Physical activity, cardiorespiratory fitness, and cardiovascular outcomes in individuals with atrial fibrillation: the HUNT study

Abstract Aims Atrial fibrillation (AF) confers higher risk of mortality and morbidity, but the long-term impact of physical activity (PA) and cardiorespiratory fitness (CRF) on outcomes in AF patients is unknown. We, therefore, examined the prospective associations of PA and estimated CRF (eCRF) with all-cause mortality, cardiovascular disease (CVD) mortality, morbidity and stroke in individuals with AF. Methods and results We followed 1117 AF patients from the HUNT3 study in 2006–08 until first occurrence of the outcomes or end of follow-up in November 2015. We used Cox proportional hazard regression to examine the prospective associations of self-reported PA and eCRF with the outcomes. Atrial fibrillation patients meeting PA guidelines had lower risk of all-cause [hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.41–0.75] and CVD mortality (HR 0.54, 95% CI 0.34–0.86) compared with inactive patients. The respective HRs for CVD morbidity and stroke were 0.78 (95% CI 0.58–1.04) and 0.70 (95% CI 0.42–1.15). Each 1-metabolic equivalent task (MET) higher eCRF was associated with a lower risk of all-cause (HR 0.88, 95% CI 0.81–0.95), CVD mortality (HR 0.85, 95% CI 0.76–0.95), and morbidity (HR 0.88, 95% CI 0.82–0.95). Conclusion Higher PA and CRF are associated with lower long-term risk of CVD and all-cause mortality in individuals with AF. The findings support a role for regular PA and improved CRF in AF patients, in order to combat the elevated risk for mortality and morbidity.

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Trajectories of physical activity from midlife to old age and associations with subsequent cardiovascular disease and all-cause mortality

Journal of Epidemiology & Community Health ◽

10.1136/jech-2019-212706 ◽

2019 ◽

Vol 74 (2) ◽

pp. 130-136 ◽

Cited By ~ 4

Author(s):

Daniel Aggio ◽

Efstathios Papachristou ◽

Olia Papacosta ◽

Lucy T Lennon ◽

Sarah Ash ◽

...

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Old Age ◽

Sensitivity Analyses ◽

Mortality And Morbidity ◽

Heart Study ◽

All Cause Mortality ◽

Cvd Mortality

IntroductionIt is well established that physical activity (PA) protects against mortality and morbidity, but how long-term patterns of PA are associated with mortality and cardiovascular disease (CVD) remains unclear.Methods3231 men recruited to the British Regional Heart Study, a prospective cohort study, reported usual PA levels at baseline in 1978–1980 (aged 40–59 years) and at 12-year, 16-year and 20-year follow ups. Twenty-year trajectories of PA, spanning from 1978/1980 to 2000, were identified using group-based trajectory modelling. Men were subsequently followed up until 30 June 2016 for mortality through National Health Service central registers and for non-fatal CVD events through primary and secondary care records. Data analyses were conducted in 2019.ResultsThree PA trajectories were identified: low/decreasing (22.7%), light/stable (51.0%) and moderate/increasing (26.3%). Over a median follow-up of 16.4 years, there were 1735 deaths. Compared with the low/decreasing group, membership of the light/stable (HR 0.83, 95% CI 0.74 to 0.94) and moderate/increasing (HR 0.76, 95% CI 0.66 to 0.88) groups was associated with a lower risk of all-cause mortality. Similar associations were observed for CVD mortality, major coronary heart disease and all CVD events. Associations were only partially explained by a range of confounders. Sensitivity analyses suggested that survival benefits were largely driven by most recent/current PA.ConclusionsA dose-response relationship was observed, with higher levels of PA from midlife to old age associated with additional benefits. However, even fairly modest and sustained PA was protective and may be more achievable for the most inactive.

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Abstract 059: Pre-stroke Physical Activity Is Associated With Lower Mortality Risk After Stroke In The Atherosclerosis Risk In Communities (ARIC) Study

Circulation ◽

10.1161/circ.143.suppl_1.059 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Mauro F Mediano ◽

Yejin Mok ◽

Josef Coresh ◽

Anna Kucharska-newton ◽

Priya Palta ◽

...

