Cardiology

2019 ◽  
pp. 177-198
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Disease ◽  
Chest Pain ◽  
Venous Pressure ◽  
Structural Defects ◽  
Pressure Waveform ◽  
St Elevation ◽  
Electrocardiogram Interpretation

Cardiology specializes in disorders of the heart, primarily ischaemic heart disease, rhythm disturbances (arrhythmias), and structural defects. Emergency presentations with chest pain, breathlessness, or palpitations are extremely common. This chapter describes the pathophysiology, presentation, diagnosis, and management of the leading cardiac complaints including unstable angina, ST elevation myocardial infarction (STEMI), non-STEMI, atrial fibrillation, heart failure, hypertension, infective endocarditis, and syncope. Basic electrocardiogram interpretation is explained, in addition to the jugular venous pressure waveform and risk stratification tools for atrial fibrillation and heart failure. A practical guide to the cardiovascular examination (as well as tips for success in exam situations) is included.

Abstract P205: Comorbities Predict Future Hospitalization Risk in Incident Myocardial Infarction Survivors

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Shannon M Dunlay ◽  
Susan Weston ◽  
Jill M Killian ◽  
Allan S Jaffe ◽  
Malcolm R Bell ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Heart Disease ◽  
Primary Reason ◽  
Olmsted County ◽  
St Segment ◽  
Repeated Events ◽  
St Elevation ◽  
Over Time

Background: Patients are surviving longer after myocardial infarction (MI), but little is known about the occurrence and predictors of subsequent hospitalizations. Methods: We identified all Olmsted Count residents with incident MI from 1987-2008 and evaluated Olmsted County hospitalizations through 2009. ICD-9 codes were used to determine the primary reason for hospitalization. To account for repeated events, Andersen-Gill models were used to examine the predictors of hospitalization post-MI. Patients were censored at death or last follow-up. Results: A total of 2617 patients (mean 67 years, 41% female, 32% with ST-elevation MI) were diagnosed with incident MI from 1987-2007 and survived MI hospitalization. Over a mean follow-up of 7.1 years, 10116 hospitalizations occurred equating to a median of 3 (range 0 to 43) per person. Only 37.5% (n=3793) of hospitalizations were due to cardiovascular causes, and of these, most were due to ischemic heart disease (n= 1865, 49.2%) and heart failure (n= 733, 19.3%). The proportion of non-cardiovascular hospitalizations increased over time and was higher in women than men, but did not differ by ST-segment status. Several factors were associated with the risk of hospitalization after adjusting for year of diagnosis and sex (Figure). Biomarker levels were not predictors of hospitalization risk. Conclusions: Two-thirds of hospitalizations among incident MI survivors in the community are for non-cardiovascular reasons, and this proportion has increased. Comorbidities are important predictors of recurrent hospitalizations. Therapies focused solely on MI management may be insufficient to prevent the majority of future admissions.

scholarly journals HUBUNGAN ANTARA RIWAYAT PENYAKIT JANTUNG DENGAN TINGKAT KEPARAHAN STROKE ISKEMIK AKUT PERTAMA KALI

2019 ◽  
Vol 37 (1) ◽  
Author(s):  
Ignatius Ivan ◽  
Budi Riyanto Wreksoatmodjo ◽  
Octavianus Darmawan
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
National Institutes Of Health ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Severe Stroke ◽  
History Of

