Screening for Atrial Fibrillation in Relation to Stroke and Mortality Risk

Abstract Aims To identify variables predicting ejection fraction (EF) recovery and characterize prognosis of heart failure (HF) patients with EF recovery (HFrecEF). Methods and results Retrospective study of adults referred for ≥2 echocardiograms separated by ≥6 months between 2008 and 2016 at the two largest echocardiography centres in Alberta who also had physician-assigned diagnosis of HF. Of 10 641 patients, 3124 had heart failure reduced ejection fraction (HFrEF) (EF ≤ 40%) at baseline: while mean EF declined from 30.2% on initial echocardiogram to 28.6% on the second echocardiogram in those patients with persistent HFrEF (defined by <10% improvement in EF), it improved from 26.1% to 46.4% in the 1174 patients (37.6%) with HFrecEF (defined by EF absolute improvement ≥10%). On multivariate analysis, female sex [adjusted odds ratio (aOR) 1.66, 95% confidence interval (CI) 1.40–1.96], younger age (aOR per decade 1.16, 95% CI 1.09–1.23), atrial fibrillation (aOR 2.00, 95% CI 1.68–2.38), cancer (aOR 1.52, 95% CI 1.03–2.26), hypertension (aOR 1.38, 95% CI 1.18–1.62), lower baseline ejection fraction (aOR per 1% decrease 1.07 (1.06–1.08), and using hydralazine (aOR 1.69, 95% CI 1.19–2.40) were associated with EF improvements ≥10%. HFrecEF patients demonstrated lower rates per 1000 patient years of mortality (106 vs. 164, adjusted hazard ratio, aHR 0.70 [0.62–0.79]), all-cause hospitalizations (300 vs. 428, aHR 0.87 [0.79–0.95]), all-cause emergency room (ER) visits (569 vs. 799, aHR 0.88 [0.81–0.95]), and cardiac transplantation or left ventricular assist device implantation (2 vs. 10, aHR 0.21 [0.10–0.45]) compared to patients with persistent HFrEF. Females with HFrEF exhibited lower mortality risk (aHR 0.94 [0.88–0.99]) than males after adjusting for age, time between echocardiograms, clinical comorbidities, medications, and whether their EF improved or not during follow-up. Conclusion HFrecEF patients tended to be younger, female, and were more likely to have hypertension, atrial fibrillation, or cancer. HFrecEF patients have a substantially better prognosis compared to those with persistent HFrEF, even after multivariable adjustment, and female patients exhibit lower mortality risk than men within each subgroup (HFrecEF and persistent HFrEF) even after multivariable adjustment.

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One-year all-cause mortality risk among atrial fibrillation patients in Middle East with and without diabetes: The Gulf SAFE registry

International Journal of Cardiology ◽

10.1016/j.ijcard.2019.12.061 ◽

2020 ◽

Vol 302 ◽

pp. 47-52

Author(s):

Magdalena Domek ◽

Yan-Guang Li ◽

Jakub Gumprecht ◽

Nidal Asaad ◽

Wafa Rashed ◽

...

Keyword(s):

Atrial Fibrillation ◽

Middle East ◽

Mortality Risk ◽

All Cause Mortality ◽

One Year

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Patients with atrial fibrillation and mid-range ejection fraction differ in anticoagulation pattern, thrombotic and mortality risk independently of CHA2DS2-VASC score

Heart and Vessels ◽

10.1007/s00380-020-01603-2 ◽

2020 ◽

Vol 35 (9) ◽

pp. 1243-1249

Author(s):

Ivana Jurin ◽

Marko Lucijanic ◽

Hrvoje Jurin ◽

Boris Starcevic ◽

Josip Varvodic ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ejection Fraction ◽

Mortality Risk

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P6543Screen-detected atrial fibrillation in a one-minute single-lead ECG predicts mortality in elderly subjects

European Heart Journal ◽

10.1093/eurheartj/ehz746.1133 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M D Zink ◽

K Mischke ◽

A Keszei ◽

C Rummey ◽

B Freedman ◽

...

Keyword(s):

Atrial Fibrillation ◽

Mortality Risk ◽

Total Mortality ◽

Elderly Subjects ◽

Prognostic Impact ◽

Recording Device ◽

Newly Diagnosed ◽

Jude Medical ◽

Screening Study

Abstract Background Atrial fibrillation (AF) is the most common arrhythmia associated with increased morbidity and mortality. Current guidelines recommend opportunistic screening for AF but the prognostic impact of screen-detected AF is unclear. Methods We performed a 4-week, prospective, pharmacy-based AF screening study in 7107 elderly citizens (≥65 years) using a hand-held, automated, one-minute single-lead ECG (SL-ECG) recording device. Prevalence and incidence of AF was assessed, and data on all-cause death and hospitalization for cardiovascular (CV) causes were collected over a median follow-up of 401 (372; 435) days. Results Automated SL-ECG analyses revealed heartbeat irregularities suspicious of AF in 432 (6.1%) participants with newly diagnosed AF in 3.6% of all subjects. During follow-up, 62 participants (0.9%) died and 390 (6.0%) were hospitalised for CV causes. Total mortality was 2.3% in participants with a SL-ECG suspicious of AF and 0.8% in subjects with a normal SL-ECG (HR 2.93; 95% CI: 1.49, 5.77; P=0.002, Figure 1A); hospitalization for CV causes occurred in 10.6% and 5.5%, respectively (HR 2.08; 95% CI: 1.52, 2.84; P<0.001, Figure 1B). Compared with subjects without a history of AF at baseline and a normal SL-ECG, participants with newly diagnosed AF or known AF had a significantly higher mortality risk with HRs of 2.63 (95% CI: 1.04, 6.63; p=0.04) and 2.68 (95% CI: 1.45, 4.98; p=0.002), respectively. After multivariable adjustment, a SL-ECG recording suspicious of AF remained a significant predictor of death or hospitalization for CV causes. Figure 1 Conclusions Pharmacy-based, automated, one-minute SL-ECG screening in elderly citizens identified subjects with unknown AF and an excess mortality risk over the next one year. Acknowledgement/Funding Unrestricted research grant by Pfizer/BMS. Matthias Zink received a DGK electrophysiology grant (funded by St. Jude Medical).

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