Keyword(s):

Lower Risk ◽

Recurrent Stroke ◽

Adverse Outcomes ◽

Specific Work ◽

Domain Specific ◽

All Cause Mortality ◽

Aric Study ◽

Cvd Mortality

Background: The association between pre-stroke PA and long-term stroke outcomes is still unclear. We examined the association of pre-stroke PA with adverse health outcomes after incident stroke in the ARIC study. Methods: We included 881 participants with incident ischemic or hemorrhagic stroke occurring between 1993-1995 and December 31 st , 2016. Follow-up for all-cause and cardiovascular disease (CVD) mortality, CVD or recurrent stroke occurred through December 31 st , 2017, allowing for at least 1-year of follow-up after incident stroke. Pre-stroke total and domain-specific (work, sports and leisure) PA was assessed with the modified Baecke questionnaire at the baseline visit (1987-1989) and in 1993-1995. The total PA score was calculated by summing scores at both visits. Distribution-based tertiles of the summed score were derived. Cox proportional hazards models estimated the hazard ratios of adverse outcomes by tertiles of pre-stroke PA, adjusted for demographic and clinical characteristics. Results: During a median follow-up of 3.1 years after incident stroke, 77% participants developed adverse outcome. Compared to low pre-stroke PA, high pre-stroke PA was associated with a lower risk of all-cause mortality (HR=0.78; 95% CI: 0.63-0.97, Table). In the analysis by domain-specific PA, the risk of all-cause mortality was lowest among participants in the highest tertile of work PA (HR; 95% CI=0.77; 0.62-0.96) and leisure PA (HR=0.72; 95% CI: 0.58 to 0.89) compared to the lowest tertiles. The risk of CVD mortality was also lower in the highest tertile of work PA (HR=0.45; 95% CI: 0.29-0.70) compared to the lowest tertile. Conclusions: Higher levels of total pre-stroke PA, as well as work and leisure PA, were associated with a lower risk of mortality after incident stroke. Strategies to increase lifetime PA should be encouraged to decrease long-term mortality after stroke.

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Impact of physical activity on all-cause mortality in European patients with atrial fibrillation: a report from the ESC-EHRA EORP AF General Long-Term Registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.2868 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Vitolo ◽

M Proietti ◽

S Harrison ◽

Z Kalarus ◽

L Tavazzi ◽

...

Keyword(s):

Physical Activity ◽

Atrial Fibrillation ◽

Funding Source ◽

Private Company ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

All Cause Mortality ◽

The Impact

Abstract Background Physical activity (PA) may have a beneficial contribution for outcomes in patients with atrial fibrillation (AF). Purpose We aimed to evaluate the impact of self-reported PA in a large contemporary cohort of European AF patients on the risk of all-cause mortality. Methods We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Self-reported PA was categorized, on the basis of reported time spent exercising, as follows: i) No PA; ii) Occasional PA; iii) Regular PA; iv) Intense PA. The primary outcome was all-cause death. Results Over 11096, a total of 8699 (78.4%) patients (mean age (SD) 69.1 (11.5); 40.7% female) had available data about PA and follow-up observation and were included in the analysis. Of these, 3703 (42.6%) reported no PA, 2829 (32.5%) occasional PA, 1824 (21.0%) regular PA, with only 343 (3.9%) reporting intense PA. With the 4 increasing PA categories, mean age, proportion of female patients, CHA2DS2-VASc and HAS-BLED scores were progressively lower (all p<0.001). Use of vitamin K antagonist (VKA) declined across the classes of PA (53.1% vs. 52.2% vs. 44.5% vs. 33.9%, p<0.001), while use of non-VKA OACs (NOACs) conversely increased. During a mean (SD) 680.6 (171.5) days of follow-up, there were a total of 848 (9.7%) all-cause death events. Based on Kaplan-Meier analysis, there was a progressively lower cumulative risk for all-cause death according to PA categories [Figure]. A multivariable Cox regression analysis, adjusting for CHA2DS2-VASc score, use of OAC at baseline and type of AF, found a lower risk of all-cause death associated with increasing levels of PA (Hazard ratio [HR]: 0.69, 95% confidence interval [CI]: 0.59–0.81 for occasional PA, HR: 0.45, 95% CI: 0.35–0.58 for regular PA, HR: 0.41, 95% CI: 0.23–0.76 for intense PA, when compared to no PA). In a sensitivity analysis, a regular-intense PA was inversely associated with occurrence of cardiovascular (CV) death, after multivariable adjustments for comorbidities (HR: 0.54, 95% CI: 0.37–0.77). Conclusions In a large contemporary cohort of European AF patients, self-reported PA was found to be inversely associated with all-cause death and CV death. Kaplan-Meier Curves Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Since the start of EORP, several companies have supported the programme with unrestricted grants

