Heart rate and premature atrial contractions at 24hECG independently predict atrial fibrillation in a population-based study

Heart ◽  
2019 ◽  
Vol 106 (4) ◽  
pp. 287-291 ◽  
Author(s):  
Anders Paul Persson ◽  
Artur Fedorowski ◽  
Bo Hedblad ◽  
Margaretha Persson ◽  
Steen Juul-Möller ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Cox Regression ◽  
Population Based ◽  
Model Assessment ◽  
Population Based Study ◽  
Diet And Cancer ◽  
Supraventricular Tachycardias ◽  
Incident Cases

BackgroundLow resting heart rate and premature atrial contractions (PACs) predict incident atrial fibrillation (AF) and could be interdependent, since PACs occur in the gaps between normal beats.ObjectiveTo study the association between low heart rate at 24hECG, PACs and incident AF in a prospective population-based cohort.MethodsIn the Malmö Diet and Cancer study, 24hECGs were performed in 377 AF-free subjects. The endpoint was clinical AF retrieved from national hospital (mean follow-up 17 years). The interaction between increased supraventricular activity (SVA) top quartile of either PACs/hour or supraventricular tachycardias/hour) and mean heart rate (mHR) as regards AF risk was assessed in multivariable Cox regression analyses adjusted for age, sex, height, BMI, systolic blood pressure, antihypertensive medication, smoking and homeostasis model assessment of insulin resistance.ResultsThere were 80 (21%) incident cases of AF. Below median mHR (80 bpm/75 bpm for women/men) was associated with increased AF incidence (HR: 1.89, 95% CI 1.18 to 3.02, p=0.008). There was no correlation between mHR and SVA (p=0.6) or evidence of a multiplicative interaction between these factors for AF risk (p for interaction=0.6) In the group with both increased SVA and below median mHR (17% of the population) the relative risk of AF was very high (HR 4.5, 95% CI 2.2 to 9.1, p=0.001).ConclusionLow mHR at 24hECG independently predicts AF, but there is no association between mHR and SVA, and these factors are independent as regards AF risk. Subjects with both low mHR and increased SVA have high AF risk.

P5665The independent effect of insulin resistance on incidence of atrial fibrillation in non-diabetics

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J K Park ◽  
J H Park ◽  
Y G Lee ◽  
J H Shin ◽  
Y H Lim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Insulin Resistance ◽  
Subgroup Analysis ◽  
Cox Regression ◽  
Population Based ◽  
Independent Effect ◽  
Model Assessment ◽  
Cox Regression Analysis ◽  
Patients With Diabetes

Abstract Purpose Patients with diabetes mellitus have an elevated risk of atrial fibrillation (AF). However, whether insulin resistance may elevate risk of AF incidence in non-diabetic is inconsistent. The aim of our study was to verify the association between insulin resistance and incidence of AF in non-diabetics. Methods We evaluated population-based cohorts embedded in the Korean Genome Epidemiology Study. Insulin resistance was expressed as Homeostasis Model Assessment for Insulin resistance (HOMA-IR). Baseline data including HOMA-IR and electrocardiography (ECG) were obtained at 2001. Subsequent biennial ECG was performed for identification of AF until 2016. Results Among the 8220 participants (46.8% male; median age 49 years), 25 participants had AF (0.3%) at baseline and 101 participants developed AF (1.2%) during follow up of 12 years. In multivariate Cox regression analysis, high HOMA-IR (≥1.4) was significantly associated with incident AF compared with low HOMA-IR (<1.40) (adjusted hazard ratio [HR] 1.9, 95% confidence interval [CI] 1.3–3.0). In subgroup analysis, these association was consistent regardless of obesity (BMI<25; adjust HR 1.8, 95% CI 1.1–3.0, BMI≥25; adjust HR 2.3, 95% CI 1.3–4.0) Subgroup analysis Conclusion Based on prospective cohort study, insulin resistance (HOMA-IR) was associated with AF independently of obesity in non-diabetics.

