scholarly journals An observational study of clinical and health system factors associated with catheter ablation and early ablation treatment for atrial fibrillation in Australia

2021 ◽  
Author(s):  
Juan C Quiroz ◽  
David Brieger ◽  
Louisa Jorm ◽  
Raymond W Sy ◽  
Michael O Falster ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Health System ◽  
Cox Regression ◽  
Primary Diagnosis ◽  
Index Admission ◽  
Private Patient ◽  
Factors Associated ◽  
Patient Status ◽  
System Factors

Objective: To investigate clinical and health system factors associated with receiving catheter ablation (CA) for non-valvular atrial fibrillation (AF). Study Design and Setting: We used hospital administrative data linked with death registrations in New South Wales, Australia for patients with a primary diagnosis of AF between 2009 and 2017. We investigated factors associated with receiving CA (using Cox regression) and early ablation (using logistic regression). Results: Cardioversion during index admission (hazard ratio [HR] 1.96; 95% CI 1.75-2.19), year of index admission (HR 1.07; 1.07; 95% CI 1.05-1.10), private patient status (HR 2.65; 95% CI 2.35-2.97), and living in more advantaged areas (HR 1.18; 95% CI 1.13-1.22) were associated with a higher likelihood of receiving CA. Private patient status (odds ratio [OR] 2.04; 95% CI 1.59-2.61) and a history of cardioversion (OR 1.25; 95% CI 1.0-1.57) and diabetes (OR 1.6; 95% CI 1.06-2.41) were associated with receiving early ablation. Conclusion: Beyond clinical factors, private patients are more likely to receive CA and earlier ablation than their public counterparts. Whether the earlier access to ablation procedures in private patients is leading to differences in outcomes among patients with atrial fibrillation remains to be explored.

scholarly journals Sociocultural and health system factors associated with mortality among febrile inpatients in Tanzania: a prospective social biopsy cohort study

2018 ◽  
Vol 3 (1) ◽  
pp. e000507 ◽  
Author(s):  
Michael E Snavely ◽  
Michael J Maze ◽  
Charles Muiruri ◽  
Lilian Ngowi ◽  
Flora Mboya ◽  
...  
Keyword(s):  
Health System ◽  
Community Education ◽  
Conditional Logistic Regression ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Care Seeking ◽  
Factors Associated ◽  
Northern Tanzania ◽  
System Factors ◽  
At Home

IntroductionCommunicable diseases are the leading causes of death in Tanzania despite the existence of effective treatment tools. We aimed to assess the sociocultural and health system factors associated with mortality from febrile illness in northern Tanzania.MethodsWe interviewed febrile inpatients to determine prevalence of barriers in seeking or receiving care and grouped these barriers using the Three Delays model (delays at home, in transport and at healthcare facilities). We assessed 6-week mortality and, after matching on age, gender and severity of illness, measured the association between delays and mortality using conditional logistic regression.ResultsWe enrolled 475 children, of whom 18 (3.8%) died, and 260 adults, of whom 34 (13.0%) died. For children, home delays were not associated with mortality. Among adults, a delay in care-seeking due to not recognising severe symptoms was associated with mortality (OR: 3.01; 95% CI 1.24 to 7.32). For transport delays, taking >1 hour to reach a facility increased odds of death in children (OR: 3.27; 95% CI 1.11 to 9.66) and adults (OR: 3.03; 95% CI 1.32 to 6.99). For health system delays, each additional facility visited was associated with mortality for children (OR: 1.59; 95% CI 1.06 to 2.38) and adults (OR: 2.00; 95% CI 1.17 to 3.41), as was spending >4 days between the first facility visit and reaching tertiary care (OR: 4.39; 95% CI 1.49 to 12.93).ConclusionOur findings suggest that delays at home, in transport and in accessing tertiary care are risk factors for mortality from febrile illness in northern Tanzania. Interventions that may reduce mortality include community education regarding severe symptoms, expanding transportation infrastructure and streamlining referrals to tertiary care for the sickest patients.