ASSOCIATION BETWEEN HISTORY OF HEART DISEASE AND SEVERITY OF ACUTE FIRST-EVER ISCHEMIC STROKEABSTRACTIntroduction: History of heart disease such as atrial  fibrillation, angina pectoris, myocardial infarction, heart failure has a role on ischemic stroke severity.Aim: This research aims to find the association between history of heart disease and stroke severity using NIHSS score on acute ischemic stroke patients in Atma Jaya hospital during 2014-2018.Method: This research used cross-sectional method with two-sided fisher’s exact test. With total sampling, samples retrieved from secondary sources in Atma Jaya hospital during 2014-2018 resulting 236 subjects. Stroke severity measured by NIHSS score during admission, categorized with severe stroke (15-42) and non-severe stroke (0-14).Result: There is a significant association between history of AF (p=0.046) on first-ever ischemic stroke severity. Acute first-ever ischemic stroke patients who are  >18 years old with history of AF has a tendency of 5,2 times to have severe stroke compared with patients without AF. Other history of heart disease has no significant association towards stroke severity.Discussion: In accordance with previous research, our findings suggest a significant association between history of atrial fibrillation and acute first-ever ischemic stroke severity in which there is a tendency of more severe stroke compared wth patients without AF. Unlike previous findings, this research shows no significant association between history of heart failure and stroke severity due to limited data characteristic  of ejection fraction preventing us to include patient with ejection fraction below 30%. This limitation may also allow history of angina pectoris and myocardial infarction to be insignificant.Keywords:  Atrial  fibrillation,  heart  failure,  ischemic  stroke,  myocardial  infarction,  National  Institutes  of Health Stroke ScaleABSTRAKPendahuluan: Riwayat penyakit jantung seperti atrial fibrilasi, angina pektoris, infark miokardium, gagal jantung memiliki peran terhadap keparahan stroke iskemik.Tujuan: Mengetahui hubungan riwayat penyakit jantung dengan tingkat keparahan stroke berdasarkan skor NIHSS pada pasien stroke iskemik akut di RS Atma Jaya pada tahun 2014-2018.Metode: Penelitian potong lintang terhadap data sekunder pasien stroke iskemik pertama kali yang dirawat di RS Atma Jaya pada tahun 2014-2018. Keparahan stroke diukur berdasarkan National Institutes of Health Stroke Scale (NIHSS) masuk dengan kategori severe stroke (skor 15-42) dan non-severe stroke (0-14). Dilakukan uji Fisher dua sisi untuk menilai hubungan.Hasil: Terdapat 236 subjek dengan mayoritas hubungan riwayat AF (p=0,046) terhadap tingkat keparahan stroke. Pasien berumur >18 tahun yang mengalami stroke iskemik akut pertama kali dengan riwayat AF akan berpeluang 5,2 kali lebih tinggi untuk mengalami severe stroke dibandingkan jika tanpa riwayat AF. Riwayat penyakit jantung lain tidak memiliki hubungan signifikan terhadap tingkat keparahan stroke.Diskusi: Terdapat hubungan yang signifikan antara riwayat AF terhadap tingkat keparahan stroke, terutama pada subjek dengan severe stroke jika dibandingkan pasien tanpa riwayat AF. Tidak ditemukan hubungan signifikan antara penyakit jantung yang lain dikarenakan keterbatasan data penelitian.Kata kunci: Atrial fibrilasi, gagal jantung, infark miokardium, National Institutes of Health Stroke Scale, stroke iskemik

The clinical course of atrial fibrillation in patients with coronary heart disease

2016 ◽  
Vol 94 (8) ◽  
pp. 591-595 ◽  
Author(s):  
V. I. Podzolkov ◽  
Aida I. Tarzimanova ◽  
R. G. Gataulin
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Chronic Heart Failure ◽  
Clinical Course ◽  
History Of ◽  
Group 2 ◽  
Group 1

The modern medical literature practically does not contain clinical publications reporting studies of factors responsible for progression of atrial fibrillation (AF) in patients with coronary heart disease (CHD). It accounts for the importance of investigations into evolution of the clinical course of AF in such patients.Aim. To elucidate evolution of the clinical course of AF in patients with CHD in a long-term prospective study.Materials and methods. The study included. 112 patient aged 57-74 (mean 67.44±3.3) years with CHD and paroxysmal form of AF carried outfrom 2011 to 2015. Evolution of the clinical course of AF was evaluated based on the number of arrhythmic attacks during the last 3 months. The appearance ofprolonged persistent AF episodes or permanent AF was regarded as progression of arrhythmia.Results. During the 4 year study, 64 (57,2%) patients (group 1) did not experiencea rise in the frequency and duration of AF attacks. Progression of arrhythmia was documented in 48 (42,8%) of the 112 (100%) patients (group 2). These patients more frequently had the history of myocardial infarction and chronic heart failure than patients of group 1. The latter had the mean values of left ventricular (LV) ejection fraction 61,23±6,24%, i.e. significantly higher than 48,47±8,4% in group 2.47 and 28 % of the patients in group 2and 1 respectively suffered mitral regurgitation (p<0,05). Patients of group 2 had significantly more akineticzones. Intake of nitroglycerin in group 1 resulted in positive dynamics of local LV contractility that did not change in patients of group 2. Conclusion. 42,8% of the patients with CHD and paroxysmal form of AF experienced progression of arrhythmia into a persistent or permanent form. Predictors of AF progression in patients with CHD are the history of myocardial infarction, chronic heart failure, mitral regurgitation, and irreversible changes in local myocardial LV contraction.

