Infarct Topography and Detection of Atrial Fibrillation in Cryptogenic Stroke: Results from CRYSTAL AF

Background: Insertable cardiac monitors (ICM) have been shown to detect atrial fibrillation (AF) at a higher rate than routine monitoring methods in patients with cryptogenic stroke (CS). However, it is unknown whether there are topographic patterns of brain infarction in patients with CS that are particularly associated with underlying AF. If such patterns exist, these could be used to help decide whether or not CS patients would benefit from long-term monitoring with an ICM. Methods: In this retrospective analysis, a neuro-radiologist blinded to clinical details reviewed brain images from 212 patients with CS who were enrolled in the ICM arm of the CRYptogenic STroke And underLying AF (CRYSTAL AF) trial. Kaplan-Meier estimates were used to describe rates of AF detection at 12 months in patients with and without pre-specified imaging characteristics. Hazard ratios (HRs), 95% confidence intervals (CIs), and p values were calculated using Cox regression. Results: We did not find any pattern of acute brain infarction that was significantly associated with AF detection after CS. However, the presence of chronic brain infarctions (15.8 vs. 7.0%, HR 2.84, 95% CI 1.13-7.15, p = 0.02) or leukoaraiosis (18.2 vs. 7.9%, HR 2.94, 95% CI 1.28-6.71, p < 0.01) was associated with AF detection. There was a borderline significant association of AF detection with the presence of chronic territorial (defined as within the territory of a first or second degree branch of the circle of Willis) infarcts (20.9 vs. 10.0%, HR 2.37, 95% CI 0.98-5.72, p = 0.05). Conclusions: We found no evidence for an association between brain infarction pattern and AF detection using an ICM in patients with CS, although patients with coexisting chronic, as well as acute, brain infarcts had a higher rate of AF detection. Acute brain infarction topography does not reliably predict or exclude detection of underlying AF in patients with CS and should not be used to select patients for ICM after cryptogenic stroke.

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071 Natalizumab extended interval dosing (EID) is associated with a significant reduction in progressive multifocal leukoencephalopathy (PML) risk compared with standard interval dosing (SID) in the touch® prescribing program

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2018-anzan.70 ◽

2018 ◽

Vol 89 (6) ◽

pp. A29.2-A29 ◽

Cited By ~ 4

Author(s):

Lana Zhovtis Ryerson ◽

John Foley ◽

Ih Chang ◽

Ilya Kister ◽

Gary Cutter ◽

...

Keyword(s):

Cox Regression ◽

Jc Virus ◽

Secondary Analysis ◽

Statistical Analysis Plan ◽

Rank Test ◽

Primary Analysis ◽

Standard Interval ◽

Kaplan Meier ◽

Hazard Ratios ◽

Dosing Intervals

IntroductionNatalizumab, approved for 300 mg intravenous every-4-weeks dosing, is associated with PML risk. Prior studies have been inconclusive regarding EID’s impact on PML risk. The US REMS program (TOUCH) offers the largest data source that can inform on PML risk in patients on EID. This analysis aimed to determine whether natalizumab EID is associated with reduced PML risk compared with SID.MethodsInvestigators developed SID and EID definitions and finalised the statistical analysis plan while blinded to PML events. Average dosing intervals (ADIs) were ≥3 to<5 weeks for SID and >5 to≤12 weeks for EID. The primary analysis assessed ADI in the last 18 months of infusion history. The secondary analysis identified any prolonged period of EID at any time in the infusion history. The tertiary analysis assessed ADI over the full infusion history. Only anti-JC virus antibody positive (JCV Ab+) patients with dosing intervals≥3 to≤12 weeks were included. PML hazard ratios (HRs) were compared using adjusted Cox regression models and Kaplan-Meier estimates.ResultsAnalyses included 13,132 SID and 1988 EID patients (primary), 15,424 SID and 3331 EID patients (secondary), and 23,168 SID and 815 EID patients (tertiary). In primary analyses, ADI (days) was 30 for SID and 37 for EID; median exposure (months) was 44 for SID and 59 for EID. Most EID patients received >2 years SID prior to EID. The PML HR (95% CI) was 0.06 (0.01–0.22; p<0.001) for primary analysis and 0.12 (0.05–0.29; p<0.001) for secondary analysis (both in favour of EID); no EID PML cases were observed in tertiary analyses (Kaplan-Meier log-rank test p=0.02).ConclusionIn JCV Ab +patients, natalizumab EID is associated with a clinically and statistically significant reduction in PML risk as compared with SID. As TOUCH does not collect effectiveness data, further studies are needed.Study supportBiogen

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H3K27M-mutant Diffuse Midline Gliomas should be Further Molecularly Stratified: An Integrated Analysis of 669 Patients

10.21203/rs.3.rs-949930/v1 ◽

2021 ◽

Author(s):

Huy Gia Vuong ◽

Hieu Trong Le ◽

Tam N.M. Ngo ◽

Kar-Ming Fung ◽

James D. Battiste ◽

...