Impact of putative chemopreventative agents on prostate cancer diagnosis.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 40-40
Author(s):  
Hanan Goldberg ◽  
Faizan Moshin ◽  
Zachary William Abraham Klaassen ◽  
Thenappan Chandrasekar ◽  
Christopher Wallis ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cox Regression ◽  
Large Population ◽  
Multivariable Analysis ◽  
Population Based ◽  
Cumulative Exposure ◽  
Population Based Study ◽  
Diagnosis Rate ◽  
The Impact

40 Background: Prostate cancer (PC) is the most common non-cutaneous cancer in Canadian men and the third most common cause of cancer death in Canada. Several studies have shown that use of commonly prescribed medications, including those used for diabetes and hypercholesterolemia, is associated with improved survival in various malignancies, including PC. There has not been any large population-based study, examining the effects of these and other commonly prescribed medications, on the rate of PC diagnosis, over a 20 years follow-up period. Methods: A retrospective population-based study using data from the institute of clinical evaluative sciences, including all male patients aged 65 and above in Ontario who have had a negative first prostate biopsy between 1994 and 2016. We assessed the impact of commonly prescribed medications on PC diagnosis. The medications included Statins (hydrophilic and hydrophobic), diabetes drugs (metformin, insulins, sulfonylureas, and thizolidinedions), proton pump inhibitors, 5 alpha reductase inhibitors, and alpha blockers. Time dependent Cox regression proportional hazards models were performed determine predictors of PC diagnosis. Medication exposure was time varying and modeled as “ever” vs. “never” use or as cumulative exposure for 6 months of usage. A priori variables included in the model included age, ADG comorbidity score, rurality index, index year, and all medications. Results: A total of 51,415 men were analyzed over a mean (SD) follow-up time of 8.06 (5.44) years. Overall, 10,466 patients (20.4%) were diagnosed with PC, 16,726 (32.5%) had died, and 1,460 (2.8%) patients died of PC. On multivariable analysis increasing age and rurality index were associated with higher PC diagnosis rate, while a more recent index year, and usage of hydrophilic statins was associated with a lower diagnosis rate in both “ever” vs. “never” and cumulative models (HR 0.832, 95% CI 0.732-0.946, p = 0.005, HR 0.973 95% CI 0.951-0.995, p = 0.016, respectively). Conclusions: Hydrophilic statins are associated with a clinically significant lower PC diagnosis. To our knowledge this is the first study demonstrating a clear advantage of one group of statins (hydrophilic) over another (hydrophobic) in PC prevention.

scholarly journals Utility of Inferior Vena Cava Filter in the Management of Venous Thromboembolism Among Patients with Brain Metastases: A Population-Based Study

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 47-48
Author(s):  
Vaibhav Kumar ◽  
Ann M Brunson ◽  
Anjlee Mahajan ◽  
Nigel S. Key ◽  
Ted Wun
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Regression Model ◽  
Cox Regression ◽  
Vena Cava ◽  
Population Based ◽  
Population Based Study ◽  
Risk Of Death ◽  
Icd 10