scholarly journals Tends in beta-blocker administration and in prevalence of indications for their usage in heart failure with preserved ejection fraction: an analysis of randomized clinical trials

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Kokhan ◽  
G Kiyakbaev ◽  
Z.H Kobalava
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ejection Fraction ◽  
Randomized Clinical Trials ◽  
The Other ◽  
Preserved Ejection Fraction ◽  
Over Time

Abstract Background Despite the lack of data supporting their benefits, beta-blockers (BBs) frequently prescribed for heart failure with preserved ejection fraction (HFpEF). This may be due to the other indications (coronary heart disease, atrial fibrillation, etc.) on the one hand and due to clinical inertia with translation evidence from heart failure with reduced ejection fraction to HFpEF on the other. Purpose To assess the trends in BBs administration and prevalence of the possible indications for their usage (hypertension, atrial fibrillation, coronary heart disease, myocardial infarction) in the participants of the randomized clinical trials (RCTs) of HFpEF. Methods A systematic literature search of PubMed database was performed. RCTs of pharmacological treatment of HFpEF carried out between 1993 and 2019 were used. Studies of the effectiveness of BBs usage, or studies performed in specific populations (HFpEF+coronary heart disease or HFpEF+hypertension, etc.) were excluded. Features at enrolment date and data on the frequency of BBs admission and the prevalence of hypertension, atrial fibrillation, coronary heart disease, and myocardial infarction were extracted. The trends over time of enrolment were analyzed using the Mann-Kendall test. Results Of the 718 filtered publications, 14 RCTs met the inclusion and exclusion criteria fully. In the most recent trials, up to 75–80% of patients received BBs. Time trends analysis revealed that between 1993–2019 years the frequency of BBs use among the participants of the RCTs of HFpEF significantly increased (tau=0.51, p=0.014). No such change was observed in the prevalence of coronary heart disease, myocardial infarction, hypertension, and atrial fibrillation (all p&gt;0.05). Prevalence of hypertension and atrial fibrillation showed a tendency toward increasing (tau=0.4, p=0.055 and tau=0.043, p=0.063, respectively) which became statistically significant for atrial fibrilation with the exclusion of the ALDO-DHF study (tau=0.5; p=0.042). The prevalence of myocardial infarction tended to decrease over time (tau=−0.73; p=0.06). Conclusion Over the last 20 years, the proportion of patients who used BB at enrolment in RCTs of HFpEF increased significantly. There was no statistically significant increase in the prevalence of the formal indications for their usage such as atrial fibrillation, hypertension, coronary heart disease or myocardial infarction. This fact requires attention since some retrospective studies have revealed that BBs use in HFpEF patients is associated with an increased risk of hospitalizations. FUNDunding Acknowledgement Type of funding sources: None.

Abstract P183: Incident Chronic Kidney Disease and Myocardial Infarction Without Chest Pain: Results From the Atherosclerosis Risk in Communities Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Bailey M DeBarmore ◽  
Matthew S Loop ◽  
Brad C Astor ◽  
Kunihiro Matsushita ◽  
Gerardo M HEISS ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Chest Pain ◽  
Female Gender ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
St Elevation ◽  
Aric Study