Keyword(s):

Cox Regression ◽

Fatal Outcome ◽

Extent Of Resection ◽

Tumor Location ◽

Genetic Alterations ◽

Integrated Analysis ◽

Prognostic Impact ◽

Kaplan Meier ◽

Hazard Ratios ◽

The Impact

Abstract Introduction: H3K27M-mutated diffuse midline gliomas (H3-DMGs) are aggressive tumors with a fatal outcome. This study integrating individual patient data (IPD) from published studies aimed to investigate the prognostic impact of different genetic alterations on survival of these patients.Methods: We accessed PubMed and Web of Science to search for relevant articles. Studies were included if they have available data of follow-up and additional molecular investigation of H3-DMGs. For survival analysis, Kaplan-Meier analysis and Cox regression models were utilized, and corresponding hazard ratios (HR) and 95% confidence intervals (CI) were computed to analyze the impact of genetic events on overall survival (OS).Result: We included 30 studies with 669 H3-DMGs. TP53 mutations were the most common second alteration among these neoplasms. In univariate Cox regression model, TP53 mutation was an indicator of shortened survival (HR = 1.446; 95% CI = 1.143-1.829) whereas ACVR1 (HR = 0.712; 95% CI = 0.518-0.976) and FGFR1 mutations (HR = 0.408; 95% CI = 0.208-0.799) conferred prolonged survival. In addition, ATRX loss was also associated with a better OS (HR = 0.620; 95% CI = 0.386-0.996). Adjusted for age, gender, tumor location, and the extent of resection, the presence of TP53 mutations, the absence of ACVR1 or FGFR1 mutations remained significantly poor prognostic factors.Conclusions: We outlined the prognostic importance of additional genetic alterations in H3-DMGs and recommended that these neoplasms should be further molecularly segregated. It could help neuro-oncologists better evaluate the risk stratification of patients and consider pertinent treatments.

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Depression, antidepressants, and the risk of non-valvular atrial fibrillation: A nationwide Danish matched cohort study

European Journal of Preventive Cardiology ◽

10.1177/2047487318811184 ◽

2018 ◽

Vol 26 (2) ◽

pp. 187-195 ◽

Cited By ~ 11

Author(s):

Morten Fenger-Grøn ◽

Mogens Vestergaard ◽

Henrik S Pedersen ◽

Lars Frost ◽

Erik T Parner ◽

...

Keyword(s):

Atrial Fibrillation ◽

Treatment Initiation ◽

Cox Regression ◽

Causal Relation ◽

Antidepressant Treatment ◽

Symptom Burden ◽

Matched Sample ◽

Therapy Initiation ◽

Hazard Ratios ◽

Increased Risk

Background Depression is associated with an increased risk of a series of cardiovascular diseases and with increased symptom burden in patients with atrial fibrillation. The aim of this study was to determine the association between depression as well as antidepressant treatment and the risk of incident atrial fibrillation. Design A nationwide register-based study comparing the atrial fibrillation risk in all Danes initiating antidepressant treatment from 2000 to 2013 ( N = 785,254) with that in a 1:5-matched sample from the general population. Methods Cox regression was used to estimate adjusted hazard ratios (aHRs) and associated 95% confidence intervals (95% CIs), both after initiation of treatment and in the month before when patients were assumed to have medically untreated depression. Results Antidepressant treatment was associated with a three-fold higher risk of atrial fibrillation during the first month (aHR = 3.18 (95% CI: 2.98–3.39)). This association gradually attenuated over the following year (aHR = 1.37 (95% CI: 1.31–1.44) 2–6 months after antidepressant therapy initiation, and aHR = 1.11 (95% CI: 1.06–1.16) 6–12 months after). However, the associated atrial fibrillation risk was even higher in the month before starting antidepressant treatment (aHR = 7.65 (95% CI: 7.05–8.30) from 30 to 15 days before, and aHR = 4.29 (95% CI: 3.94–4.67) the last 15 days before). Overall, 0.4% of patients were diagnosed with atrial fibrillation from 30 days before to 30 days after antidepressant treatment. Conclusions Antidepressant users had a substantially increased atrial fibrillation risk, particularly before treatment initiation. Whether this mirrors a causal relation between depression and atrial fibrillation may have large consequences for public health and should be discussed.

