Abstract P115: Atrial Fibrillation And The Risk Of Subsequent Fracture

Background: There is conflicting evidence regarding the association between atrial fibrillation (AF) and the risk of subsequent fractures. Methods: We included participants aged 45 years or older from the Framingham Heart Study Offspring, Third Generation, New Offspring Spouse, Omni 1, and Omni 2 cohorts. We prespecified analyzing index age 65 years as our primary analysis; we repeated analyses for index age 45, 55, and 75 years. The primary outcome was any bone fracture, except finger, toe, foot, skull, and facial fractures. We assessed the association between time-varying AF and subsequent fractures by an illness-death model that accounted for the competing risk of death. We estimated hazard ratios (HR) adjusted for age, sex, body mass index, smoking, diabetes, alcohol intake, and prior fracture. Results: We included 3,403 participants (mean age of 68 years, 53.3% female) in the analysis at index age 65 years and above. In all, 525 (15%) participants developed incident fractures during follow-up. The HR between AF and subsequent fracture was 1.36 95%CI (1.05-1.77). There was no evidence of effect modification by sex (HR 1.63, 95%CI 1.05-2.23 in men; HR 1.22, 95%CI 0.84-1.76; interaction p value 0.27). Results were consistent at other index ages. Conclusion: AF was associated with increased risk of incident fracture in the community-based Framingham Heart Study.

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P946Abnormal ankle brachial indices are associated with ischemic stroke: evidence from a large cohort study

European Heart Journal ◽

10.1093/eurheartj/ehz747.0540 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Bhatt ◽

A S Tseng ◽

M Girardo ◽

C Firth ◽

D Fortuin ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

P Value ◽

Care Hospital ◽

Hazard Ratios ◽

Increased Risk ◽

Artery Disease ◽

Peripheral Arterial

Abstract Background Peripheral arterial disease is a marker of aggressive atherosclerosis. The ankle brachial index (ABI) is a simple and non-invasive tool to diagnose peripheral arterial disease (PAD). Patients with PAD are at increased risk for ischemic strokes and other cardiovascular diseases. Purpose To evaluate the association of abnormal ABI and poorly compressible vessels with ischemic stroke in a large patient cohort. Methods We analyzed lower extremity vascular studies of all patients with ABI measurements at a tertiary care hospital between January 1996 and August 2018. PAD is defined as ABI<1.0, and poorly or non-compressible (PC/NC) arteries as ABI>1.4 while ABI between 1.0–1.4 is normal. Association of these ABIs with new ischemic stroke events post ABI measurement were analyzed after adjusting for high risk confounders such as atrial fibrillation. Hazard ratios (HR) were calculated using multivariable Cox proportional regression with 95% confidence intervals. Results In total, 38,016 unique patients (mean age 66.1±14.8 years, female 42.3%) were included. Abnormal ABI was found to be more prevalent among elderly male patients compared to patients with normal ABI. In contrast to non-PAD patients, both PAD and PC/NC patients as defined by ABI had a statistically significant risk of ischemic stroke, with PAD conferring the greatest risk compared to PC/NC vessels. The data is summarized in Table 1. Table 1 Unadjusted HR p-value Adjusted HR p-value PAD vs. No PAD 2.77 (2.62, 2.92) <0.001 2.10 (1.98, 2.22) <0.001 PC/NC vs. No PAD 2.11 (1.95, 2.28) <0.001 1.38 (1.26, 1.51) <0.001 PAD vs. PC/NC 1.37 (1.28, 1.46) <0.001 1.37 (1.28, 1.48) <0.001 Adjusted and unadjusted hazard ratios with p-values. HR adjusted for age, sex, atrial fibrillation, ischemic stroke, transient ischemic attack, chronic heart failure, diabetes mellitus, hyperlipidemia, hypertension, and coronary artery disease. PAD = Peripheral artery disease and PC/NC = poorly compressible/non-compressible. Conclusion This study adds to the growing body of evidence that PAD and poorly-compressible vessels are independently associated with an increased risk of ischemic stroke. Given the associated risk of cerebrovascular disease, clinicians should aggressively treat to minimize risk factors in those with abnormal ABIs.