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Dose–Response Relation between Tea Consumption and Risk of Cardiovascular Disease and All-Cause Mortality: A Systematic Review and Meta-Analysis of Population-Based Studies

Advances in Nutrition ◽

10.1093/advances/nmaa010 ◽

2020 ◽

Vol 11 (4) ◽

pp. 790-814 ◽

Cited By ~ 4

Author(s):

Mei Chung ◽

Naisi Zhao ◽

Deena Wang ◽

Marissa Shams-White ◽

Micaela Karlsen ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cohort Studies ◽

Prospective Cohort ◽

Lower Risk ◽

Meta Analysis ◽

Risk Of Bias ◽

Tea Consumption ◽

All Cause Mortality ◽

Specific Mortality ◽

Cvd Mortality

ABSTRACT Tea flavonoids have been suggested to offer potential benefits to cardiovascular health. This review synthesized the evidence on the relation between tea consumption and risks of cardiovascular disease (CVD) and all-cause mortality among generally healthy adults. PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Food Science and Technology Abstracts, and Ovid CAB Abstract databases were searched to identify English-language publications through 1 November 2019, including randomized trials, prospective cohort studies, and nested case-control (or case-cohort) studies with data on tea consumption and risk of incident cardiovascular events (cardiac or peripheral vascular events), stroke events (including mortality), CVD-specific mortality, or all-cause mortality. Data from 39 prospective cohort publications were synthesized. Linear meta-regression showed that each cup (236.6 mL) increase in daily tea consumption (estimated 280 mg and 338 mg total flavonoids/d for black and green tea, respectively) was associated with an average 4% lower risk of CVD mortality, a 2% lower risk of CVD events, a 4% lower risk of stroke, and a 1.5% lower risk of all-cause mortality. Subgroup meta-analysis results showed that the magnitude of association was larger in elderly individuals for both CVD mortality (n = 4; pooled adjusted RR: 0.89; 95% CI: 0.83, 0.96; P = 0.001), with large heterogeneity (I2 = 72.4%), and all-cause mortality (n = 3; pooled adjusted RR: 0.92; 95% CI: 0.90, 0.94; P < 0.0001; I2 = 0.3%). Generally, studies with higher risk of bias appeared to show larger magnitudes of associations than studies with lower risk of bias. Strength of evidence was rated as low and moderate (depending on study population age group) for CVD-specific mortality outcome and was rated as low for CVD events, stroke, and all-cause mortality outcomes. Daily tea intake as part of a healthy habitual dietary pattern may be associated with lower risks of CVD and all-cause mortality among adults.

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Regular exercise is associated with a lower risk of developing dementia in patients with a new diagnosis of atrial fibrillation: a nationwide population-based study

European Heart Journal ◽

10.1093/ehjci/ehaa946.0534 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J.H Lim ◽

S.R Lee ◽

E.K Choi ◽

J.P Yun ◽

H.J Ahn ◽

...

Keyword(s):

Physical Activity ◽

Atrial Fibrillation ◽

Vascular Dementia ◽

Lower Risk ◽

Alzheimer’S Dementia ◽

P Value ◽

Regular Exercise ◽

Newly Diagnosed ◽

Exercise Habit ◽

New Diagnosis

Abstract Introduction Regular exercise is known to decrease the risk of dementia. There is a paucity of information about the impact of the change of exercise habit on cardiovascular outcomes after a new diagnosis of atrial fibrillation (AF). We aimed to investigate whether regular exercise is associated with the risk of developing dementia in patients with AF. Methods Using the Korean National Health Insurance Service database, we enrolled patients with newly diagnosed AF who had undergone health screening between 2010 and 2016. The study population was divided into four groups based on the consistency of regular exercise before and after AF diagnosis: (1) persistent non-exerciser, (2) exercise starter, (3) exercise quitter, and (4) exercise maintainer. We investigated the association between exercise and the risk of dementia. Results A total of 126,555 patients were included (mean age 62.7 years, male 62.0%, and mean CHA2DS2-VASc Score 2.7). During a median follow-up duration of 3.0 years, 5,943 patients were newly diagnosed as dementia (1.57 per 100 person-years). Among patients with incident dementia, 4,410 patients had Alzheimer's dementia and 951 patients had vascular dementia (1.16 and 0.25 per 100 person-years, respectively). Persistent non-exerciser, exercise starter, quitter, and maintainer groups were 65.1%, 12.8%, 12.7%, and 9.4%, respectively. After multivariable adjustment, we found that exercise was associated with a lower risk of developing overall dementia. When compared to persistent non-exerciser, exercise starter and maintainer showed reduced risk of developing dementia (hazard ratio [HR] 0.80, 95% confidence interval [95% CI] 0.73–0.88 and HR 0.63, 95% CI 0.54–0.73, respectively, all p-value <0.0001), but exercise quitter showed no significant risk reduction (HR 0.95, 95% CI 0.88–1.03, Figure). Alzheimer's dementia showed consistent results: a 20% lower risk with exercise starter, and a 37% lower risk with exercise maintainer. Change of exercise habit, however, did not affect the risk of vascular dementia (all, p-value >0.05, Figure). Conclusions Regular exercise showed a lower risk of dementia in patients with new-onset AF. Starting exercise even after the diagnosis of AF was beneficial to patients who had little physical activity previously. These findings may support physicians to recommend that AF patients should start exercise or keep their physical activity to reduce the risk of dementia. Funding Acknowledgement Type of funding source: None