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Prognostic Potential of Liver Enzymes in Patients With COVID-19 at the Leishenshan Hospital in Wuhan

Frontiers in Cellular and Infection Microbiology ◽

10.3389/fcimb.2021.636999 ◽

2021 ◽

Vol 11 ◽

Author(s):

Zeming Liu ◽

Di Hu ◽

Jinpeng Li ◽

Qing Xia ◽

Yan Gong ◽

...

Keyword(s):

Liver Function ◽

Liver Enzymes ◽

Cox Regression ◽

Liver Function Tests ◽

Regression Analyses ◽

Survival Curves ◽

Severity Of Disease ◽

Kaplan Meier ◽

Hazard Ratios ◽

Disease Mortality

BackgroundCoronavirus disease 2019 (COVID-19) has evolved into a pandemic. We hypothesized that biochemical indicators of liver function may help determine the prognosis of COVID-19 patients.MethodsPatient information was collected from the Wuhan-Leishenshan hospital. Logistic and Cox regression analyses, Kaplan-Meier curves, and Curve fitting were used to determine the correlation between elevated levels of aspartate transaminase (AST), alanine transaminase (ALT), and AST/ALT and severity of disease/mortality.ResultsLogistic and Cox regression analyses and Kaplan-Meier survival curves showed that COVID-19 progression correlated with elevated levels of AST and AST/ALT. The odds ratios for elevated levels of AST and AST/ALT in patients were 0.818 (95% confidence interval [CI]: 0.274-2.441, P = 0.035) and 2.055 (95% CI: 1.269-3.327, P = 0.003), respectively; the hazard ratios were 4.195 (95% CI: 1.219-14.422, P = 0.023) and 3.348 (95% CI: 1.57-7.139, P = 0.002), respectively. The Kaplan-Meier survival curves demonstrated that patients with elevated AST and AST/ALT levels had a higher risk of developing severe COVID-19.ConclusionElevated AST and AST/ALT levels correlated with severity of COVID-19 and mortality. Liver function tests may help clinicians in determining the prognosis of patients undergoing treatment for COVID-19.

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Rivaroxaban Versus Warfarin for Management of Obese African Americans With Non-Valvular Atrial Fibrillation or Venous Thromboembolism: A Retrospective Cohort Analysis

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029620954910 ◽

2020 ◽

Vol 26 ◽

pp. 107602962095491

Author(s):

Olivia S. Costa ◽

Jan Beyer-Westendorf ◽

Veronica Ashton ◽

Dejan Milentijevic ◽

Kenneth Todd Moore ◽

...

Keyword(s):

Atrial Fibrillation ◽

Venous Thromboembolism ◽

African Americans ◽

Major Bleeding ◽

Cox Regression ◽

Cohort Analysis ◽

Bleeding Risk ◽

Nonvalvular Atrial Fibrillation ◽

Thrombotic Risk ◽

Hazard Ratios

African Americans (AAs) and obese individuals have increased thrombotic risk. This study evaluated the effectiveness and safety of rivaroxaban versus warfarin in obese, AAs with nonvalvular atrial fibrillation (NVAF) or venous thromboembolism (VTE). Optum® De-Identified Electronic Health Record (EHR) data was used to perform separate propensity-score matched analyses of adult, oral anticoagulant (OAC)-naïve AAs with NVAF or acute VTE, respectively; who had a body mass index≥30kg/m2 and ≥12-months EHR activity with ≥1-encounter before OAC initiation. Cox regression was performed and reported as hazard ratios (HRs) with 95% confidence intervals (CIs). For the NVAF analysis, 1,969 rivaroxaban- and 1,969 warfarin-users were matched. Rivaroxaban was not associated with a difference in stroke/systemic embolism versus warfarin (HR = 0.88, 95%CI = 0.60-1.28), but less major bleeding (HR = 0.68, 95%CI = 0.50-0.94) was observed. Among 683 rivaroxaban-users with VTE, 1:1 matched to warfarin-users, rivaroxaban did not alter recurrent VTE (HR = 1.36, 95%CI = 0.79-2.34) or major bleeding (HR = 0.80, 95%CI = 0.37-1.71) risk versus warfarin at 6-months (similar findings observed at 3- and 12-months). Rivaroxaban appeared to be associated with similar thrombotic, and similar or lower major bleeding risk versus warfarin in these obese, AA cohorts.