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Abstract 2429: ICD Efficacy In Patients Who Developed New Onset Atrial Fibrillation After Enrollment In The MADIT-II Trial

Circulation ◽

10.1161/circ.116.suppl_16.ii_533-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Anant K Vyas ◽

Ilan Goldenberg ◽

Wojciech Zareba ◽

Scott McNitt ◽

Arthur J Moss

Keyword(s):

Atrial Fibrillation ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Functional Class ◽

Icd Therapy ◽

Risk Of Death ◽

Hazard Ratios ◽

Increased Risk ◽

Madit Ii ◽

New Onset

Introduction: In the Multicenter Automatic Defibrillator Implantation Trial-II (MADIT-II), the presence of atrial fibrillation (AF) at baseline was associated with an increased risk of death, and these patients received a substantial benefit from ICD therapy. In the current study, we evaluated the risk of death and the efficacy of ICD therapy in patients who developed new-onset AF after enrollment in the MADIT-II study. Methods/Results: Hazard ratios (HR) were determined using multivariate Cox proportional hazards method. Age ≥ 65 (HR 3.02, p < 0.01), QRS duration > 120 ms (HR 2.30, p < 0.01), and NYHA functional class ≥ 2 (HR 1.78, p = 0.03) were independent predictors of new-onset AF. In both treatment arms, there was a significant increase in the risk of death after developing new-onset AF (Post-AF) (n = 25 in conventional arm, n = 51 in ICD arm) than among patients before or without AF (Pre-AF) (n = 416 in conventional arm, n = 624 in ICD arm) as shown in the Mantel-Byar graphs. After adjusting for relevant covariates (including age, BUN, EF, and beta-blocker use), ICD therapy was associated with a greater reduction in the risk of death in patients who developed new-onset AF (HR 0.31, p = 0.013) compared to patients with no interim AF (HR 0.73, p = 0.055) [p = 0.085 for interaction between interim AF and ICD therapy]. Conclusions: The development of new-onset AF is associated with a significant increase in mortality and this group may be a target for closer follow-up and more aggressive treatment. ICD therapy was highly effective in reducing mortality in MADIT-II patients who developed new-onset AF after enrollment in the trial.

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Abstract P051: Circulating Beta-2-microglobulin Predicts Cardiovascular, Cancer, and All-cause Mortality: The Framingham Heart Study

Circulation ◽

10.1161/circ.137.suppl_1.p051 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Shih-Jen Hwang ◽

Joshua Keefe ◽

Michael Mendelson ◽

Paul Courchesne ◽

Jennifer Ho ◽

...

Keyword(s):

Framingham Heart Study ◽

P Value ◽

Cvd Risk ◽

Multifunctional Protein ◽

Heart Study ◽

Increased Risk ◽

All Cause Mortality ◽

Specific Mortality ◽

Beta 2 ◽

Beta 2 Microglobulin

Beta-2-microglobulin (β 2 M), a multifunctional protein involved in immune function, is a filtration marker that has been reported to predict renal failure, cancer, cardiovascular disease (CVD), and all-cause mortality. Previous studies of β 2 M and mortality were limited to select study samples (elderly or patient-based) lacking information on cancer or kidney function. We examined plasma β 2 M as a predictor of all-cause and cause-specific mortality in those with and without chronic kidney disease (CKD). The study sample consisted of Framingham Heart Study participants from the 2 nd (n=3196) and 3 rd (n=3911) generations who attended an on-site examination (2001-2007). Plasma β 2 M concentration was measured using a Luminex bead-based immunoassay. Mortality events were adjudicated by a physician committee. Proportional hazard models were conducted based on standardized values of β 2 M, adjusted for CVD risk factors, prevalent CVD, cancer, and family structure. We additionally analyzed subgroups stratified for CKD (defined as GFR ckdepi < 60 mL/min/1.73 m 2 ). The study sample included 7107 individuals [mean age 50 years, 54% female, 4% with prevalent CKD, mean length of follow-up: 13 years]. In the overall sample, β 2 M concentrations were associated with increased risk of CVD death (HR=1.42 [CI=1.17-1.72]), cancer death (HR=1.27 [CI=1.07-1.5]), and all-cause mortality (HR=1.27 [CI=1.16-1.4]). β 2 M performed better in participants with prevalent CKD than in those free of CKD. Adjusting for cystatin C, a filtration biomarker, did not affect the results. For all-cause mortality, including plasma β 2 M yielded a relative integrated discrimination improvement of 3% (p-value 0.03) beyond the covariate-only model. The net reclassification improvements (NRI) for all-cause mortality was 4% that was not statistically significant (p-value 0.26). We conclude that among middle-aged adults, plasma β 2 M is a predictor of all-cause and cause-specific mortality. Much of the risk associated with β 2 M is concentrated in those with CKD.

