Clustering of healthy lifestyle behaviors is associated with a lower incidence of adverse events in patients with newly diagnosed atrial fibrillation: a nationwide cohort study

Abstract Background Although unhealthy or healthy lifestyle behaviors tend to be clustered, studies on the risk of clinical outcomes depending on how the lifestyle behaviors are managed after atrial fibrillation (AF) diagnosis remain limited. Purpose We aimed to evaluate the association between a cluster of healthy lifestyle behaviors and the risk of adverse outcomes in patients with AF. Methods Using the Korean National Insurance Service database, patients who were newly diagnosed as nonvalvular AF between 2009 and 2016 and received national health screening examination within 2-year after AF diagnosis were included. A healthy lifestyle behavior score (HLS) was calculated by assigning 1 point each for “non-current” smoking, for non-drinking, and for performing regular exercise from the self-reported questionnaire in health screening examinations. The primary outcome was defined as major adverse cardiovascular events (MACE), including ischemic stroke, myocardial infarction, and hospitalization for heart failure. The secondary outcomes included individual components of the primary composite outcome and all-cause death. Results A total of 208,662 patients were included and 7.1%, 22.7%, 58.6%, and 11.6% were HLS 0, 1, 2, and 3 group, respectively. After multivariable adjustment, patients with HLS 1, 2, and 3 were associated with lower risks of MACE compared to those with HLS 0 (adjusted hazard ratio [95% confidence interval]: 0.788 [0.762–0.855], 0.654 [0.604–0.708], and 0.579 [0.527–0.636], respectively) (Figure). Increased number of healthy lifestyle behaviors were associated with lower risks of ischemic stroke, hospitalization for heart failure, and all-cause death. The risk reduction of healthy lifestyle combinations was consistently observed in various subgroups, regardless of CHA2DS2-VASc score and oral anticoagulant use. Conclusion Increased number of healthy lifestyle behaviors were significantly associated with lower MACE and all-cause death risks in patients with new-onset AF. These findings support the promotion of a healthy lifestyle to reduce the risk of adverse events in AF patients. FUNDunding Acknowledgement Type of funding sources: None.

Download Full-text

Risk of Ischemic Stroke in Patients Newly Diagnosed With Heart Failure: Focus on Patients Without Atrial Fibrillation

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2018.03.012 ◽

2019 ◽

Vol 25 (6) ◽

pp. 436-447 ◽

Cited By ~ 3

Author(s):

Jeffrey S. Berger ◽

Eric Peterson ◽

François LalibertÉ ◽

Guillaume Germain ◽

Dominique Lejeune ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

Newly Diagnosed

Download Full-text

A three-year longitudinal study of healthy lifestyle behaviors and adherence to pharmacological treatments in newly diagnosed patients with acute coronary syndrome: hierarchical linear modeling analyses

Journal of Public Health ◽

10.1007/s10389-020-01369-x ◽

2020 ◽

Author(s):

Andrea Greco ◽

Agostino Brugnera ◽

Marco D’Addario ◽

Angelo Compare ◽

Cristina Franzelli ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Longitudinal Study ◽

Hierarchical Linear Modeling ◽

Healthy Lifestyle ◽

Lifestyle Behaviors ◽

Newly Diagnosed ◽

Pharmacological Treatments ◽

Linear Modeling ◽

Coronary Syndrome ◽

Healthy Lifestyle Behaviors

Download Full-text

2MACE score predicts cardiovascular adverse events in real-world atrial fibrillation patients under rivaroxaban therapy. Data from EMIR study

European Heart Journal ◽

10.1093/eurheartj/ehab724.2484 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