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P4795Comparative safety of factor-xa inhibitors vs phenprocoumon in patients with non-valvular atrial fibrillation and renal disease - insights from the RELOADED study

European Heart Journal ◽

10.1093/eurheartj/ehz745.1171 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

H Bonnemeier ◽

R Kreutz ◽

D Enders ◽

N Schmedt ◽

T Vaitsiakhovich ◽

...

Keyword(s):

Atrial Fibrillation ◽

Renal Disease ◽

Hospital Discharge ◽

Cox Regression ◽

Factor Xa ◽

Factor Xa Inhibitors ◽

Sensitivity Analyses ◽

Hazard Ratios ◽

Fatal Bleeding ◽

Number Of Patients

Abstract Background Data on safety of Factor-Xa inhibitors and phenprocoumon in patients with non-valvular atrial fibrillation (NVAF) and renal disease is scarce. Among others, our study aimed to investigate the safety risks of fatal bleeding and intracranial haemorrhage (ICH) in new users of Factor-Xa inhibitors vs. phenprocoumon, the vitamin-K antagonist (VKA) of choice in Germany. Methods We conducted a new user cohort study (one year washout period) in patients with NVAF and renal disease. German claims data between January 1st, 2013 and June 30th, 2017 were utilized and a multiple Cox-regression was performed to calculate confounder-adjusted hazard ratios (HRs) for the risk of fatal bleeding and ICH in Factor-Xa inhibitors and phenprocoumon initiators. Additionally, a propensity score matching and an inverse probability of treatment weight analysis were performed as sensitivity analyses. Cases of fatal bleeding were defined as hospitalization with a primary hospital discharge diagnoses for bleeding with documented death as reason for hospital discharge or within 30 days after hospital discharge. Results The overall population comprised 23,552 phenprocoumon initiators, 22,338 rivaroxaban initiators and 16,201 apixaban initiators, where the number of patients with renal disease initiating these agents were 7,289 for phenprocoumon, 5,121 patients for rivaroxaban 15mg or 20mg and 4,750 patients for apixaban 2.5mg or 5mg, respectively. In the confounder-adjusted analysis, a beneficial effect for rivaroxaban and apixaban over phenprocoumon was observed for the risk of ICH and fatal bleeding (figure 1) for both the overall and renal disease population. Hazard ratios for rivaroxaban and the risk of ICH were calculated as 0.57 (0.43; 0.75) for the overall population and 0.62 (0.37; 1.01) for the renal disease population where hazard ratios for apixaban were calculated as 0.43 (0.31; 0.60) for the overall population and 0.41 (0.23; 0.74) for the renal disease population, respectively. There was not sufficient data to conduct the analyses for edoxaban. Figure 1 Conclusion This large retrospective database study conducted in Germany confirms the safety profile of rivaroxaban and apixaban over VKA in patients overall and specifically in patients with renal disease when assessing the risk of ICH and fatal bleeding. Our study adds evidence in a relevant subgroup of patients where anticoagulation is often challenging. Acknowledgement/Funding This study was funded by Bayer AG

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Mortality in Patients with Diabetic Foot Ulcers: Causes, Risk Factors, and Their Association with Evolution and Severity of Ulcer

Journal of Clinical Medicine ◽

10.3390/jcm9093009 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3009

Author(s):

José Antonio Rubio ◽

Sara Jiménez ◽

José Luis Lázaro-Martínez

Keyword(s):

Diabetic Foot ◽

Cox Regression ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Hazard Ratios ◽