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HYPOTHYROIDISM IS NOT ASSOCIATED WITH INCREASED RISK OF ATRIAL FIBRILLATION: THE FRAMINGHAM HEART STUDY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(13)61582-x ◽

2013 ◽

Vol 61 (10) ◽

pp. E1582

Author(s):

Eun-Jeong Kim ◽

Asya Lyass ◽

Na Wang ◽

Joseph Massaro ◽

Caroline Fox ◽

...

Keyword(s):

Atrial Fibrillation ◽

Framingham Heart Study ◽

Heart Study ◽

Increased Risk

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Prolonged PR interval is associated with increased risk of atrial fibrillation: the framingham heart study

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(02)80552-6 ◽

2002 ◽

Vol 39 ◽

pp. 125-126

Author(s):

Ramachandran S. Vasan ◽

Martin G. Larson ◽

Daniel Levy ◽

Eric P. Leip ◽

Ralph B. D'Agostino ◽

...

Keyword(s):

Atrial Fibrillation ◽

Framingham Heart Study ◽

Heart Study ◽

Increased Risk ◽

Pr Interval

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Association Between Frailty and Atrial Fibrillation in Older Adults: The Framingham Heart Study Offspring Cohort

Journal of the American Heart Association ◽

10.1161/jaha.120.018557 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Ariela R. Orkaby ◽

Jelena Kornej ◽

Steven A. Lubitz ◽

David D. McManus ◽

Thomas G. Travison ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiovascular Disease ◽

Framingham Heart Study ◽

Offspring Cohort ◽

Frailty Status ◽

Risk Of Death ◽

Heart Study ◽

Incident Cases ◽

New Onset

Background Frailty is associated bidirectionally with cardiovascular disease. However, the relations between frailty and atrial fibrillation (AF) have not been fully elucidated. Methods and Results Using the FHS (Framingham Heart Study) Offspring cohort, we sought to examine both the association between frailty (2005–2008) and incident AF through 2016 and the association between prevalent AF and frailty status (2011–2014). Frailty was defined using the Fried phenotype. Models adjusted for age, sex, and smoking. Cox proportional hazards models, adjusted for competing risk of death, assessed the association between prevalent frailty and incident AF. Logistic regression models assessed the association between prevalent AF and new‐onset frailty. For the incident AF analysis, we included 2053 participants (56% women; mean age, 69.7±6.9 years). By Fried criteria, 1018 (50%) were robust, 903 (44%) were prefrail, and 132 (6%) were frail. In total, 306 incident cases of AF occurred during an average 9.2 (SD, 3.1) follow‐up years. After adjustment, there was no statistically significant association between prevalent frailty status and incident AF (prefrail versus robust: hazard ratio [HR], 1.22 [95% CI, 0.95–1.55]; frail versus robust: HR, 0.92 [95% CI, 0.57–1.47]). At follow‐up, there were 111 new cases of frailty. After adjustment, there was no statistically significant association between prevalent AF and new‐onset frailty (odds ratio, 0.48 [95% CI, 0.17–1.36]). Conclusions Although a bidirectional association between frailty and cardiovascular disease has been suggested, we did not find evidence of an association between frailty and AF. Our findings may be limited by sample size and should be further explored in other populations.