Background: Chronic kidney disease (CKD) and cardiovascular disease share similar risk factors, such as diabetes, hypertension, and dyslipidemia promoting atherosclerosis. Acute myocardial infarction (MI) presenting without chest pain is associated with higher case fatality compared to MI with chest pain. Patients with non-ST-elevation MI (NSTEMI) are more likely to present without chest pain than patients with ST-elevation MI (STEMI). Few if any studies have examined the risk of incident CKD following MI with and without chest pain. Hypothesis: We hypothesized that MI presenting without chest pain is associated with greater risk of incident CKD after adjustment for demographic factors, in-hospital complications, and comorbidities among adults in the Atherosclerosis Risk in Communities (ARIC) Study. Methods: The ARIC Study is a community-based cohort study that began recruitment in 1987. MI without chest pain includes persons presenting with shortness of breath, nausea, or dyspnea that is determined to be of cardiac origin. Follow-up time for this analysis was calculated from date of MI hospitalization (index date) to incident CKD, death, or administrative censoring in 2017. Incident CKD was defined as eGFR <60 mL/min/1.73 m 2 and ≥25% eGFR decline from previous measurements, CKD-related hospitalization or death, or end-stage renal disease. In-hospital complications included acute heart failure, ventricular fibrillation, and cardiogenic shock. Prevalent CHD and chronic heart failure were measured at visit 1 (1987-1989) and history of diabetes and hypertension were captured from the MI hospitalization record. Results: There was a total of 1,332 MI hospitalizations with data on MI type and symptom presentation. Among 1,038 NSTEMI events, 19% presented without chest pain, compared to 7% of the 294 STEMI events presenting without chest pain. Age greater than 65 years, female gender, and hypertension at the time of the MI as well as in-hospital complications of heart failure and ventricular fibrillation were more common among NSTEMI without chest pain compared to NSTEMI with chest pain. Median follow-up time was 4.9 years (Q1, Q3: 0.9, 11.4 years). Persons with NSTEMI events presenting without chest pain had 1.82 times the risk of incident CKD (95% CI: 1.39, 2.38) compared to NSTEMI events presenting with chest pain. This association was attenuated after adjustment for age at MI, female gender, and black race (HR: 1.36, 95% CI: 1.04, 1.80) and further attenuated after additional adjustment for reperfusion within 24 hours (HR: 1.30, 95% CI: 0.99, 1.72). Conclusion: NSTEMI presenting without chest pain was associated with increased risk of incident CKD, though this association was attenuated after adjustment.

Abstract P136: Identifying Opportunities to Further Improve Outcomes for Patients With Coronary Artery Disease and Heart Failure in a Managed Care Organization

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Courtney O Jordan ◽  
Thomas E Kottke
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Heart Disease ◽  
Decision Support ◽  
Decision Support Tool ◽  
Medical Group ◽  
National Data ◽  
Support Tool ◽  
Chronic Heart Disease ◽  
St Elevation

Background: We have created and evaluated a decision support tool to identify opportunities to improve outcomes for patients with coronary heart disease and heart failure (CAD/HF). Applying national data, we concluded that improving care for patients with chronic disease would generate the greatest improvement in outcomes. The purpose of this analysis is two-fold: 1) to determine whether the decision support tool can be applied to data available from a “real” medical group, and 2) to determine whether the conclusions generated from analysis of the medical group data are similar to the conclusions generated from U.S. data. Methods: We created the tool to calculate the number of deaths that might be prevented or postponed if care for heart disease prevention and treatment were improved from current levels to optimal care_that is, the elimination of risk factors and the prescription of all effective medications before and between acute events, and the delivery of all effective therapies to individuals during an acute event. In this analysis we focus on calculating the impact of optimizing care for 40-74 year old patients treated for CAD/HF in a HealthPartners Medical Group (HPMG) clinic or at Regions Hospital between August 8, 2007 and July 31, 2008. Results: Condition or Event Deaths Prevented or Postponed by Optimizing Care Chronic heart disease with EF >35% 39 Chronic heart disease with EF <=35% 20 Myocardial infarction with ST elevation 1 Myocardial infarction without ST elevation 1 Unstable angina/other acute heart disease 3 Acute heart failure with EF <35% 10 New ambulatory or incidental diagnosis 10 Conclusions: This study demonstrates that 1) it is feasible to use our decision support tool to identify opportunities to improve outcomes for patients of a medical group, and that 2) as we concluded from the analysis of national data, the greatest opportunities to improve outcomes for patients with CAD/HF treated by this medical group lie with patients who are between acute events.

scholarly journals Patients with a Combination of Atrial Fibrillation and Chronic Heart Failure in Clinical Practice: Comorbidities, Drug Treatment and Outcomes

2022 ◽  
Vol 17 (6) ◽  
pp. 816-824
Author(s):  
M. M. Loukianov ◽  
S. Yu. Martsevich ◽  
Yu. V. Mareev ◽  
S. S. Yakushin ◽  
E. Yu. Andreenko ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Clinical Practice ◽  
Cerebral Stroke ◽  
Cardiovascular Pharmacotherapy ◽  
Hemorrhagic Complications