History Of

Background: This study reviews the mortality of patients with diabetic foot ulcers (DFU) from the first consultation with a Multidisciplinary Diabetic Foot Team (MDFT) and analyzes the main cause of death, as well as the relevant clinical factors associated with survival. Methods: Data of 338 consecutive patients referred to the MDFT center for a new DFU during the 2008–2014 period were analyzed. Follow-up: until death or until 30 April 2020, for up to 12.2 years. Results: Clinical characteristics: median age was 71 years, 92.9% had type 2 diabetes, and about 50% had micro-macrovascular complications. Ulcer characteristics: Wagner grade 1–2 (82.3%), ischemic (49.2%), and infected ulcers (56.2%). During follow-up, 201 patients died (59.5%), 110 (54.7%) due to cardiovascular disease. Kaplan—Meier curves estimated a reduction in survival of 60% with a 95% confidence interval (95% CI), (54.7–65.3) at 5 years. Cox regression analysis adjusted to a multivariate model showed the following associations with mortality, with hazard ratios (HRs) (95% CI): age, 1.07 (1.05–1.08); HbA1c value < 7% (53 mmol/mol), 1.43 (1.02–2.0); active smoking, 1.59 (1.02–2.47); ischemic heart or cerebrovascular disease, 1.55 (1.15–2.11); chronic kidney disease, 1.86 (1.37–2.53); and ulcer severity (SINBAD system) 1.12 (1.02–1.26). Conclusion: Patients with a history of DFU have high mortality. Two less known predictors of mortality were identified: HbA1c value < 7% (53 mmol/mol) and ulcer severity.

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6116Thromboembolic risk in infection-related atrial fibrillation: is infection or atrial fibrillation the sinner?

European Heart Journal ◽

10.1093/eurheartj/ehz746.0142 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Gundlund ◽

J B Olesen ◽

J H Butt ◽

M A Christensen ◽

G H Gislason ◽

...

Keyword(s):

Atrial Fibrillation ◽

Hospital Admission ◽

Cox Regression ◽

Anticoagulation Therapy ◽

First Year ◽

Thromboembolic Events ◽

Cox Regression Analysis ◽

Hazard Ratios ◽

Study Population ◽

Hospital Contact

Abstract Introduction Infection-related atrial fibrillation (AF) has been associated with similar risk of thromboembolic events as AF without a concurrent infection. However, it is unknown whether the increased thromboembolic risk in this patient group is primarily associated with AF or with the infection. Purpose We compared type of infection and 1-year outcomes in patients with AF during an infection and in patients with infection without AF. Methods By crosslinking data from Danish nationwide registries, AF naïve patients admitted with an infection from 1996–2016 were identified. Patients with infection-related AF (defined as patients who developed AF during their hospital admission with infection) were matched 1:3 on age, calendar year, sex, and type of infection (gastrointestinal infection, pneumonia, urinary tract infection, sepsis, and other infections) with those who had infection without AF. Cumulative incidences of thromboembolic events were calculated using the Aalen Johansen estimator and adjusted hazard ratios (HR) of thromboembolic events and hospital contacts with AF were assessed by multivariable Cox regression analysis comparing those with infection-related AF with those with infection without AF. Results The study population comprised 30,711 patients with infection-related AF and 92,133 patients with infection without AF (median age 79 years [interquartile range 71–86] and 47.6% males in both groups). In general, patients with infection-related AF had more concurrent diseases than patients with infection without AF. During the first week after the hospital admission, 9.8% of the patients with infection-related AF and 0.1% of the patients with infection without AF initiated oral anticoagulation therapy. During the first year after the infection, 7.6% of patients with infection-related AF and 4.4% of patients with infection without AF had a thromboembolic event, while 36.1% and 1.8% had a new hospital-contact with AF. Cumulative incidences of thromboembolic events are depicted in the Figure. In the multivariable models, infection-related AF was associated with an increased 1-year risk of thromboembolic events and new hospital contacts with AF compared with infection without AF (HR 2.05, 95% confidence interval (CI) 1.94–2.17 for thromboembolic events and HR 26.06, 95% CI 24.72–27.48 for new AF episodes, respectively). Conclusion More than one third of patients with infection-related AF had a new hospital contact with AF during the first year after their infection. Further, infection-related AF was associated with a significantly increased 1-year risk of thromboembolic events compared with infection without AF. Consequently, this study suggests that AF begets AF, even if it presents during an infection. Acknowledgement/Funding None

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Einfluss der Fallzahl pro Klinik auf die 5-Jahres-Überlebensrate des unikondylären Kniegelenkersatzes in Deutschland

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/s-0043-116490 ◽

2017 ◽

Vol 156 (01) ◽

pp. 62-67

Author(s):

Elke Jeschke ◽

Thorsten Gehrke ◽

Christian Günster ◽

Karl-Dieter Heller ◽

Jürgen Malzahn ◽

...

