predictors of subsequent onset and mortality. Methods and Results In N=58 693 individuals free of AF/HF from 5 population‐based European cohorts, Cox regressions were used to find predictors for AF, HF, subsequent onset, and mortality. Differences between associations were estimated using bootstrapping. Median follow‐up time was 13.8 years, with a mortality of 15.7%. AF and HF occurred in 5.0% and 5.4% of the participants, respectively, with 1.8% showing subsequent onset. Age, male sex, myocardial infarction, body mass index, and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) showed similar associations with both diseases. Antihypertensive medication and smoking were stronger predictors of HF than AF. Cholesterol, diabetes mellitus, and hsCRP (high‐sensitivity C‐reactive protein) were associated with HF, but not with AF. No variable was exclusively associated with AF. Population‐attributable risks were higher for HF (75.6%) than for AF (30.9%). Age, male sex, body mass index, diabetes mellitus, and NT‐proBNP were associated with subsequent onset, which was associated with the highest all‐cause mortality risk. Conclusions Common risk factors and biomarkers showed different associations with AF and HF, and explained a higher proportion of HF than AF risk. As the subsequent onset of both diseases was strongly associated with mortality, prevention needs to be rigorously addressed and remains challenging, as conventional risk factors explained only 31% of AF risk.

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Prevalence and clinical predictors of inappropriate direct oral anticoagulant dosage in octagenarians with atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehab724.2818 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

A Carbone ◽

F Santelli ◽

R Bottino ◽

E Attena ◽

C Mazzone ◽

...

Keyword(s):

Diabetes Mellitus ◽

Atrial Fibrillation ◽

Coronary Artery Disease ◽

Body Mass Index ◽

Coronary Artery ◽

Body Mass ◽

Male Gender ◽

Research Database ◽

Clinical Predictors ◽

Artery Disease

Abstract Aims Older age was associated to inappropriate dose prescription of direct oral anticoagulants. The aim of our study was to describe the prevalence and the clinical predictors of inappropriate DOACs dosage among octogenarians in real-world setting. Methods and results Data for this study were sourced from the multicenter prospectively maintained Atrial Fibrillation (AF) Research Database (NCT03760874). AF patients aged ≥ 80 who received DOACs treatment 253 patients were selected. Participants were categorized as appropriate dosage, overdosage, or underdosage. Underdosage and overdosage were respectively defined as administration of a lower or higher DOAC dose than recommended in the EHRA consensus. A total of 178 patients (71%) received appropriate DOACs dose and 75 patients (29%) inappropriate DOACs dose; among them 19 patients (25.6%) were overdosed and 56 (74.4%) were underdosed. Subgroup analysis demonstrated that underdosage was independently associated with male gender [OR=3,15 (95% IC 1.45–6.83); p<0,01], coronary artery disease [OR= 3,6 (95% IC 1.41–9.1); p<0,01] and body mass index [OR=1,27 (1.14–1.41); p<0,01]. Overdosage was independently associated with diabetes mellitus [OR= 18 (3.36–96); p<0,01]. There wasn't significant difference in thromboembolic, major bleeding events and mortality among different subgroups. Underdosage group showed a significatively lower survival compared with appropriate dose group (p<0,001). Conclusion In our analysis, nearly one-third of octogenarians with AF received an inappropriate dose of DOAC. Several clinical factors increased the risk of DOACs' overdosage (diabetes mellitus type II) or underdosage (male gender, coronary artery disease and higher body mass index). Octogenarians with inappropriate DOACs underdosage resulted in less survival. FUNDunding Acknowledgement Type of funding sources: None.

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Body Mass Index can influence Connexin 43 distribution in patients with atrial fibrillation or sinus rhythm

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0034-1367435 ◽

2014 ◽

Vol 62 (S 01) ◽

Author(s):

S. Dhein ◽

S. Rothe ◽

A. Busch ◽

H. Bittner ◽

M. Kostelka ◽

...

