Temporal pattern/episode duration-based classification of atrial fibrillation as paroxysmal vs. persistent: is it time to develop a more integrated prognostic score to optimize management?

ObjectiveTo determine trends and impact on outcomes of atrial fibrillation (AF) in patients with pre-existing psychosis.BackgroundWhile post-AF psychosis has been extensively studied, contemporary studies including temporal trends on the impact of pre-AF psychosis on AF and post-AF outcomes are largely lacking.MethodsWe used Nationwide Inpatient Sample (NIS) from the healthcare cost and utilization project (HCUP) from year's 2002–2012. We identified AF and psychosis as primary and secondary diagnosis respectively using validated international classification of diseases, 9th revision, and Clinical Modification (ICD-9-CM) codes, and used Cochrane–Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR).ResultsWe analyzed total of 3.887.827AF hospital admissions from 2002–2012 of which 1.76% had psychosis. Proportion of hospitalizations with psychosis increased from 5.23% to 14.28% (P trend < 0.001). Utilization of atrial-cardioversion was lower in patients with psychosis (0.76%v vs. 5.79%, P < 0.001). In-hospital mortality was higher in patients with Psychosis (aOR 1.206; 95%CI 1.003–1.449; P < 0.001) and discharge to specialty care was significantly higher (aOR 4.173; 95%CI 3.934–4.427; P < 0.001). The median length of hospitalization (3.13 vs. 2.14 days; P < 0.001) and median cost of hospitalization (16.457 vs. 13.172; P < 0.001) was also higher in hospitalizations with psychosis.ConclusionsOur study displayed an increasing proportion of patients with Psychosis admitted due to AF with higher mortality and extremely higher morbidity post-AF, and significantly less utilization of atrial-cardioversion. There is a need to explore reasons behind this disparity to improve post-AF outcomes in this vulnerable population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Overview on prediction, detection, and classification of atrial fibrillation using wavelets and AI on ECG

Computers in Biology and Medicine ◽

10.1016/j.compbiomed.2021.105168 ◽

2022 ◽

pp. 105168

Author(s):

Hassan Serhal ◽

Nassib Abdallah ◽

Jean-Marie Marion ◽

Pierre Chauvet ◽

Mohamad Oueidat ◽

...

Keyword(s):

Atrial Fibrillation

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Abstract 16199: Trend of Hypertensive Emergencies in Atrial Fibrillation Hospitalization; National Estimate

Circulation ◽

10.1161/circ.142.suppl_3.16199 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Mae'n Al-Dabbas ◽

Jay Shah ◽

devina adalja ◽

Archana Gundabolu ◽

Ashish Kumar ◽

...

Keyword(s):

Atrial Fibrillation ◽

International Classification Of Diseases ◽

Primary Diagnosis ◽

Hypertensive Emergency ◽

P Value ◽

National Inpatient Sample ◽

Common Risk Factor ◽

The Past ◽

Classification Of Diseases

Introduction: Hypertension has been reported as one of the most common risk factor causing atrial fibrillation (AF). Also, hypertension is associated with more persistent AF. However the epidemiology for incidence of hypertensive emergency in AF hospitalization is not well documented. Hypothesis: We hypothesize that frequency of hypertensive emergency has been increasingly associated with Atrial fibrillation. Methods: National inpatient sample from 2005 -2015 was used for the present analysis. Patients over 18 years, with AF as the primary diagnosis were identified using International Classification of Diseases, Ninth Revision-Clinical Modification (ICD-9-CM) code, 427.31. Patients with hypertensive emergency were identified using ICD-9-CM code. 401.0, 402.0, 403.0, 404.0, 405.0. Results: A total of 4,988,269 AF patients over 18 years of age were included in the present analysis. Of these hospitalization 49,423 had hypertensive emergency during hospitalizations and the rest 4,938,846 had no hypertensive emergency. There was a monotonic increase in the trend of rates of hypertensive emergency per 1000 AF hospitalizations, from 2005 - 2015. (P value <0.001) [Figure 1]. Conclusion: There has been a significant increase in the rates of hypertensive emergency among AF hospitalization, over the past decade. Further research is needed to investigate the reason for this increased trend.

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Abstract 14682: Impact of Atrial Fibrillation in Aortic Stenosis Patients: Insights From the United States Readmissions Database

Circulation ◽

10.1161/circ.142.suppl_3.14682 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Shashank Shekhar ◽

Anas M Saad ◽

Toshiaki Isogai ◽

Mohamed M Gad ◽

Keerat Ahuja ◽

...