Abstract 16255: Acute Pericarditis Related Hospitalization and Readmission in the United States

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Prakash Acharya ◽  
Farhad Sami ◽  
Omar Al-Taweel ◽  
Sagar Ranka ◽  
Brianna Stack ◽  
...  
Keyword(s):  
Cox Regression ◽  
Secondary Analysis ◽  
The United States ◽  
Primary Diagnosis ◽  
Emergency Department Visits ◽  
Index Admission ◽  
Acute Pericarditis ◽  
Increased Risk ◽  
Multiple Variables ◽  
The Mean

Introduction: Acute pericarditis accounts for one in every twenty emergency department visits for chest pain and a majority of these patients get admitted to a hospital. However, apart from small studies, there is a lack of data regarding the incidence and predictors of readmissions in these patients. Methodology: A secondary analysis of the Nationwide Readmission Database for years 2016-2017 was performed. Patients who were admitted with a primary diagnosis of acute pericarditis in the first six months of each year were identified based on International Classification of Diseases (ICD-10), Clinical Modification codes, and were followed for 180 days. A multivariate cox-regression model was utilized to delineate the predictors of pericarditis related readmissions. Results: A total of 21,115 patients were admitted with a primary diagnosis of acute pericarditis. The mean age was 53.3+19 years and 60.83% were males. About 23% of patients had pericardial effusion or tamponade and 19.4% of patients presenting with pericarditis required pericardiocentesis. The mortality rate during index admission was 3.21% and the mean length of stay was 6.4+9 days. The rate of all-cause readmission was 30.8% within 180 days, of which 23.8% were pericarditis related. The mean time to readmission for pericarditis was 37.7+41 days. Females were at higher risk of readmission for pericarditis [OR 1.66, CI (1.38-1.99), p<0.001] after adjustment for multiple variables (including connective tissue disease, congestive heart failure and malignancy). Presence of comorbidities like diabetes mellitus [HR 1.21, CI(1.01-1.45), p=0.04], obesity [HR 1.27, CI(1.05-1.54), p=0.01], and chronic lung disease [HR 1.32, CI(1.12-1.57), p=0.001] also increased risk of pericarditis related readmissions. Moreover, the length of index hospitalization was significantly higher in patients with pericarditis related readmissions [5.4+6 vs1.6+5 days, p<0.001]. Conclusion: Even though the mortality during index admission in patients admitted with pericarditis is low, about 1 in every 3 patients will be readmitted within 180 days. While females account for a minority of initial admissions for pericarditis, their risk of readmission is significantly higher.

scholarly journals The Predictive Value of Growth Differentiation Factor-15 in Recurrence of Atrial Fibrillation after Catheter Ablation

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Ying Wei ◽  
Shuwang Liu ◽  
Haiyi Yu ◽  
Yuan Zhang ◽  
Wei Gao ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Recurrent Events ◽  
Cox Regression ◽  
Enzyme Linked Immunosorbent Assay ◽  
Atrial Remodeling ◽  
Baseline Serum ◽  
Growth Differentiation Factor 15 ◽  
Differentiation Factor ◽  
Af Recurrence

The mechanisms underlying the recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA) are not well concerned. The study sought to explore the association between growth differentiation factor-15 (GDF-15) and the incidence of recurrent events among AF patients after the ablation procedure. We prospectively included 150 consecutive AF patients who underwent RFCA. Clinical information about the patients was collected. Blood samples on the second morning of hospital admission and three months after RFCA were collected, and enzyme-linked immunosorbent assay (ELISA) was used to measure the concentration of GDF-15. All participants were followed up at specific times (1st/3rd/6th/12th/18th/24th months) after RFCA to record recurrences events. During a median follow-up of 14.0 months, AF recurrence occurred in 37(24.7%) patients. Baseline serum GDF-15 level in the persistent AF group was significantly higher than the paroxysmal AF group [1140(854~1701)ng/L vs. 1062(651~1374)ng/L, P=0.039]. Baseline serum GDF-15 level in the recurrence group was significantly higher than the nonrecurrence group [1287(889~1768) ng/L vs. 1062(694~1373)ng/L, P=0.022]. Serum GDF-15 level at three months after RFCA was significantly lower than the baseline [870 (579~1270) ng/L vs. 1155 (735~1632)ng/L, P<0.001]. The baseline GDF-15 correlated significantly with LAP (r=0.296, P<0.001) and LAAV(r=−0.235, P=0.003). Kaplan-Meier analysis showed a significantly lower event-free survival time in the high baseline GDF-15 (≥1287.3 ng/L) group than the low baseline GDF-15 (<1287.3 ng/L) group (17.1 months vs. 20.4 months, Log Rank P=0.017). In the multivariate Cox regression, baseline GDF-15(HR 1.053, 95% CI 1.007-1.100, P=0.022) and LAD (HR 1.124, 95% CI 1.011-1.250, P=0.030) were independent predictors of AF recurrence after RFCA. Our study indicated increased preprocedural GDF-15 is associated with left atrial remodeling and acts as a predictor of AF recurrence after ablation.

