509 A biochemical approach to atrial fibrillation in older patients

Abstract Aims Atrial fibrillation (AF) is the most common arrhythmia among the elderly. It is characterized by a disordered electrical activity of the atria and is associated with increased morbidity and mortality. The pathogenesis of AF is not completely understood as it depends on a multifactorial combination of electrical and structural remodelling and inflammation. Metabolomics is the study of the small molecules present in a given biological sample and it has been widely used to determine the metabolic signatures of certain diseases. Untargeted metabolomics consists of a comprehensive screening of all measurable metabolites to identify patterns related to a certain disease, while targeted metabolomics aims at analysing a defined group of metabolites belonging to a specific metabolic pathway or class of compounds. Mass spectrometry (MS), coupled with gas chromatography (GC) and liquid chromatography (LC) offers the possibility of performing quantitative analyses with high selectivity and sensitivity. Aims of this project were to understand the biomolecular mechanisms underlying the onset of AF. Methods We compared plasma samples of older patients with AF with those of healthy subjects. We started from untargeted metabolomics to explore the whole metabolome; then we focused on the lipidomic profile, and, finally, we measured the plasma concentration of acylcarnitines and some amino acids, known to be diagnostic markers of certain metabolic diseases. Fifty patients (age: 76 ± 6 years) and 26 healthy subjects (age: 65 ±19 years) were recruited for the study. A blood sample was drawn by each patient. Samples for metabolomics and lipidomics were processed, respectively, with a GC-MS platform and with high-resolution LC-MS. Results Differences in diseased and healthy metabolomic and lipidomic profiles were not detected, while the concentration of some acylcarnitines and amino acids resulted to be significantly different in the two groups. In particular, two long-chain acylcarnitines (LCACs), C14 and C18:1, were more abundant in the plasma of AF patients, while glycine, which has scavenger properties, had a lower concentration. High levels of circulating LCACs have been associated with cardiovascular diseases and they are known to alter the heart electrophysiology, thus representing a possible marker of the development of arrhythmias. We can hypothesize that the different concentrations we found possibly reflect a higher oxidative and metabolic stress induced by the arrhythmia. Conclusions The alterations of the LCACs we found in AF patients could represent the basis to guide specific therapeutic interventions aimed at reducing the incidence of the hemodynamic and embolic complications of the arrhythmia. In particular, recent guidelines for the management of AF patients introduced the acronym ABC, which means ‘Avoid stroke’—A, ‘Better symptoms management’—B, and ‘Cardiovascular risk and comorbidity management’—C. In this sense, the present research represents an attempt to join and enrich the traditional clinical approach with data derived from laboratory activity, to improve the outcome of the oldest segment of cardiac patients, often presenting rhythm alterations.

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A new medical Internet system in healthcare: innovation of Telegeriatrics and healthcare demands of older patients of different age groups (Preprint)

10.2196/preprints.24676 ◽

2020 ◽

Author(s):

Yu Gong ◽

Jianyuan Zhou

Keyword(s):

Cardiovascular Diseases ◽

General Practitioners ◽

Older Patients ◽

Metabolic Diseases ◽

Treatment Plan ◽

Age Groups ◽

The Elderly ◽

Diagnosis And Treatment ◽

World Health ◽

New Model

BACKGROUND Healthcare for older patients is a worldwide challenge for public health system. A new medical Internet system in healthcare which is a new model of telegeriatrics system has been established. The key innovation is the new telegeriatrics system was conducted jointly by general practitioners in the Community Health Service Center and specialists in university teaching hospital. Unlike the typical telemedicine that has been practiced in other countries, the new model provides a solution for the key issues in telemedicine where a doctor is unable to conduct a direct physical examination and the associated potential diagnostic error. OBJECTIVE This study is to introduce the operation mechanism of the new Telegeriatrics system and analyze healthcare demands of older patients in different age groups applying the new Telegeriatrics system. METHODS 472 older patients (aged≥60) were enrolled and divided into the young older group (aged 60 to 74), the old older group (aged 75 to 89) and the very old group (aged≥90) according to the age stratification of World Health Organization. Proportion of the top 10 diseases of older patients of different age groups was analyzed. RESULTS The process of older patients’ diagnosis and treatment made by specialist and general practitioners formed a closed loop. It ensures the timeliness and effectiveness of diagnosis and treatment of older patients. The treatment effect can be observed by general practitioners and specialist can adjust the treatment plan in time. In this study, it was found that older patients in different age groups have different healthcare demands. Coronary heart disease and type 2 diabetes mellitus were found to be the main diseases of the older patients and the young older patients as well as the old older patients applying Telegeriatrics. CONCLUSIONS The new telegeriatrics system can provide convenient and efficient healthcare services for older patients and overcome the disadvantage of currently used models of telegeriatrics. Older patients in different age groups have different medical care demands. Cardiovascular diseases and metabolic diseases have become the main diseases of the elderly applying the new Telegeriatrics system. Healthcare policy makers should invest more medical resources to the prevention of cardiovascular diseases and metabolic diseases in the elderly.

