ATRIAL FIBRILLATION IN HEART FAILURE IS ASSOCIATED WITH AN INCREASED RISK OF DEATH ONLY IN PATIENTS WITH ISCHEMIC HEART DISEASE

Objective This study examined the association between statin usage (discontinued, reduced or continued) and two-year death following a 21% increase in the Pharmaceutical Benefits Scheme (PBS) consumer co-payment in Western Australia. Methods A retrospective observational study in Western Australia using linked administrative Commonwealth PBS data and State hospital inpatient and death data (n = 207,066) was undertaken. We explored the two-year all-cause and ischemic heart disease(IHD)/stroke-specific-death in individuals who discontinued, reduced or continued statin medication following the January 2005 PBS co-payment increase, overall, by beneficiary status (general population vs. social security recipients) and by a history of admission for ischemic heart disease or stroke. Non-cardiovascular (CVD)-related death was also considered. Results In the first six months of 2005, 3.3% discontinued, 12.5% reduced and 84.2% continued statin therapy. We found those who discontinued statins were also likely to discontinue at least two other medicines compared to those who continued therapy. There were 4,607 all-cause deaths. For IHD/stroke-specific death, there were 1,317. For all non-CVD-related death, there were 2,808 deaths during the 2-year follow-up period. Cox regression models, adjusted for demographic and clinical characteristics, showed a 39%-61% increase in the risk of all-cause death for individuals who reduced or discontinued statin medication compared to those who continued their statin medication (Discontinued: Adj HR = 1.61, 95% CI 1.40–1.85; Reduced: Adj HR = 1.39, 95% CI 1.28–1.51). For IHD/stroke-specific death, there was an increased risk of death by 28–76% (Discontinued: Adj sHR = 1.76, 95% CI 1.37–2.27; Reduced: Adj sHR = 1.28, 95% CI 1.10–1.49), and for non-CVD-related death, there was an increased risk of death by 44–57% (Discontinued: Adj sHR = 1.57, 95% CI 1.31–1.88; Reduced: Adj sHR = 1.44, 95% CI 1.30–1.60), for individuals who discontinued or reduced their statin medication compared to those who continued. Conclusions Patients who discontinued their statin therapy had a significantly increased risk of IHD and stroke death. Health professionals should be aware that large co-payment changes may be associated with patients discontinuing or reducing medicines to their health detriment. Factors that lead to such changes in patient medication-taking behaviour need to be considered and addressed at the clinical and policy levels.

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Short-term and one-year prognosis of diabetic patients with a first-ever myocardial infarction

Medicina ◽

10.3390/medicina43070070 ◽

2007 ◽

Vol 43 (7) ◽

pp. 555 ◽

Cited By ~ 2

Author(s):

Lina Jančaitytė ◽

Daiva Rastenytė

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Acute Heart Failure ◽

Female Gender ◽

Ischemic Heart ◽

Diabetic Patients ◽

Risk Of Death ◽

One Year

Objectives. To clarify the importance of clinical features and changes in the first electrocardiogram in 28-day and 1-year mortality in patients with diabetes. Material and methods. Men and women of Kaunas city aged 25–64 years with the first-ever myocardial infarction during 1983–1992 and with the first electrocardiogram were enrolled in the study. Electrocardiograms were coded using the WHO MONICA Project Protocol criteria and the Minnesota Code. The Kaunas Ischemic Heart Disease Register was the source of data; deaths from ischemic heart disease were identified via death register. Results. Diabetes was diagnosed in 124 patients: 65 (52.4%) men and 59 (47.6%) women. The 28-day (P=0.01) and 1-year mortality rates (P<0.001) were higher in diabetic than in nondiabetic patients with myocardial infarction. Among diabetic patients, who died during 28 days or one year, myocardial infarction was more often complicated by acute heart failure, and changes in ECG were more often detected than among those who were alive. Female gender (RR=30.2, P=0.02) was associated with an increased risk of death from a first-ever myocardial infarction during the first 28 days, while acute heart failure (RR=4.48, P=0.01) and anterior location of Q wave in the first ECG (RR=2.71, P=0.04) increased the risk of death from ischemic heart disease during one year after a first-ever myocardial infarction. Conclusions. Acute heart failure and Q-wave in derivations of the first electrocardiogram reflecting anterior site of myocardial infarction increased the risk of death from ischemic heart disease during the first year, and female gender – during the first 28 days in diabetic patients with myocardial infarction.