Background: Brain metastases are a frequently occurring and devastating complication of solid organ malignancies. Individuals with brain metastases are noted to be high risk for venous thromboembolism (VTE) due to hypercoagulability from their malignancy, immobility, and need for cancer directed therapies. The management of VTE in patients with brain metastases is challenging due to the risk of intracranial hemorrhage (ICH) with therapeutic anticoagulation. Inferior vena cava filter (IVCF) are often used to mitigate the risk of ICH, however the utility of this practice and the impact on survival is not clear. Methods: We performed a retrospective cohort study using the linked California Cancer Registry (CCR) and California Patient Discharge Database (PDD) between 2005-2017 with follow up available to 2018. We identified individuals with breast and lung cancer (because they are common), and renal cell carcinoma and melanoma (because of bleeding tendency of brain metastases) who had an incident hospitalization with VTE (either pulmonary embolism, deep vein thrombosis or both). Brain metastasis were identified using the presence of International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) code 198.3 or ICD-10-CM code C79.31 present anytime in PDD and cases were classified as having brain metastases if the code was present prior to or at the time of the index VTE. Cases with multiple malignancies were excluded. ICD-9-CM code 38.7 and ICD-10-CM code 02HV was used to identify patients who received an IVCF. Univariate analysis was used to determine differences in baseline characteristics between those that did and did not receive an IVCF. A logistic regression model that included patient and index VTE hospital characteristics was used to develop a propensity score for IVCF placement. The primary outcomes were 30-day mortality and 180-day intracranial hemorrhage (ICH) determined by ICD codes. A Cox proportional hazards model, inverse propensity weighted for IVCF placement, was used to assess the effect of IVCF placement (as a time-dependent variable) on 30-day mortality. The effect of IVCF on ICH was assessed with a 1:3 propensity matched Fine-Gray model, accounting for the competing risk of death. Results: There were 17,182 patients with a diagnosis of VTE present on admission and an active first primary cancer diagnosis of interest, of these 3,309 (19.3%) had a diagnosis of brain metastasis with median follow-up of 96.8 months. The baseline characteristics of patients are summarized in Table 1. Among patients with brain metastases, 757 of 3309 (22.9%) had an IVCF inserted versus 1801 of 13873 (13.0%) in those without brain metastases (p&lt;0.001). In a multivariable logistic regression model the presence of brain metastasis was an independent predictor for the placement of IVCF (Odds Ratio (OR) 1.84 (95% CI 1.64-2.05). Using balanced (standardized mean difference less than 0.1 for all covariates included in the model) IPW-adjusted Cox regression model, the use of IVCF did not reduce the 30-day risk of death in those with acute VTE (Hazard Ratio (HR) 1.08 (95% CI 0.95-1.23). The presence of brain metastases was associated with a higher 30-day risk of death (HR 1.23 (95% CI 1.13- 1.35). Using IPW-adjusted Cox model restricted to those with brain metastasis, IVCF use was associated with a trend towards reduced 30-day risk of death (HR 0.86 (95% CI 0.73-1.01). In a propensity matched Cox regression competing risk model, the presence of brain metastases was significantly associated with an increased 180-day risk of ICH (HR 6.91 (95% CI 3.54-13.48), with no difference for those that received an IVCF (HR 1.31 (95% CI 0.85-2.01). When compared to breast cancer patients, those with lung cancer had lower risk of ICH (HR 0.28, CI 0.13-0.64), but melanoma and renal cell cancer did not have higher risk. Conclusions: This real-world retrospective population-based study demonstrated the use of IVCF was higher for patients with brain metastases among these four tumor types. There was a suggestion of reduced short-term mortality associated with IVCF placement in VTE patients and brain metastases, but this was not statistically significant. Although limited by the lack of data on anticoagulation use, there was no effect of IVCF placement on the risk of ICH. Randomized clinical trials are needed to determine the effect of IVCF on clinically relevant outcomes for VTE in patients with brain metastasis. Disclosures Key: Takeda: Research Funding; Grifols: Research Funding; Uniqure: Consultancy; Novo Nordisk: Other: Chair of Grants Committee. Wun:Glycomimetics, Inc.: Consultancy.

scholarly journals Exploration of pathophysiological pathways for incident atrial fibrillation using a multiplex proteomic chip

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001190 ◽  
Author(s):  
John Molvin ◽  
Amra Jujic ◽  
Olle Melander ◽  
Manan Pareek ◽  
Lennart Råstam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Matrix Metalloproteinase ◽  
Cox Regression ◽  
Matrix Metalloproteinase 2 ◽  
First Episode ◽  
Risk Markers ◽  
Swedish Population ◽  
Incident Cases

ObjectiveAtrial fibrillation (AF) is the most common arrhythmia and associated with increased morbidity and mortality. Its increasing prevalence calls for novel biomarkers to identify underlying pathophysiological mechanisms as well as patients at risk.MethodsPlasma samples from 1694 individuals from the Swedish population-based Malmö Preventive Project (mean age 69.5 years; 29.3% female; mean follow-up time 9.7±3.1 years) were analysed with the Olink proximity extension assay CVD III panel consisting of 92 proteins to identify proteins associated with incident AF or atrial flutter, referred to as incident AF. Incident cases of AF (n=278) were retrieved by linkage to the registers. Participants were followed until the first episode of AF or until censoring by death or emigration. Bonferroni-corrected multivariable Cox regression models adjusted for known risk factors were used to explore possible associations of the 92 proteins and incidence of AF.ResultsMultivariable Cox regression analyses of 11 proteins associated with incident AF (mean follow-up time 9.7±3.1 years) after Bonferroni correction confirmed N-terminal pro-B-type natriuretic peptide (HR per 1 SD increment (95% CI) 1.80 (1.58 to 2.04); p=1.2×10−19) as risk marker of incident AF. Further, matrix metalloproteinase-2 (1.22 (1.07 to 1.39); p=0.002) and osteopontin (1.27 (1.12 to 1.44); p=2.7×10−4) were associated with incident AF at follow-up independently of traditional risk markers and NT-proBNP.ConclusionIn a general Swedish population, we confirmed the well-known association of NT-proBNP with incident AF and also identified matrix metalloproteinase-2 and osteopontin as novel risk markers for incident AF, independently of traditional risk factors and NT-proBNP.