Keyword(s):

Cox Regression ◽

Kaplan Meier ◽

Hazard Ratios

Zusammenfassung Hintergrund Die Angaben zu Überlebensraten des unikondylären Kniegelenkersatzes (UKE) sind ganz unterschiedlich. Der Einfluss von Patientenfaktoren und Implantat wurden bereits untersucht. Ziel der Analyse war es, den Einfluss der Fallzahl pro Klinik auf die 5-Jahres-Überlebensrate (5-JÜR) anhand von Routinedaten der größten Krankenkasse Deutschlands zu überprüfen. Methodik Die Abrechnungsdaten von 20 946 UKEs der Allgemeinen Ortskrankenkasse (AOK) der Jahre 2006 – 2012 wurden analysiert. Zur Ermittlung der Standzeiten wurden Kaplan-Meier-Analysen durchgeführt. Der Einfluss der Fallzahl pro Klinik auf die 5-JÜR wurde mithilfe einer multivariablen Cox-Regression unter Berücksichtigung von Patientenfaktoren analysiert und Hazard Ratios (HR) mit 95%-Konfidenzintervallen (KI) berechnet. Dazu wurden 5 Fallzahlgruppen gebildet: < 12 Fälle, 13 – 24 Fälle, 25 – 52 Fälle, 53 – 104 Fälle, > 104 Fälle (jeweils pro Klinik und Jahr). Ergebnisse Insgesamt betrug die 5-JÜR nach Kaplan-Meier 87,8% (95%-KI: 87,3 – 88,3%). Sie nahm mit der Fallzahl stetig zu (< 12 Fälle: 84,1% vs. > 104 Fälle: 93,2%). Die Cox-Analyse ergab, dass kleinere Fallzahlen einen unabhängigen Risikofaktor für eine Revision darstellen (< 12 Fälle: HR = 2,13 [95%-KI: 1,83 – 2,48]; 13 – 24 Fälle: HR = 1,94 [95%-KI: 1,67 – 2,25]; 25 – 52 Fälle: HR = 1,66 [95%-KI: 1,41 – 1,96]; 53 – 104 Fälle: HR = 1,51 [95%-KI: 1,28 – 1,77]; > 104 Fälle: Referenz). Diskussion In dem untersuchten Kollektiv besteht ein klarer Zusammenhang zwischen einer höheren Fallzahl pro Klinik und der 5-JÜR. Diese nimmt stetig über alle analysierten Fallzahlkategorien zu. So ist etwa das Risiko einer Revision innerhalb von 5 Jahren in Kliniken mit einer Fallzahl von weniger als 25 UKE pro Jahr gegenüber einer Klinik mit mehr als 104 Fällen etwa doppelt so hoch.

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Gout and the risk of incident atrial fibrillation in older adults: a study of US Medicare data

RMD Open ◽

10.1136/rmdopen-2018-000712 ◽

2018 ◽

Vol 4 (2) ◽

pp. e000712 ◽

Cited By ~ 7

Author(s):

Jasvinder A Singh ◽

John D Cleveland

Keyword(s):

Atrial Fibrillation ◽

Cox Regression ◽

The Elderly ◽

Incidence Rates ◽

Index Score ◽

Medicare Data ◽

Hazard Ratios ◽

Cardiovascular Medications ◽

The Mean ◽

Artery Disease

ObjectiveTo assess the association of gout with new-onset atrial fibrillation (AF) in the elderly.MethodsWe used the 5% Medicare data from 2005 to 2012 to assess whether a diagnosis of gout was associated with incident AF. We used multivariable Cox regression adjusted for demographics, Charlson-Romano comorbidity index, common cardiovascular medications, allopurinol and febuxostat use, to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsAmong 1 647 812 eligible people, 9.8% had incident AF. The mean age was 75 years, 42% were male, 86% were white and the mean Charlson-Romano index score was 1.52. We noted 10 604 incident AF cases in people with gout and 150 486 incident AF cases in people without gout. The crude incidence rates of AF in people with and without gout were 43.4 vs 16.3 per 1000 patient-years, respectively. After multivariable-adjustment, gout was associated with a higher HR of incident AF, 1.92 (95% CI 1.88 to 1.96), with minimal attenuation of HR in sensitivity models that replaced the Charlson-Romano index score with a categorical variable, HR was 1.91 (95% CI 1.87 to 1.95). In another model that adjusted for AF-specific risk factors including hypertension, hyperlipidaemia and coronary artery disease and individual Charlson-Romano index comorbidities, the HR was slightly attenuated at 1.71 (95% CI 1.67 to 1.75). Older age, male sex, white race and higher Charlson-Romano index score were each associated with higher hazard of incident AF.ConclusionA diagnosis of gout almost doubled the risk of incident AF in the elderly. Future studies should explore the pathogenesis of this association.

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