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Rate of Heart Failure Following Atrial Fibrillation According to Presence of Family History of Dilated Cardiomyopathy or Heart Failure: A Nationwide Study

Journal of the American Heart Association ◽

10.1161/jaha.120.021286 ◽

2021 ◽

Author(s):

Magnus N. Ebbesen ◽

Maria D’Souza ◽

Charlotte Andersson ◽

Jawad H. Butt ◽

Christian Madelaire ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Heart Disease ◽

Family History ◽

Ischemic Heart Disease ◽

Dilated Cardiomyopathy ◽

Family Member ◽

Ischemic Heart ◽

Degree Relative ◽

History Of

Background It is poorly understood why some patients with atrial fibrillation develop heart failure (HF) and others do not. We examined the rate of developing HF in patients with atrial fibrillation with and without first‐degree family members with HF or dilated cardiomyopathy (DCM). Methods and Results Using Danish nationwide registries, patients born after 1942 diagnosed with atrial fibrillation in the period 2005 to 2015 were identified and followed for up to 5 years. Patients with pre‐existing HF, DCM, and/or ischemic heart disease diagnoses were excluded. Exposure was defined as a first‐degree relative with HF or DCM. The rate of developing the composite end point of HF or death, and the components, was estimated with multivariable Cox proportional hazard regression models. We included 10 605 patients. A total of 17% had a family member with DCM/HF. Having a family member with HF/DCM was associated with an increased 5‐year risk of the composite of HF/death (cumulative incidence, 9.2% [95% CI, 7.8–10.7] versus 5.6% [95% CI, 5.0–6.1]; adjusted hazard ratio [HR] 1.36 [95% CI, 1.13–1.64]). (HF 8.4% [95% CI, 7.0–9.8] versus 4.5% [95% CI, 4.1–5.0]); (adjusted HR, 1.49 [95% CI, 1.22–1.82]). However, familial HF/DCM was not significantly associated with an increased 5‐year risk and rate of death (0.8% [95% CI, 0.4–1.2] versus 1.1% [95% CI, 0.8–1.3]); (adjusted HR, 0.80 [95% CI, 0.46–1.39]). Conclusions In patients with incident atrial fibrillation without prior ischemic heart disease or HF diagnoses, 1 of 6 had a first‐degree relative with HF, and having such a family history of HF/DCM was associated with an 87% increase in 5‐year incidence of HF compared with those without.

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Oral Anticoagulants Preference in Hospitalized Patients with Acute Deep Vein Thrombosis or Non-Valvular Atrial Fibrillation

Healthcare ◽

10.3390/healthcare8040404 ◽

2020 ◽

Vol 8 (4) ◽

pp. 404

Author(s):

Ştefan Cristian Vesa ◽

Sonia Irina Vlaicu ◽

Sorin Crișan ◽

Octavia Sabin ◽

George Saraci ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Heart Disease ◽

Deep Vein Thrombosis ◽

Ischemic Heart Disease ◽

Oral Anticoagulants ◽

Lower Limbs ◽

Ischemic Heart ◽

Vein Thrombosis ◽

Deep Vein

(1) Aim: The aim of this study was to assess the preferences of oral anticoagulants (OA) in patients diagnosed with deep vein thrombosis (DVT) of lower limbs or non-valvular atrial fibrillation (AF) requiring anticoagulation for medium/long term. (2) Materials and methods: the study included consecutive patients admitted with a diagnosis of either acute DVT of lower limbs (without signs of pulmonary embolism) or non-valvular AF who required oral anticoagulation, in a time frame of 18 months from January 2017 until June 2018. The following data were recorded: demographic variables, comorbidities (ischemic heart disease, arterial hypertension, heart failure, stroke, peripheral artery disease, diabetes mellitus, obesity), type and dose of OA (acenocoumarol, dabigatran, apixaban, rivaroxaban), complications due to the use of OA. (3) Results: AF patients were older and had considerably more cardiovascular comorbidities than DVT patients. Vitamin K antagonists (VKA) were more likely to be administered in patients with AF, as they had indication for indefinite anticoagulation. VKA were more frequently prescribed in patients with ischemic heart disease, heart failure, and diabetes compared with DVT patients. Moreover, complications related to OA use were more frequent in the VKA group. Almost half of patients with acute DVT (48.5%) were treated with direct OA (DOAC) rather than VKA, and only a quarter of AF patients (24.8%) were treated with DOACs.