525 A population-based study of phenoconversion to parkinsonism from REM sleep behavior: a Population-based Study in the CLSA

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A207-A207
Author(s):  
Chun Yao ◽  
Sheida Zolfaghari ◽  
Paramita Saha Chaudhuri ◽  
Amelie Pelletier ◽  
Christina Wolfson ◽  
...  
Keyword(s):  
Rem Sleep ◽  
Cox Regression ◽  
De Novo ◽  
Population Based ◽  
Population Based Study ◽  
Sleep Behavior ◽  
Increased Risk ◽  
Canadian Provinces ◽  
New Diagnosis

Abstract Introduction To date, studies have estimated the phenoconversion rate from sleep clinics, using polysomnography proven RBD. However, no population-based estimates have been reported, testing to what degree possible RBD, screened by questionnaire is associated with increased risk of neurodegeneration. Methods We included those aged 45–85 years, living in one of 10 Canadian provinces in between 2012–2015 (at the baseline), recruited via three population-based sampling methods. Dream enactment behavior/possible RBD was screened using the RBD1Q single question-questionnaire. De-novo parkinsonism was defined as free of pre-existing diagnosis at the baseline with a ‘new’ diagnosis at the follow-up (205–2019). Relative risk (log-binomial regression), hazard ratio (Cox regression), incidence rate (Poisson regression) between the affected group and the symptom naïve group were assessed, adjusting for age and sex (and total years of education and language). Results Overall, 58 participants phenoconverted into parkinsonism and 53 into dementia at the follow-up (mean intervals=3.06±0.37 years). Participants with dream enactment behavior had 2.75 times higher risk to phenoconvert into parkinsonism than the symptom-free. Similarly, those with dream enactment behavior at the baseline possessed higher risk to screening positive of parkinsonism. No difference in time to phenoconversion was found between groups, The results remained robust after excluding non-RBD related symptoms, such as apnea and non-REM sleep parasomnia. Conclusion Compared to symptom-free, those with pRBD had higher risk to developing parkinsonism in near future. Support (if any):

scholarly journals Heart rate and adverse outcomes in patients with prevalent atrial fibrillation

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001606
Author(s):  
Giorgio Moschovitis ◽  
Linda S B Johnson ◽  
Steffen Blum ◽  
Stefanie Aeschbacher ◽  
Maria Luisa De Perna ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Cox Regression ◽  
Threshold Effect ◽  
Adverse Outcomes ◽  
Systemic Embolism ◽  
Target Heart Rate ◽  
Heart Failure Hospitalisation

ObjectiveThe optimal target heart rate in patients with prevalent atrial fibrillation (AF) is not well defined. The aim of this study was to analyse the associations between heart rate and adverse outcomes in a large contemporary cohort of patients with prevalent AF.MethodsFrom two prospective cohort studies, we included stable AF outpatients who were in AF on the baseline ECG. The main outcome events assessed during prospective follow-up were heart failure hospitalisation, stroke or systemic embolism and death. The associations between heart rate and adverse outcomes were evaluated using multivariable Cox regression models.ResultsThe study population consisted of 1679 patients who had prevalent AF at baseline. Mean age was 74 years, and 24.6% were women. The mean heart rate on the baseline ECG was 78 (±19) beats per minute (bpm). The median follow-up was 3.9 years (IQR 2.2–5.0). Heart rate was not significantly associated with heart failure hospitalisation (adjusted HR (aHR) per 10 bpm increase, 1.00, 95% CI 0.94 to 1.07, p=0.95), stroke or systemic embolism (aHR 0.95, 95% CI 0.84 to 1.07, p=0.38) or death (aHR 1.02, 95% CI 0.95 to 1.09, p=0.66). There was no evidence of a threshold effect for heart rates <60 bpm or >100 bpm.ConclusionsIn this large contemporary cohort of outpatients with prevalent AF, we found no association between heart rate and adverse outcome events. These data are in line with recommendations that strict heart rate control is not needed in otherwise stable outpatients with AF.

scholarly journals Reduced Risk of Atrial Fibrillation Following Cholecystectomy: A Nationwide Population-Based Study