M Esteve Pastor ◽

F Marin ◽

M Anguita ◽

M Sanmartin ◽

C Rafols ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

High Risk ◽

Adverse Events ◽

Cardiovascular Mortality ◽

Real World ◽

Cardiovascular Events ◽

Major Adverse Cardiovascular Events

Abstract Background Atrial Fibrillation (AF) patients have higher risk of major adverse cardiovascular events (MACEs). In 2015, the 2MACE score (2 points for metabolic syndrome and age ≥75, and 1 point for myocardial infarction [MI] or revascularization, congestive heart failure [ejection fraction ≤40%] and thromboembolism [stroke or transient ischemic attack]) was described to stratify cardiovascular risk and 2MACE≥3 was related with high risk of MACE in AF patients but a long-term validation in prospective patients under direct anticoagulants has not been performed yet. The aim of this study was to analyse the incidence of cardiovascular events and to validate the 2MACE score as predictor of MACEs. Methods EMIR study [acronym from 'Estudio observacional para la identificaciόn de los factores de riesgo asociados a eventos cardiovasculares Mayores en pacientes con fIbrilaciόn auricular no valvular tratados con un anticoagulante oral directo (Rivaroxaban)'] was an observational, multicenter, post-authorization and prospective study that involved AF patients under oral anticoagulation with rivaroxaban at least 6 months before enrolment. We analyzed baseline clinical characteristics and adverse events after 2.5 years of follow up: annual incidence of thromboembolic events, MACE (composite of nonfatal MI, coronary revascularization and cardiac death) and cardiovascular mortality were analyzed. Results We analyzed 1,433 patients (55.5% women, mean 74.2±9.7 years). 385 (26.9%) patients had 2MACE score ≥3 and of those high-risk patients, 42.1% had previous coronary disease, 12.5% had previous peripheral artery disease, 40.7% had diabetes mellitus, 39% heart failure and 50% had chronic kidney disease (GFR<60 ml/min). After 2.5 (2.2–2.6) years of follow-up, we observed patients with 2MACE score ≥3 had higher rate of adverse events (Table), specially of higher rate of cardiovascular mortality and MACE. Patients with 2MACE score ≥3 had RR 4.09 (2.59–6.45; p<0.001) for MACE. Indeed, patients with 2MACE score ≥3 had around 6-fold risk of cardiovascular death due heart failure than patients with 2MACE score <3 (0.17%/year vs 1.09%/year; p=0.003). 2MACE score had suitable predictive performance for MACE (AUC 0.638 [(0.534–0.742); p=0.010). Conclusion In a Real-world AF patients under rivaroxaban therapy from EMIR registry, the 2MACE score is a good predictor of long-term cardiovascular events, MACE and major bleeding. A 2MACE score ≥3 categorize patients at “high-risk” with almost 4-fold risk of MACE in a long-term follow-up. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Bayer Hispania S.L. Table 1. Adverse events according to 2MACE

Download Full-text

INCREMENTAL RISK OF ISCHEMIC STROKE OVER TIME IN NEWLY DIAGNOSED HEART FAILURE PATIENTS WITHOUT ATRIAL FIBRILLATION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(17)34128-1 ◽

2017 ◽

Vol 69 (11) ◽

pp. 739

Author(s):

Jeffrey S. Berger ◽

Eric Peterson ◽

François Laliberté ◽

Guillaume Germain ◽

Dominique Lejeune ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

Newly Diagnosed ◽

Heart Failure Patients ◽

Over Time

Download Full-text

Workplace Healthy Lifestyle Determinants and Wellbeing Needs across the Preconception and Pregnancy Periods: A Qualitative Study Informed by the COM-B Model

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18084154 ◽

2021 ◽

Vol 18 (8) ◽

pp. 4154

Author(s):

Seonad K. Madden ◽

Claire A. Blewitt ◽

Kiran D. K. Ahuja ◽

Helen Skouteris ◽

Cate M. Bailey ◽

...

Keyword(s):

Healthy Lifestyle ◽

Intervention Development ◽

Health Behavior Change ◽

Overweight And Obesity ◽

Specific Reference ◽

Lifestyle Behaviors ◽

Policy Makers ◽

Health And Wellbeing ◽

Healthy Lifestyle Behaviors ◽

And Control

Overweight and obesity present health risks for mothers and their children. Reaching women during the key life stages of preconception and pregnancy in community settings, such as workplaces, is an ideal opportunity to enable health behavior change. We conducted five focus groups with 25 women aged between 25 and 62 years in order to investigate the determinants of healthy lifestyle behaviors, weight management, and wellbeing needs during the preconception and pregnancy periods in an Australian university workplace. Discussions explored women’s health and wellbeing needs with specific reference to workplace impact. An abductive analytical approach incorporated the capability, opportunity, and motivation of behavior (COM-B) model, and four themes were identified: hierarchy of needs and values, social interactions, a support scaffold, and control. Findings highlight the requirement for greater organization-level support, including top-down coordination of wellbeing opportunities and facilitation of education and support for preconception healthy lifestyle behaviors in the workplace. Interventionists and organizational policy makers could incorporate these higher-level changes into workplace processes and intervention development, which may increase intervention capacity for success.

Download Full-text

Comparative effectiveness of bisoprolol and carvedilol among patients receiving maintenance hemodialysis

Clinical Kidney Journal ◽

10.1093/ckj/sfaa248 ◽

2021 ◽

Author(s):

Ping-Hsun Wu ◽

Yi-Ting Lin ◽

Jia-Sin Liu ◽

Yi-Chun Tsai ◽

Mei-Chuan Kuo ◽

...