scholarly journals Assessment of clinical factors associated with a successful catheter ablation outcome in younger patients with atrial fibrillation

2014 ◽  
Vol 63 (6) ◽  
pp. 438-443 ◽  
Author(s):  
Tadashi Fujino ◽  
Atsushi Takahashi ◽  
Taishi Kuwahara ◽  
Yoshihide Takahashi ◽  
Kenji Okubo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Clinical Factors ◽  
Younger Patients ◽  
Factors Associated

Factors associated with silent cerebral events during catheter ablation for atrial fibrillation in the era of uninterrupted oral anticoagulation therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Harada ◽  
Y Nomura ◽  
A Nishimura ◽  
Y Motoike ◽  
M Koshikawa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Vitamin K ◽  
Oral Anticoagulation ◽  
Brain Mri ◽  
Anticoagulation Therapy ◽  
Surrogate Marker ◽  
Brain Magnetic Resonance Imaging ◽  
Vitamin K Antagonist ◽  
Factors Associated

Abstract Background A silent cerebral event (SCE), detected by brain magnetic resonance imaging (MRI), is defined as an acute new brain lesion without clinically apparent neurological deficit, and is frequently observed after catheter ablation in atrial fibrillation (AF) patients. Although the small number of SCEs does not cause neurocognitive dysfunction, the greater volume and/or larger number of SCE lesions are reportedly related to neuropsychological decline; SCE incidence may be a surrogate marker for the potential thromboembolic risk. Thus, strategies to reduce SCEs would be beneficial. Uninterrupted oral anticoagulation strategy for peri-procedural period reportedly reduced the risk of SCEs, but the incidence hovers at 10% to 30%. We sought factors associated with SCEs during catheter ablation for AF in patients with peri-procedural uninterrupted oral anticoagulation (OAC) therapy. Methods AF patients undergoing catheter ablation were eligible (n=255). All patients took non-vitamin K antagonist oral anticoagulants (NOACs) or vitamin K antagonist (VKA) for peri-procedural OAC (&gt;4 weeks) without interruption during the procedure. Brain MRI was performed within 2 days after the procedure to detect SCEs. Clinical characteristics and procedure-related parameters were compared between patients with and without SCEs. Results SCEs were detected in 59 patients (23%, SCE[+]) but not in 196 patients (77%, SCE[-]). Average age was higher in SCE[+] than SCE[-] (66±10 years vs. 62±12 years, p&lt;0.05). Persistent AF prevalence, CHADS2/CHA2DS2-VASc scores, and serum NT-ProBNP levels increased in SCE[+] vs. SCE[-]. In transthoracic/transesophageal echocardiography, left-atrial dimension (LAD) was larger and AF rhythm/spontaneous echo contrast were more frequently observed in SCE[+] than SCE[-]. SCE[+] had lower initial activated clotting time (ACT) before unfractionated heparin (UFH) injection and longer time to reach optimal ACT (&gt;300 sec) before trans-septal puncture than SCE [-]. In multivariate analysis, LAD, initial ACT before UFH injection, and time to reach optimal ACT were predictors for SCEs. Conclusions LAD and intra-procedural ACT kinetics affect SCEs during the procedure in patients with uninterrupted OAC for AF ablation. Shortening time to achieve optimal ACT during the procedure may reduce the risk of SCEs. Funding Acknowledgement Type of funding source: None

scholarly journals One-year Versus Five-year Hospital Readmission after Ischemic Stroke and TIA