Aim. To assess in clinical practice the structure of multimorbidity, cardiovascular pharmacotherapy and outcomes in patients with a combination of atrial fibrillation (AF) and chronic heart failure (CHF) based on prospective registries of patients with cardiovascular diseases (CVD).Materials and Methods. The data of 3795 patients with atrial fibrillation (AF) were analyzed within the registries RECVASA (Ryazan), RECVASA FP (Moscow, Kursk, Tula, Yaroslavl), REGION-PO and REGION-LD (Ryazan), REGION-Moscow, REGATA (Ryazan). The comparison groups consisted of 3016 (79.5%) patients with AF in combination with CHF and 779 (29.5%) patients with AF without CHF. The duration of prospective observation is from 2 to 6 years.Results. Patients with a combination of AF and CHF (n=3016, age was 72.0±10.3 years; 41.8% of men) compared with patients with AF without CHF (n=779, age was 70.3±12.0 years; 43.5% of men) had a higher risk of thromboembolic complications (CHA2DS2-VASc – 4.68±1.59 and 3.10±1.50; p<0.001) and hemorrhagic complications (HAS-BLED – 1.59±0.77 and 1.33±0.76; p<0.05). Patients with a combination of AF and CHF significantly more often (p<0.001) than in the absence of CHF were diagnosed with arterial hypertension (93.9% and 83.8%), coronary heart disease (87.9% and 53,5%), myocardial infarction (28.4% and 14.0%), diabetes mellitus (22.4% and 7.7%), chronic kidney disease (24.8% and 16.2%), as well as respiratory diseases (20.1% and 15.3%; p=0.002). Patients with AF in the presence of CHF, compared with patients without CHF, were more often diagnosed with a permanent form of arrhythmia (49.3% and 32.9%; p<0.001) and less often paroxysmal (22.5% and 46.2%; p<0.001) form  of  arrhythmia.  Ejection  fraction  ≤40%  (9.3%  and  1.2%;  p<0.001),  heart  rate  ≥90/min  (23.7% and 19.3%; p=0.008) and blood pressure ≥140/90 mm Hg (59.9% and 52.2%; p<0.001) were recorded with AF in the presence of CHF more often than in the absence of CHF. The frequency of proper cardiovascular pharmacotherapy was higher, albeit insufficient, in the presence of CHF (64.9%) than in the absence of it (56.1%), but anticoagulants were prescribed less frequently when AF and CHF were combined (38.8% and  49, 0%; p<0.001). The frequency of unreasonable prescription of antiplatelet agents instead of anticoagulants was 52.5% and 33.3% (p<0.001) in the combination of AF, CHF and coronary heart disease, as well as in the combination of AF with coronary heart disease but without CHF. Patients with AF and CHF during the observation period compared with those without CHF had higher mortality from all causes (37.6% and 30.3%; p=0.001), the frequency of non-fatal cerebral stroke (8.2% and 5.4%; p=0.032) and myocardial infarction (4.7% and 2.5%; p=0.036), hospitalizations for CVD (22.8% and 15.5%; p<0.001).Conclusion. Patients with a combination of AF and CHF, compared with the group of patients with AF without CHF, were older, had a higher risk of thromboembolic and hemorrhagic complications, they were more often diagnosed with other concomitant cardiovascular and chronic noncardiac diseases, decreased left ventricular ejection fraction, tachysystole, failure to achieve the target blood pressure level in the presence of arterial hypertension. The frequency of prescribing proper cardiovascular pharmacotherapy was higher, albeit insufficient, in the presence of CHF, while the frequency of prescribing anticoagulants was less. The  incidence of mortality from all causes, the development of non-fatal myocardial infarction   and cerebral stroke, as well as the incidence of hospitalizations for CVDs were higher in AF associated with CHF.

scholarly journals LVS‐HARMED Risk Score for Incident Heart Failure in Patients With Atrial Fibrillation Who Present to the Emergency Department: Data from a World‐Wide Registry

2021 ◽  
Vol 10 (18) ◽  
Author(s):  
Linda S. B. Johnson ◽  
Jonas Oldgren ◽  
Tyler W. Barrett ◽  
Candace D. McNaughton ◽  
Jorge A. Wong ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Emergency Department ◽  
Heart Disease ◽  
Valvular Heart Disease ◽  
Left Ventricular ◽  
C Statistic ◽  
Rheumatic Heart ◽  
New Onset