Keyword(s):

Heart Failure ◽

Ischemic Stroke ◽

Lower Risk ◽

Cox Model ◽

Major Adverse Cardiovascular Events ◽

Maintenance Hemodialysis ◽

Risk Of Death ◽

Relative Safety ◽

Dialysis Vintage ◽

All Cause Mortality

Abstract Background Despite widespread use, there is no trial evidence to inform β-blocker’s (BB) relative safety and efficacy among patients undergoing hemodialysis (HD). We herein compare health outcomes associated with carvedilol or bisoprolol use, the most commonly prescribed BBs in these patients. Methods We created a cohort study of 9305 HD patients who initiated bisoprolol and 11 171 HD patients who initiated carvedilol treatment between 2004 and 2011. We compared the risk of all-cause mortality and major adverse cardiovascular events (MACEs) between carvedilol and bisoprolol users during a 2-year follow-up. Results Bisoprolol initiators were younger, had shorter dialysis vintage, were women, had common comorbidities of hypertension and hyperlipidemia and were receiving statins and antiplatelets, but they had less heart failure and digoxin prescriptions than carvedilol initiators. During our observations, 1555 deaths and 5167 MACEs were recorded. In the multivariable-adjusted Cox model, bisoprolol initiation was associated with a lower all-cause mortality {hazard ratio [HR] 0.66 [95% confidence interval (CI) 0.60–0.73]} compared with carvedilol initiation. After accounting for the competing risk of death, bisoprolol use (versus carvedilol) was associated with a lower risk of MACEs [HR 0.85 (95% CI 0.80–0.91)] and attributed to a lower risk of heart failure [HR 0.83 (95% CI 0.77–0.91)] and ischemic stroke [HR 0.84 (95% CI 0.72–0.97)], but not to differences in the risk of acute myocardial infarction [HR 1.03 (95% CI 0.93–1.15)]. Results were confirmed in propensity score matching analyses, stratified analyses and analyses that considered prescribed dosages or censored patients discontinuing or switching BBs. Conclusions Relative to carvedilol, bisoprolol initiation by HD patients was associated with a lower 2-year risk of death and MACEs, mainly attributed to lower heart failure and ischemic stroke risk.

Download Full-text

Individual-Level Determinants of Lifestyle Behavioral Changes during COVID-19 Lockdown in the United States: Results of an Online Survey

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18084364 ◽

2021 ◽

Vol 18 (8) ◽

pp. 4364

Author(s):

Xiaotao Zhang ◽

Abiodun Oluyomi ◽

LeChauncy Woodard ◽

Syed Ahsan Raza ◽

Maral Adel Fahmideh ◽

...

Keyword(s):

Physical Activity ◽

Alcohol Use ◽

Online Survey ◽

Healthy Lifestyle ◽

The United States ◽

Lifestyle Changes ◽

Lifestyle Behaviors ◽

Individual Level ◽

Diet And Physical Activity ◽

Healthy Lifestyle Behaviors

This study examined individual-level determinants of self-reported changes in healthy (diet and physical activity) and addictive (alcohol use, smoking, and vaping) lifestyle behaviors during the initial COVID-19 lockdown period in the USA. A national online survey was administered between May and June 2020 that targeted a representative U.S. sample and yielded data from 1276 respondents, including 58% male and 50% racial/ethnic minorities. We used univariate and multivariable linear regression models to examine the associations of sociodemographic, mental health, and behavioral determinants with self-reported changes in lifestyle behaviors. Some study participants reported increases in healthy lifestyle behaviors since the pandemic (i.e., 36% increased healthy eating behaviors, and 33% increased physical activity). However, they also reported increases in addictive lifestyle behaviors including alcohol use (40%), tobacco use (41%), and vaping (46%). With regard to individual-level determinants, individuals who reported adhering to social distancing guidelines were also more likely to report increases in healthy lifestyle behaviors (β = 0.12, 95% CI 0.04 to 0.21). Conversely, women (β = −0.37, 95% CI −0.62 to −0.12), and unemployed individuals (β = −0.33, 95% CI −0.64 to −0.02) were less likely to report increases in healthy lifestyle behaviors. In addition, individuals reporting anxiety were more likely to report increases in addictive behaviors (β = 0.26, 95% CI 0.09 to 0.43). Taken together, these findings suggest that women and unemployed individuals may benefit from interventions targeting diet and physical activity, and that individuals reporting anxiety may benefit from interventions targeting smoking and alcohol cessation to address lifestyle changes during the pandemic.

Download Full-text