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Impact of Baseline Neutrophil-to-Lymphocyte Ratio on Long-Term Prognosis in Patients With Atrial Fibrillation

Angiology ◽

10.1177/00033197211000495 ◽

2021 ◽

pp. 000331972110004

Author(s):

Shuang Wu ◽

Yan-min Yang ◽

Jun Zhu ◽

Jia-meng Ren ◽

Juan Wang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Continuous Variable ◽

Cox Proportional Hazards ◽

Neutrophil To Lymphocyte Ratio ◽

Long Term Outcomes ◽

Lymphocyte Ratio ◽

Net Reclassification Improvement ◽

Increased Risk ◽

All Cause Mortality

We performed a retrospective analysis involving 1269 patients with atrial fibrillation (AF) to evaluate the predictive value of the neutrophil-to-lymphocyte ratio (NLR) on long-term outcomes. The primary outcomes were all-cause mortality and combined end point events (CEEs). Cox proportional hazards regression analysis and net reclassification improvement (NRI) analysis were performed. During a median follow-up of 3.32 years, 285 deaths and 376 CEEs occurred. With the elevation of the NLR, the incidence of all-cause mortality (2.77, 4.14, 6.12, and 12.18/100 person-years) and CEEs (4.19, 7.40, 8.03, and 15.22/100 person-years) significantly increased. Multivariate Cox analysis indicated that the highest NLR quartile was independently associated with the incidence of all-cause mortality (hazard ratio [HR] = 1.77, 95% CI: 1.19-2.65) and CEEs (HR = 1.66, 95% CI: 1.18-2.33). When the NLR was analyzed as a continuous variable, a 1-unit increment in log NLR was related to 134% increased risk of all-cause mortality and 119% increased risk of CEEs. Net reclassification improvement analysis revealed that NLR significantly improved risk stratification for all-cause death and CEEs by 15.0% and 9.6%, respectively. Neutrophil-to-lymphocyte ratio could be an independent predictor of long-term outcomes in patients with AF.

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Are Prolonged Ventricular Pauses in Atrial Fibrillation a Marker of Poor Prognosis?

Cardiology ◽

10.1159/000520183 ◽

2021 ◽

Author(s):

Dorte Marie Stavnem ◽

Rakin Hadad ◽

Bjørn Strøier Larsen ◽

Olav Wendelboe Nielsen ◽

Mark Aplin Frederiksen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Poor Prognosis ◽

Pacemaker Implantation ◽

Real Life ◽

Increased Risk ◽

All Cause Mortality ◽

Long Term Prognosis ◽

Rate Limiting

Background: In patients with atrial fibrillation (AF), the long-term prognosis of long electrocardiographic pauses in the ventricular action is not well-studied. Methods: Consecutive Holter recordings in patients with AF (n=200) between 2009-2011 were evaluated, focusing on pauses of at least 2.5 s. Outcomes of interest were all-cause mortality and pacemaker implantation. Results: Forty-three patients (21.5%) had pauses with a mean of 3.2 s and SD of 0.9 s. After a median follow-up of 99 months (ranging 89-111), 47% (20/43) of the patients with, and 45% (70/157) without pauses were deceased. Pauses of ≥ 2.5 s did not constitute a risk of increased mortality: HR = 0.75; (95% CI: 0.34 - 1.66); p = 0.48. Neither did pauses of ≥ 3.0 s: HR = 0.43; (95% CI: 0.06 - 3.20); p = 0.41. Sixteen percent of patients with pauses underwent pacemaker implantation during follow-up. Only pauses in patients referred to Holter due to syncope and/or dizzy spells were associated with an increased risk of pacemaker treatment: HR = 4.7 (95% CI: 1.4-15.9), p = 0.014, adjusted for age, sex and rate-limiting medication. Conclusion: In patients with AF, prolonged electrocardiographic pauses of ≥ 2.5 s or ≥ 3.0 s are not a marker for increased mortality in this real-life clinical study.