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How I treat elderly patients with myeloma

Blood ◽

10.1182/blood-2009-10-163329 ◽

2010 ◽

Vol 116 (13) ◽

pp. 2215-2223 ◽

Cited By ~ 25

Author(s):

Jayesh Mehta ◽

Michele Cavo ◽

Seema Singhal

Keyword(s):

Adverse Effects ◽

Older Patients ◽

Supportive Therapy ◽

The Elderly ◽

High Dose Chemotherapy ◽

Cytotoxic Agents ◽

High Dose ◽

Clinical Approach ◽

Younger Patients ◽

Best Response

Abstract The clinical approach to older patients with myeloma has to be modified to take into account comorbidities and the likelihood of higher treatment-related toxicity. Individualization of management and adequate supportive therapy are important to obtain the best response while minimizing adverse effects. Corticosteroids, novel agents, conventional cytotoxic agents, and high-dose chemotherapy with autotransplantation (modalities used in younger patients) are also used in older patients, although the elderly undergo transplantation less frequently. The sequential use of active agents singly and in different combinations has improved response rates and survival of all patients with myeloma, including the elderly.

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Acute cerebellar ataxia: differential diagnosis and clinical approach

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20190020 ◽

2019 ◽

Vol 77 (3) ◽

pp. 184-193 ◽

Cited By ~ 7

Author(s):

José Luiz Pedroso ◽

Thiago Cardoso Vale ◽

Pedro Braga-Neto ◽

Lívia Almeida Dutra ◽

Marcondes Cavalcante França Jr ◽

...

Keyword(s):

Cerebellar Ataxia ◽

Healthy Subjects ◽

Metabolic Diseases ◽

Screening Tests ◽

Common Finding ◽

Clinical Approach ◽

Initial Screening ◽

Immune Mediated ◽

Acute Cerebellar Ataxia ◽

Cerebellar Lesions

ABSTRACT Cerebellar ataxia is a common finding in neurological practice and has a wide variety of causes, ranging from the chronic and slowly-progressive cerebellar degenerations to the acute cerebellar lesions due to infarction, edema and hemorrhage, configuring a true neurological emergency. Acute cerebellar ataxia is a syndrome that occurs in less than 72 hours, in previously healthy subjects. Acute ataxia usually results in hospitalization and extensive laboratory investigation. Clinicians are often faced with decisions on the extent and timing of the initial screening tests, particularly to detect treatable causes. The main group of diseases that may cause acute ataxias discussed in this article are: stroke, infectious, toxic, immune-mediated, paraneoplastic, vitamin deficiency, structural lesions and metabolic diseases. This review focuses on the etiologic and diagnostic considerations for acute ataxia.

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Could Some Geriatric Characteristics Hinder the Prescription of Anticoagulants in Atrial Fibrillation in the Elderly?

Journal of Aging Research ◽

10.1155/2014/693740 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 10

Author(s):

Paule Denoël ◽

Jacques Vanderstraeten ◽

Pierre Mols ◽

Thierry Pepersack

Keyword(s):

Atrial Fibrillation ◽

Older Patients ◽

Anticoagulation Therapy ◽

The Elderly ◽

Blood Analysis ◽

Relative Importance ◽

Emergency Unit ◽

Old Patients ◽

Oral Anticoagulation Therapy ◽

Anticoagulation Treatment

Several studies have reported underprescription of anticoagulants in atrial fibrillation (AF). We conducted an observational study on 142 out of a total of 995 consecutive ≥75 years old patients presenting AF (14%) when admitted in an emergency unit of a general hospital, in search of geriatric characteristics that might be associated with the underprescription of anticoagulation therapy (mostly antivitamin K at the time of the study). The following data was collected from patients presenting AF: medical history including treatment and comorbidities, CHADS2score, ISAR scale (frailty), Lawton’s scale (ADL), GDS scale (mood status), MUST (nutrition), and blood analysis (INR, kidney function, and albumin). Among those patients for who anticoagulation treatment was recommended (73%), only 61% were treated with it. In the group with anticoagulation therapy, the following characteristics were observed more often than in the group without such therapy: a recent (≤6 months) hospitalization and medical treatment including digoxin or based on >3 different drugs. Neither the value of the CHADS2score, nor the geriatric characteristics could be correlated with the presence or the absence of an anticoagulation therapy. More research is thus required to identify and clarify the relative importance of patient-, physician-, and health care system-related hurdles for the prescription of oral anticoagulation therapy in older patients with AF.

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What is the role of profibrogenic and proinflammatory factors in developing atrial fibrillation associated with metabolic syndrome components?

Russian Journal of Cardiology ◽

10.15829/1560-4071-2021-4752 ◽

2021 ◽

Vol 26 (11) ◽

pp. 4752

Author(s):

V. A. Ionin ◽

E. I. Barashkova ◽

V. A. Pavlova ◽

G. I. Borisov ◽

K. A. Averchenko ◽

...