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FUNCTIONAL CLASSES AND CLINICAL CHARACTERISTICS OF CHRONIC HEART FAILURE IN PATIENTS WITH ATRIAL FIBRILLATION AND/OR FLUTTER AFTER RADIOFREQUENCY ABLATION

The Journal of V. N. Karazin Kharkiv National University, Series "Medicine" ◽

10.26565/2313-6693-2018-35-11 ◽

2018 ◽

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Heart Disease ◽

Radiofrequency Ablation ◽

Chronic Heart Failure ◽

Ischemic Heart Disease ◽

Arterial Hypertension ◽

Diabetes Mellitus Type 1 ◽

Functional Class ◽

Ischemic Heart

The combination of atrial fibrillation and/or flutter and chronic heart failure is a frequent problem for many patients. Radiofrequency ablation is effective in the strategy for controlling the rhythm of patients with atrial fibrillation and/or flutter, but always requires concomitant therapeutic support. The study involved 70 patients with atrial fibrillation and/or flutter after radiofrequency ablation which were divided into groups according to the functional class of chronic heart failure. Gender and age of patients; types of ischemic heart disease; stages of chronic heart failure; degrees of arterial hypertension; the form of atrial fibrillation and flutter; class EHRA; the presence of diabetes mellitus type 1 or 2 we evaluated. The female sex prevailed in the group of II functional class of chronic heart failure than in I functional class or III functional class. Ischemic heart disease, first of all angina of effort, in patients with III functional class of chronic heart failure was significantly more frequent. In group of III functional class of chronic heart failure there were significantly more patients with 3 degrees of arterial hypertension. Male patients, regardless of functional class of chronic heart failure, more often than females are conducted invasive methods of treatment for atrial fibrillation/flutter. With increasing of functional class of angina the functional class of chronic heart failure is increasing. Among patients II and III functional class of chronic heart failure prevails the arterial hypertension III degree, which may be a predictor of adverse prognosis.

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Risk of heart disease following breast cancer: results from a population-based cohort study

10.1101/2021.09.16.21263682 ◽

2021 ◽

Author(s):

Haomin Yang ◽

Nirmala Bhoo Pathy ◽

Judith Brand ◽

Elham Hedayati ◽

Felix Grassmann ◽

...

Keyword(s):

Breast Cancer ◽

Heart Failure ◽

Cohort Study ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Cancer Patients ◽

Time Dependent ◽

Ischemic Heart ◽

Breast Cancer Patients ◽

Increased Risk

BACKGROUND: There is a rising concern about treatment-associated cardiotoxicities in breast cancer patients.<br />OBJECTIVES?This study aimed to determine the time- and treatment-specific incidence of arrhythmia, heart failure and ischemic heart disease in women diagnosed with breast cancer.<br /> METHODS: A register-based matched cohort study was conducted including 8338 breast cancerpatients diagnosed from 2001-2008 in the Stockholm-Gotland region and followed-up until 2017. Overall and time dependent risks of arrhythmia, ischemic heart disease and heart failure in breast cancer patients were assessed using flexible parametric models as compared to matched controls from general population. Treatment-specific effects were estimated in breast cancer patients using Cox model.<br />RESULTS: During a median follow-up of 10.8 years, the hazard ratios for arrhythmia, heart failure and ischemic heart disease, were 1.27 (95% CI = 1.18-1.37), 1.38 (95% CI = 1.23-1.55), and 0.93 (95% CI = 0.84-1.03), respectively. Time-dependent analyses revealed long-term increased risks of arrhythmia, and heart failure in breast cancer patients compared to matched controls. The risk of ischemic heart disease was only elevated in the first year after cancer diagnosis. Trastuzumab and anthracyclines were associated with increased risk of heart failure. Aromatase inhibitors, but not tamoxifen, were associated with risk of ischemic heart disease. No increased risk of heart disease was identified following loco-regional radiotherapy.<br />CONCLUSIONS: Administration of systemic adjuvant therapies appear to be associated with increased risks of heart disease. The risk estimates observed in this study may serve as reference to aid adjuvant therapy decision-making and patient counseling in oncology practices.

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