Background Heart failure (HF) is a common complication to atrial fibrillation (AF), leading to rehospitalization and death. Early identification of patients with AF at risk for HF might improve outcomes. We aimed to derive a score to predict 1‐year risk of new‐onset HF after an emergency department (ED) visit with AF. Methods and Results The RE‐LY AF (Randomized Evaluation of Long‐Term Anticoagulant Therapy) registry enrolled patients with AF presenting to an ED in 47 countries, and followed them for a year. The end point was HF hospitalization and/or HF death. Among 15 400 ED patients, 9765 had no prior HF (mean age, 64.9±14.9 years). Within 1 year, new‐onset HF developed in 6.8% of patients, of whom 21% died of HF. Independent predictors of HF included left ventricular hypertrophy (odds ratio [OR], 1.47; 95% CI, 1.19–1.82), valvular heart disease (OR, 1.55; 95% CI, 1.18–2.04), smoking (OR, 1.42; 95% CI, 1.12–1.78), height (OR, 0.93; 95% CI, 0.90–0.95 per 3 cm), age (OR, 1.11; 95% CI, 1.07–1.15 per 5 years), rheumatic heart disease (OR, 1.77, 95% CI, 1.24–2.51), prior myocardial infarction (OR, 1.85; 95% CI, 1.45–2.36), remaining in AF at ED discharge (OR, 1.86; 95% CI, 1.46–2.36), and diabetes (OR, 1.33; 95% CI, 1.09–1.64). A continuous risk prediction score (LVS‐HARMED [left ventricular, valvular heart disease, smoking or other tobacco use, height, age, rheumatic heart disease, myocardial infarction, emergency department discharge rhythm, and diabetes]) had good discrimination (C statistic, 0.735; 95% CI, 0.716–0.755). Validation was conducted internally using bootstrapping (optimism‐corrected C statistic, 0.705) and externally (C statistic, 0.699). The 1‐year incidence of HF hospitalization and/or HF death across quartile groups of the score was 1.1%, 4.5%, 6.9%, and 14.4%, respectively. LVS‐HARMED also predicted incident stroke (C statistic, 0.753; 95% CI, 0.728–0.778). Conclusions The LVS‐HARMED score predicts new‐onset HF after an ED visit for AF. Preventative strategies should be considered in patients with high LVS‐HARMED HF risk.

Atrial fibrillation detected after stroke is related to a low risk of ischemic stroke recurrence

Neurology ◽  
2018 ◽  
Vol 90 (11) ◽  
pp. e924-e931 ◽  
Author(s):  
Luciano A. Sposato ◽  
Joshua O. Cerasuolo ◽  
Lauren E. Cipriano ◽  
Jiming Fang ◽  
Sebastian Fridman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Heart Rhythm ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Artery Disease

ObjectiveTo compare the risk of 1-year ischemic stroke recurrence between atrial fibrillation (AF) diagnosed after stroke (AFDAS) and sinus rhythm (SR) and investigate whether underlying heart disease is as frequent in AFDAS as it is in AF known before stroke (KAF).MethodsIn this retrospective cohort study, we included all ischemic stroke patients admitted to institutions participating in the Ontario Stroke Registry from July 1, 2003, to March 31, 2013. Based on heart rhythm assessed during admission, we classified patients as AFDAS, KAF, or SR. We modeled the relationship between heart rhythm groups and 1-year ischemic stroke recurrence by using Cox regression adjusted for multiple covariates (e.g., oral anticoagulants). We compared the prevalence of coronary artery disease, myocardial infarction, and heart failure among the 3 groups.ResultsAmong 23,376 ischemic stroke patients, 15,885 had SR, 587 AFDAS, and 6,904 KAF. At 1 year, 39 (6.6%) patients with AFDAS, 661 (9.6%) with KAF, and 1,269 (8.0%) with SR had recurrent ischemic strokes (p = 0.0001). AFDAS-related ischemic stroke recurrence adjusted risk was not different from that of SR (hazard ratio 0.90 [95% confidence interval 0.63, 1.30]; p = 0.57). Prevalence of coronary artery disease (18.2% vs 34.7%; p < 0.0001), myocardial infarction (11.6% vs 20.5%; p < 0.0001), and heart failure (5.5% vs 16.8%; p < 0.0001) were lower in AFDAS relative to KAF.ConclusionsThe lack of difference in 1-year ischemic stroke recurrence between AFDAS and SR and the lower prevalence of heart disease in AFDAS compared to KAF suggest that the underlying pathophysiology of AFDAS may differ from that of KAF.

Sign in / Sign up

Export Citation Format

Share Document