2018 ◽  
Author(s):  
Anna Therese Bjerkreim ◽  
Halvor Naess ◽  
Andrej Netland Khanevski ◽  
Lars Thomassen ◽  
Ulrike Waje-Andreassen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Functional Outcome ◽  
Cox Regression ◽  
Index Admission ◽  
Unplanned Readmission ◽  
Cardiovascular Comorbidity ◽  
Factors Associated ◽  
Artery Disease ◽  
One Year

Abstract Background: The burden of readmission after stroke is substantial, but little knowledge exists on factors associated with long-term readmission after stroke. In a cohort composing patients with ischemic stroke and transient ischemic attack (TIA), we examined and compared factors associated with readmission within 1 year and first readmission during year 2-5. Methods: Patients with ischemic stroke or TIA who were discharged alive between July 2007 and October 2012, were followed for five years by review of medical charts. Timing and cause of the first unplanned readmission were registered. Cox regression was used to identify independent risk factors for readmission within 1 year and first readmission during year 2-5 after discharge. Results: The cohort included 1453 patients, of whom 568 (39.1%) were readmitted within 1 year. Of the 830 patients that were alive and without readmission 1 year after discharge, 439 (52.9%) were readmitted within 5 years. Patients readmitted within 1 year were older, had more severe strokes, poorer functional outcome, and a higher occurrence of complications during index admission than patients readmitted during years 2-5. Cardiovascular comorbidity did not differ between the two groups of readmitted patients. Higher age, poorer functional outcome, coronary artery disease and hypertension were independently associated with first readmission within both 1 year and during year 2-5. Peripheral artery disease was independently associated with readmission within 1 year, and atrial fibrillation was associated with first readmission during year 2-5. Conclusions: More than half of all patients who survived the first year after stroke without any readmissions were readmitted within 5 years. Patients readmitted within 1 year and between years 2-5 shared many risk factors for readmission, but they differed in age, functional outcome and occurrence of complications during the index admission.

P1035Factors associated with quality-of-life improvement after catheter ablation of atrial fibrillation: insights from the Kansai Plus Atrial Fibrillation (KPAF) registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Kanda ◽  
M Masuda ◽  
S Shizuta ◽  
A Kobori ◽  
K Inoue ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Multivariate Analysis ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Left Atrial Diameter ◽  
Factors Associated ◽  
Af Recurrence

Abstract Background Improving the quality of life (QoL) is one of the main purposes of catheter ablation (CA) of persistent atrial fibrillation (AF). Factors associated with QoL improvement after CA of AF patients have not been clarified. The Kansai Plus Atrial Fibrillation (KPAF) Registry is a multi-center registry enrolling more than 5,000 consecutive patients undergoing the first radiofrequency catheter ablation of AF. Purpose The aim of this study was to investigate the QoL change after AF ablation and its associated factors. Methods A total of 2030 patients in whom the QoL score was assessed before and one year after the ablation were enrolled from the KPAF registry (age 64±10 years, 75% male, paroxysmal 66%, CHADS2 score 1.1±1.1). The QoL was evaluated using the AF specific QoL evaluation method (AFQLQ), which scores the patient QoL within a range of 0–98 points. Results Overall, catheter ablation showed a significant increase in the AFQLQ score (68±19 vs. 86±13 points, P<0.01). AF recurrence was observed in 372 cases (18%) during a 1-year follow-up period. A multivariate analysis showed that AF recurrence, symptomatic AF, long AF duration, high preprocedural heart rate (>110 bpm) and small left atrial diameter were independent predictors of a QoL improvement defined as a >10% score increase. Multivariate analysis Conclusions CA of AF significantly improved the QoL. AF recurrence was one of the strong factors associated with QoL improvement. Symptomatic AF, long AF duration, high preprocedural heart rate and small left atrial diameter were independent predictors of QoL improvement.