Keyword(s):

Atrial Fibrillation ◽

Metabolic Syndrome ◽

Abdominal Obesity ◽

Healthy Subjects ◽

Metabolic Diseases ◽

Inflammatory Biomarkers ◽

Control Group ◽

Galectin 3 ◽

Laboratory Investigations

Aim. To determine the concentration of blood fibrotic and inflammatory biomarkers in patients with atrial fibrillation (AF) associated with metabolic syndrome (MS) components.Material and methods. The study included 646 patients aged 35-65 years: patients with AF and MS (n=142), those with AF and without MS (n=113), those with MS and without AF (n=175) and the control group consisted of healthy subjects without cardiovascular and metabolic diseases (n=107). All participants underwent anthropometric and laboratory investigations. Profibrogenic (aldosterone, galectin-3, TGF-beta1, CTGF) and proinflammatory (CT-1, IL-6) factors were determined in serum and plasma by ELISA. Statistical analysis was performed using IBM SPSS Statistics software (version 22.0).Results. The highest concentrations of fibrotic and inflammatory biomarkers were found in patients with AF in combination with MS. In MS patients without AF, the concentration of aldosterone, galectin-3, TGF-beta1, CTGF, CT-1, and IL-6 was also higher than in healthy subjects. The levels of aldosterone, CT-1 and IL-6 in patients with AF were higher in the presence of three or more MS components, while the highest values of these parameters were found in patients with five MS components. The lowest concentrations of galectin-3, CTGF, and CT-1 in patients with AF were found in patients without MS components, and in the presence of even 1 MS component, they were significantly higher. Correlation analysis made it possible to establish a stronger relationship between aldosterone and TGF-betal with systolic blood pressure (p=0,493, p<O,O001 and p=0,530, p<O,O001), and CT-1, CTGF and IL-6 in a greater degree correlated with waist circumference (p=0,563, p<0,0001; p=0,626, p<0,0001; p=0,480, p<O,O001). The concentrations of galectin-3 and CTGF were more positively correlated with an increase in the number of MS components. In patients with AF and hypertension (HTN), but without abdominal obesity (AO), higher values of aldosterone (108,1±70,3 pg/ml and 89,3±32,2 pg/ml, p=0,003) and TGF-beta1 (3680,1±1863,3 pg/ml and 1968,1±1611,5 pg/ml, p=0,015) in serum than in AF patients without HTN and without AO. In the group of patients with AF and AO, but without HTN, higher concentrations of IL-6 (2,9±0,7 pg/ml and 1,9±0,6 pg/ml, p=0,001) and CTGF (162,9±92,2 pg/ml and 116,3±63,4 pg/ml, p=0,0001).Conclusion. It can be assumed that hypertension through the aldosterone system and TGF-beta1, as well as abdominal obesity through the cytokine system CT-1 and IL-6 activate various mechanisms and pathways for myocardial remodeling. Integral molecules galectin-3 and CTGF mediate their interactions, in particular in patients with a combination of several MS components and contribute to a higher AF risk.

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Acute breathlessness

10.1093/med/9780199568741.003.0012 ◽

2018 ◽

Author(s):

Jonathan Timperley ◽

Sandeep Hothi

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Embolism ◽

Older Patients ◽

Decompensated Heart Failure ◽

Chronic Obstructive ◽

Clinical Approach ◽

Obstructive Pulmonary Disease ◽

New Onset

Acute breathlessness or dyspnoea is the new onset of an unpleasant awareness of breathing, at rest or at a level of exercise, which did not previously cause symptoms. It is often associated with other symptoms—including wheeze, cough, chest pain, and palpitation—which, together with the patient’s comorbidities, help shape the differential diagnosis. Five disorders—decompensated heart failure, exacerbations of asthma or chronic obstructive pulmonary disease, pneumonia, and pulmonary embolism—account for 80% of diagnoses. In older patients, acute breathlessness often results from multiple interrelated pathologies (e.g. pneumonia on a background of COPD, triggering acute atrial fibrillation). This chapter describes the clinical approach to the patient presenting with acute breathlessness.

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Oral anticoagulant therapy for older patients with atrial fibrillation

Geriatric Care ◽

10.4081/gc.2017.7038 ◽

2017 ◽

Vol 3 (3) ◽

Cited By ~ 1

Author(s):

Mario Bo ◽

Enrico Brunetti

Keyword(s):

Atrial Fibrillation ◽

Anticoagulant Therapy ◽

Cardiac Arrhythmias ◽

Oral Anticoagulant ◽

Older Patients ◽

Oral Anticoagulant Therapy ◽

Vitamin K Antagonists ◽

The Elderly ◽

Age Related ◽

Significant Burden

Atrial fibrillation (AF) is one of the most common cardiac arrhythmias. Its incidence and prevalence increase with age, representing a significant burden for health services in western countries. The most feared consequence of AF is cardio-embolic stroke, accounting for roughly one third of ischemic strokes in the elderly. Oral anticoagulant therapy is currently recommended for patients with AF and a CHA2DS2-VASc score ≥2 in men and ≥3 in women, but it is widely underused, particularly in the oldest patients who, in reason of their higher risk of stroke, might benefit more from it. Among the main reasons for anticoagulant underuse in older patients, advanced age itself, physician’s perceived high risk of age-related and fall-related bleedings, and difficulties in monitoring vitamin K antagonists-based therapies are the most frequently reported.

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