2021 ◽  
Vol 13 ◽  
Author(s):  
Tung Ching Ho ◽  
Yu-Ching Chen ◽  
Che-Chen Lin ◽  
Hsu-Chih Tai ◽  
Cheng-Yu Wei ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Gallstone Disease ◽  
Age Groups ◽  
Population Based ◽  
Research Database ◽  
Population Based Study ◽  
Number Of Patients ◽  
Taiwan National Health Insurance ◽  
Using Data

Background: Gallstone disease (GD) is associated with a high risk of cardiovascular disease. However, it is unknown whether GD contributes to atrial fibrillation (AF). We aimed to investigate the association between GD and AF.Methods: We performed a population-based cohort study using data from the Taiwan National Health Insurance Research Database between 2001 and 2011. A GD cohort of 230,076 patients was compared with a control cohort consisting of an equal number of patients matched for age, sex, cardiovascular and gastrointestinal comorbidities.Results: In total, 5,992 (49.8/10,000 person-years) patients with GD and 5,804 (44.5/10,000 person-years) controls developed AF. GD increased AF risk with a hazard ratio (HR) of 1.20 [95% confidence interval (CI), 1.16–1.25]. In patients with GD but without cholecystectomy, the HR of AF reached 1.57 (95% CI = 1.50–1.63). After cholecystectomy, the HR of AF significantly decreased to 0.85 (95% CI = 0.81–0.90). Among the three age groups with GD (&lt;45, 45–64, and ≥65 years), the adjusted HRs of AF were 1.59 (95% CI = 1.08–2.33), 1.31 (95% CI = 1.18–1.45), and 1.18 (95% CI = 1.13–1.22), respectively. Compared with patients with a CHA2DS2-VASc score equal to 0, the HRs of AF risk among total cohort patients and a score equal to 1, 2, 3, and ≥ 4 were 1.28 (95% CI = 1.15–1.43), 2.26 (95% CI = 2.00–2.56), 3.81 (95% CI = 3.35–4.34), and 5.09 (95% CI = 4.42–5.87), respectively.Conclusion: This population-based longitudinal follow-up study showed that patients with GD had an increased AF risk. Moreover, cholecystectomy was related to reduced AF risk. Cardiovascular checkups may be necessary for patients with GD, especially those who are young and have other typical risk factors.

scholarly journals Atrial fibrillation is associated with increased risk of lethal ventricular arrhythmias

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yun Gi Kim ◽  
Yun Young Choi ◽  
Kyung-Do Han ◽  
Kyongjin Min ◽  
Ha Young Choi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ventricular Arrhythmias ◽  
Population Based ◽  
Cardiac Events ◽  
Population Based Study ◽  
Increased Risk ◽  
Adverse Cardiac Events ◽  
Korean National Health Insurance ◽  
New Onset

AbstractAtrial fibrillation (AF) is associated with various major adverse cardiac events such as ischemic stroke, heart failure, and increased overall mortality. However, its association with lethal ventricular arrhythmias such as ventricular tachycardia (VT), ventricular flutter (VFL), and ventricular fibrillation (VF) is controversial. We conducted this study to determine whether AF can increase the risk of VT, VFL, and VF. We utilized the Korean National Health Insurance Service database for this nationwide population-based study. This study enrolled people who underwent a nationwide health screen in 2009 for whom clinical follow-up data were available until December 2018. Primary outcome endpoint was the occurrence of VT, VFL, or VF in people who were and were not diagnosed with new-onset AF in 2009. We analyzed a total of 9,751,705 people. In 2009, 12,689 people were diagnosed with new-onset AF (AF group). The incidence (events per 1000 person-years of follow-up) of VT, VFL, and VF was 2.472 and 0.282 in the AF and non-AF groups, respectively. After adjustment for covariates, new-onset AF was associated with 4.6-fold increased risk (p < 0.001) of VT, VFL, and VF over 10 years of follow-up. The risk of VT, VFL, and VF was even higher if identification of AF was based on intensified criteria (≥ 2 outpatient records or ≥ 1 inpatient record; hazard ratio = 5.221; p < 0.001). In conclusion, the incidence of VT, VFL, and VF was significantly increased in people with new-onset AF. The potential risk of suffering lethal ventricular arrhythmia in people with AF should be considered in clinical practice.

Sign in / Sign up

Export Citation Format

Share Document