Keyword(s):

Atrial Fibrillation ◽

Aortic Stenosis ◽

Hospital Mortality ◽

Large Scale ◽

International Classification Of Diseases ◽

The United States ◽

Large Scale Data ◽

Classification Of Diseases

Introduction: Even though atrial fibrillation (AF) is present in >30% of patients with aortic stenosis (AS), it is not typically included in the decision-making algorithm for the timing or need for aortic valve replacement (AVR), either by transcatheter (TAVR) or surgical (SAVR) approaches. Large scale data on how AF affects outcomes of AS patients remain scarce. Methods: From the Nationwide Readmissions Database (NRD), we retrospectively identified AS patients aged ≥18years, with and without AF admitted between January and June in 2016 and 2017 (to allow for a six month follow up), using the International Classification of Diseases-10 th revision codes. Multivariable logistic regression was performed to examine the predictors of in-hospital mortality during index hospitalization. In-hospital complications and 6 month in-hospital mortality during any readmission after being discharged alive were compared in patients with and without AF, for patients undergoing TAVR, SAVR or no-AVR. Results: We identified 403,089 AS patients, of which 41% had AF. Patients with AF were older (median age in years: 83 vs. 79) and were more frequently females (52% vs. 48%; p<0.001). Table summarizes outcomes of AS patients with and without AF. TAVR in patients with AF was associated with higher in-hospital mortality and follow-up mortality as compared to patients without AF. Although AF did not influence in-hospital mortality in SAVR population, follow-up mortality was also significantly higher after SAVR in patients with AF compared to patients without AF. For patients not undergoing AVR, in-hospital and follow-up mortality were higher in AF population compared to no AF and was higher than patients undergoing AVR (Table). Conclusions: AF is associated with worse outcomes in patients with AS irrespective of treatment (TAVR, SAVR or no-AVR). More studies are needed to understand the implications of AF in AS population and whether earlier treatment of AS in patients with AF can improve outcomes.

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Abstract 13915: Atrial Fibrillation Begets Atrial Fibrillation in Cryptogenic Stroke Patients: Results from the Crystal-AF Trial

Circulation ◽

10.1161/circ.130.suppl_2.13915 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Rod S Passman ◽

Jodi L Koehler ◽

Paul D Ziegler

Keyword(s):

Atrial Fibrillation ◽

Cryptogenic Stroke ◽

Secondary Stroke Prevention ◽

Stroke Patients ◽

Cardiac Monitor ◽

Long Duration ◽

Episode Duration ◽

Duration Information ◽

The Impact ◽

Insertable Cardiac Monitor

Introduction: Initial episodes of atrial fibrillation (AF) detected following a cryptogenic stroke (CS) may be brief in duration and the clinical relevance of such episodes is uncertain. Hypothesis: We investigated whether an initial brief episode of AF was predictive of subsequent long duration AF episodes in CS patients (pts) with an insertable cardiac monitor (ICM). Methods: CS pts (n=208, age 61.6±11.3 years, 66% male) randomized to the ICM arm of the CRYSTAL-AF study and inserted with a device (Reveal® XT) were followed for 21±9 months. AF episodes (>30 seconds) were independently adjudicated and the first adjudicated AF episode was classified as brief (<1 hour) or long (≥1 hour). The incidence of subsequent long duration AF episodes among pts with an initially brief episode was computed. The impact of episode duration on prescription of oral anticoagulation (OAC) therapy was also assessed. Results: Among 36 pts with an adjudicated AF episode for which duration information was available, the initial episode was classified as brief in 18 (50%) pts and long in 18 (50%) pts. Among those with initially brief episodes, 10 (56%) experienced only subsequent brief episodes while 8 (44%) went on to experience at least one long AF episode. The median time between the initial brief episode and first long AF episode was 75 days [interquartile range: 27-624 days]. OAC was prescribed in 7/10 pts (70%) with only brief AF episodes compared to 26/26 pts (100%) with at least one long episode of AF (p=0.017). Conclusion: Initial AF episodes in pts with CS are equally likely to be of short or long duration. However, nearly half of CS pts with initially brief episodes of AF subsequently have long duration episodes detected much later via prolonged monitoring with ICMs. Therefore, early detection of brief AF episodes may merit more rigorous monitoring of AF with ICMs since physicians were significantly more likely to prescribe OAC for secondary stroke prevention in response to longer duration episodes.

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