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Abstract P609: Restarting Anticoagulant Therapy After Intracranial Hemorrhage With Atrial Fibrillation: A Nationwide Retrospective Cohort Study

Stroke ◽

10.1161/str.52.suppl_1.p609 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Dong Hoon Shin ◽

Jaehun Jung ◽

Gi Hwan Bae

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Lower Risk ◽

Retrospective Cohort ◽

Antiplatelet Agents ◽

Risk Of Death ◽

Hemorrhagic Events ◽

All Cause Mortality ◽

Severe Hemorrhage

Background: Atrial fibrillation (AF) should be treated with anticoagulants to prevent stroke and systemic embolism. Resuming anticoagulation after intracerebral hemorrhage (ICH) poses a clinical conundrum. The absence of evidence-based guidelines to address this issue has led to wide variations in restarting anticoagulation after ICH. This study aimed to evaluate the risks and benefits of anticoagulation therapy on all-cause mortality, severe thromboembolism, and severe hemorrhage and compare the effect of novel direct oral anticoagulants (NOACs) with warfarin on post-ICH mortality in patients with AF. Methods: This retrospective cohort study was performed using health insurance claim data obtained between 2002 and 2017 from individuals with newly developed ICH with comorbid AF. We excluded participants aged < 40 years and those with traumatic ICH, subdural hemorrhage, or subarachnoid hemorrhage. The primary endpoint was all-cause mortality, and the secondary endpoints were severe thrombotic and hemorrhagic events. Anticoagulants, antiplatelet agents, and non-users were analyzed for survival with propensity score matching. Results: Among 6735 participants, 1743 (25.9%) and 1690 (25.1%) used anticoagulants and antiplatelet agents, respectively. Anticoagulant (HR, 0.321; 95% CI, 0.264-0.390; P < 0.0001) or antiplatelet users (HR, 0.393; 95% CI, 0.330-0.468; P < 0.0001) had a lower risk of all-cause mortality than non-users. However, there was no difference between the two drug users (HR, 1.183; 95% CI, 0.94-1.487; P = 0.152; reference: anticoagulant). The risk of acute thrombotic events, although not hemorrhagic events, was significantly lower in anticoagulant users than in antiplatelet users. In addition, anticoagulation between 6 to 8 weeks post-ICH showed a tendency of the lowest risk of death. Further, NOACs were associated with a lower risk of all-cause mortality than warfarin. Conclusions: Our results showed that in patients with AF, resuming anticoagulants between 6 and 8 weeks after ICH improved all-cause mortality, severe thromboembolism, and severe hemorrhage. Further, compared with warfarin, NOAC had additional benefits.

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Utilization of Collaborations to Engage Children in Physical Activity: A Community-Based Research Approach

Kinesiology Review ◽

10.1123/kr.2017-0029 ◽

2017 ◽

Vol 6 (4) ◽

pp. 323-328

Author(s):

Sheri J. Brock ◽

Danielle Wadsworth ◽

Shelby Foote ◽

Mary E. Rudisill

Keyword(s):

Physical Activity ◽

The United States ◽

Research Approach ◽

Collaborative Partnerships ◽

Community Based ◽

Community Partners ◽

Community Based Research ◽

Quality Product ◽

Long Term Impact

Institutions of higher education have a responsibility to prioritize the needs of society and local communities. One essential need prevalent in all communities is to address the rise of obesity and health risks due to lack of participation in physical activity. In the United States, children spend a small percentage of time engaged in physical activity, and engagement decreases further in adolescence and adulthood. Collaborative partnerships between kinesiology faculty at universities and community organizations are one avenue for engaging children in physical activity. Partnerships must be multilevel and community wide to evoke change and have long-term impact and sustainability. Within the context of community-based research, we propose a three-step framework for establishing collaborative partnerships: (1) determining the needs of partners; (2) discussing expertise, services, and philosophy; and (3) providing a quality product. In addition, we outline and illustrate our experiences when collaborating with community partners to promote physical activity.

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