Keyword(s):

Atrial Fibrillation ◽

Body Mass Index ◽

Sinus Rhythm ◽

Body Mass ◽

Connexin 43

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Leitliniengerechte Therapie der Adipositas

Adipositas - Ursachen Folgeerkrankungen Therapie ◽

10.1055/s-0037-1618626 ◽

2008 ◽

Vol 02 (02) ◽

pp. 59-66

Author(s):

H. Hauner

Keyword(s):

Diabetes Mellitus ◽

Body Mass Index ◽

Body Mass ◽

Typ 2 Diabetes ◽

Typ 2 Diabetes Mellitus ◽

Chirurgische Maßnahmen ◽

Leitliniengerechte Therapie ◽

Strukturelle Voraussetzungen

ZusammenfassungAdipositas stellt eines der zentralen Gesundheitsprobleme dar. Der Phänotyp ist durch eine Vermehrung des Körperfetts charakterisiert, die mit einem erhöhten Morbiditätsund Mortalitätsrisiko einhergeht. Ab einem Body-Mass-Index (BMI) von 30 kg/m2 bzw. ab einem BMI von 25 kg/m2 bei gleichzeitigem Vorliegen von Begleiterkrankungen wie z. B. Typ-2-Diabetes mellitus ist daher eine gewichtssenkende Behandlung indiziert. Dafür steht ein breites Spektrum von evidenzbasierten Therapiemaßnahmen zur Verfügung, deren Einsatz auf die individuellen Bedürfnisse und Möglichkeiten des Patienten zugeschnitten werden muss. Die Primärbehandlung zielt auf eine langfristige Lebensstiländerung mit energieärmerer Kost und Steigerung der körperlichen Aktivität. Das Konzept der abgestuften Therapie beinhaltet auch sehr niedrig kalorische Diäten, gewichtssenkende Medikamente und, bei extremer therapieresistenter Adipositas, chirurgische Maßnahmen. Der Therapieerfolg hängt entscheidend von der Motivation des Patienten ab, die Eigenverantwortung für sein Gewichtsmanagement zu übernehmen. Bereits eine Senkung des Körpergewichts um fünf bis zehn Prozent führt zu einer signifikanten Besserung der Lebensqualität sowie zahlreicher Begleiterkrankungen. Eine wirksame Adipositastherapie ist im deutschen Gesundheitssystem bisher nicht möglich, da keine Kostenübernahme durch Krankenkassen stattfindet und deshalb auch viele strukturelle Voraussetzungen dafür fehlen. Daneben sind zusätzlich Aktivitäten zur Primärprävention der Adipositas auf gesamtgesellschaftlicher Ebene dringend erforderlich.

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Rolle der metabolischen Chirurgie bei Diabetes mellitus Typ 2 und NASH

Adipositas - Ursachen Folgeerkrankungen Therapie ◽

10.1055/s-0037-1618703 ◽

2010 ◽

Vol 04 (02) ◽

pp. 79-83

Author(s):

F. X. Felberbauer ◽

A. Bohdjalian ◽

F. Langer ◽

S. Shakeri-Leidenmühler ◽

B. Ludvik ◽

...

Keyword(s):

Diabetes Mellitus ◽

Body Mass Index ◽

Body Mass ◽

Bariatrische Chirurgie ◽

Diabetes Mellitus Typ 2 ◽

Metabolische Chirurgie ◽

Nichtalkoholische Steatohepatitis

Zusammenfassung Diabetes mellitus Typ 2 stellt bereits heute in ökonomischer, medizinischer und sozialer Hinsicht ein globales Problem dar, dessen Bedeutung in den nächsten zwei Jahrzehnten noch massiv zunehmen wird. Bariatrische Chirurgie ist zweifelsohne die wirkungsvollste Behandlung von morbider Adipositas, führt zu substantiellem, anhaltendem Gewichtsverlust, Verbesserung von Begleiterkrankungen und Reduktion von Mortalität. Metabolische Chirurgie führt bei 56 bis 95 % der morbid adipösen Typ-2-Diabetiker zur Diabetesremission. Jüngste Ergebnisse zeigen für Patienten mit einem Body-Mass-Index zwischen 30 und 40 kg/m2 ebenfalls exzellente Ergebnisse. Die Verbesserung der diabetischen Stoffwechsellage ist auch auf eine kalorische Restriktion und Änderung der gastrointestinalen Hormonsekretion zurückzuführen. Die Etablierung von Diabeteschirurgie verlangt ein besseres pathophysiologisches Verständnis der Erkrankung und der Operationsmethoden – diese Arbeit beschreibt den Einfluss etablierter Operationsmethoden auf die diabetische Stoffwechsellage und die Hormonsekretion des Gastrointestinaltrakts. NASH (nichtalkoholische Steatohepatitis) betrifft rund ein Drittel der morbid adipösen Patienten. Es werden Prävalenz, Diagnosestellung und Beeinflussung der Erkrankung durch metabolische Chirurgie diskutiert. Der Goldstandard zur Diagnosestellung ist nach wie vor die Leberbiopsie. In mehreren Publikationen konnte die positive Beeinflussung der NASH durch metabolische Chirurgie gezeigt werden – für morbid adipöse Patienten stellt metabolische Chirurgie die effektivste Therapie der NASH dar.

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