scholarly journals A systematic review protocol for examining 30-day readmission costs for atrial fibrillation patients

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e032101
Author(s):  
Taylor-Jade Woods ◽  
Peter Speck ◽  
Billingsley Kaambwa
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Meta Analysis ◽  
Primary Diagnosis ◽  
Index Admission ◽  
Cochrane Library ◽  
Forest Plot ◽  
Study Results ◽  
Meta Analyses ◽  
The Cost

IntroductionAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia and readmissions of AF patients place a huge burden on the healthcare system, including economically. With an increasing prevalence, the burden of AF will continue evolving. To illuminate the readmission-specific economic burden, we aim to provide quality evidence on the cost of readmissions within 30 days where AF has been the primary diagnosis at the index admission.Methods and analysisWe will conduct a systematic review of all peer-reviewed articles examining readmission costs for AF patients. We will search MedLine, Cumulative Index to Nursing and Allied Health Literature, Scopus and Cochrane Library for articles written in English, published in peer-reviewed journals from inception to 2019. Reporting of this protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols checklist. Studies will be included if patients were aged 18 years and over, AF was the primary diagnosis of index admission and costs of readmission within 30 days were reported. Quality assessment of studies will be done using a modified Evers checklist. Study results will be summarised in a Forest plot and heterogeneity tested for using the Cochran’s Q and I2statistic. A random-effects model will be applied for meta-analysis if studies are sufficiently homogeneous. The cost of readmission to hospital within 30 days for AF patients is the main outcome of interest while additional outcomes are 30-day readmission rate, predictors of readmission and predictors of readmission costs.Ethics and disseminationFormal ethical approval is not required as no patients will be involved. Dissemination of results will be through a peer-reviewed publication.PROSPERO registration numberCRD42019132017

Prognostic factors and survival of patients with brain metastasis (BM) from breast cancer (BC) who underwent craniotomy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e22017-e22017
Author(s):  
Jose Pablo Leone ◽  
Diana E. Cunningham ◽  
Adrian Lee ◽  
Rohit Bhargava ◽  
Ronald L. Hamilton ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Primary Diagnosis ◽  
Cox Proportional Hazards ◽  
Factors Associated ◽  
Brain Radiotherapy ◽  
Whole Brain Radiation ◽  
First Recurrence

e22017 Background: BC is the second most frequent cause of BM after lung cancer, with metastases occurring in 10-16% of all patients. BM in patients with BC is a catastrophic event that results in poor prognosis. Identification of prognostic factors associated with breast cancer brain metastases (BCBM) could help to identify patients at risk. The aim of this study was to assess clinical characteristics, prognostic factors and survival of patients with BCBM who had craniotomy and resection in a series of patients treated with modern multimodality therapy. Methods: We analyzed 42 patients with BCBM who underwent resection. Patients were diagnosed with BC between April 1994 and May 2010. Cox proportional hazards regression was selected to describe factors associated with time to BM, survival from the date of first recurrence, and overall survival (OS). Results: Median age was 51 years (range 24-74). Median follow-up was 4.2 years (range 0.6-18.5). The mean time to BM from primary diagnosis was 49 months (range 0-206.22). Patients had a median of 2 BM with a median size of 3.25 cm. The proportion of the biological subtypes of BC was ER+/HER2- 25%, ER+/HER2+ 15%, ER-/HER2+ 30% and ER-/HER2- 30%. Brain radiotherapy was given to 28 patients, of which 10 had stereotactic radiosurgery, 7 whole brain radiation, and 11 both. Median OS from the date of primary diagnosis was 5.74 years. Median survival after diagnosis of BM was 1.33 years. In multivariate Cox regression analyses, stage was the only factor associated with shorter time to the development of BM (P=0.059), whereas age was the only factor associated with survival from the date of recurrence (P=0.027) and with OS (P=0.037). Controlling for age and stage, neither the biological subtype of cancer, the radiation modality nor the site of first recurrence showed any impact on survival. Conclusions: Stage at primary diagnosis correlated with shorter time to the development of BM, while age at diagnosis was associated with shorter survival in BCBM. None of the other clinical factors had influence on survival.

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