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Stroke risk scores to predict hospitalization for acute decompensated heart failure in atrial fibrillation patients

Romanian Journal of Internal Medicine ◽

10.2478/rjim-2020-0032 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Andreea Cristina Ivănescu ◽

Gheorghe-Andrei Dan

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Stroke Risk ◽

Predictive Accuracy ◽

Acute Decompensated Heart Failure ◽

University Hospital ◽

Risk Scores ◽

P Value ◽

Risk Of Death ◽

Increased Risk

AbstractIntroduction: Atrial fibrillation (AF) is the most frequent hospitalized arrhythmia. It associates increased risk of death, stroke and heart failure (HF). Stroke risk scores, especially CHA2DS2-VASc, have been applied also for populations with different diseases. There is, however, limited data focusing on the ability of these scores to predict HF decompensation.Methods: We conducted a retrospective observational study on a cohort of 204 patients admitted for cardiovascular pathology to the Cardiology Ward of our tertiary University Hospital. We aimed to determine whether the stroke risk scores could predict hospitalisations for acute decompensated HF in AF patients.Results: C-statistics for CHADS2 and R2CHADS2 showed a modest predictive ability for hospitalisation with decompensated HF (CHADS2: AUC 0.631 p=0.003; 95%CI 0.560-0.697. R2CHADS2: AUC 0.619; 95%CI 0.548-0.686; p=0.004), a marginal correlation for CHA2DS2-VASc (AUC 0.572 95%CI 0.501-0.641 with a p value of only 0.09, while the other scores failed to show a correlation. A CHADS2≥2 showed a RR=2.96, p<0.0001 for decompensated HF compared to a score <2. For R2CHADS2 ≥2, RR= 2.41, p=0.001 compared to a score <2. For CHA2DS2-VASc≥2 RR=2.18 p=0.1, compared to CHA2DS2-VASc <2. The correlation coefficients showed a weak correlation for CHADS2 (r=0.216; p=0.001) and even weaker for R2CHADS2 (r=0.197; p=0.0047 and CHA2DS2-VASc (r=0.14; p=0.035).Conclusions: Among AF patients, CHADS2, CHA2DS2-VASc and R2CHADS2 were associated with the risk of hospitalisation for decompensated HF while ABC and ATRIA failed to show an association. However, predictive accuracy was modest and the clinical utility for this outcome remains to be determined.

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Faculty Opinions recommendation of 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725484109.793508979 ◽

2015 ◽

Author(s):

Gad Cotter ◽

Olga Milo

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Cohort Study ◽

Framingham Heart Study ◽

Heart Study ◽

Incidence Risk

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Sex-Specific Associations between Blood Pressure and Risk of Atrial Fibrillation Subtypes in the Tromsø Study

Journal of Clinical Medicine ◽

10.3390/jcm10071514 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1514

Author(s):

Hilde Espnes ◽

Jocasta Ball ◽

Maja-Lisa Løchen ◽

Tom Wilsgaard ◽

Inger Njølstad ◽

...

Keyword(s):

Atrial Fibrillation ◽

Blood Pressure ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Pressure Management ◽

Reference Models ◽

Proportional Hazards Regression ◽

Hazard Ratios ◽

Increased Risk

The aim of this study was to explore sex-specific associations between systolic blood pressure (SBP), hypertension, and the risk of incident atrial fibrillation (AF) subtypes, including paroxysmal, persistent, and permanent AF, in a general population. A total of 13,137 women and 11,667 men who participated in the fourth survey of the Tromsø Study (1994–1995) were followed up for incident AF until the end of 2016. Cox proportional hazards regression analysis was conducted using fractional polynomials for SBP to provide sex- and AF-subtype-specific hazard ratios (HRs) for SBP. An SBP of 120 mmHg was used as the reference. Models were adjusted for other cardiovascular risk factors. Over a mean follow-up of 17.6 ± 6.6 years, incident AF occurred in 914 (7.0%) women (501 with paroxysmal/persistent AF and 413 with permanent AF) and 1104 (9.5%) men (606 with paroxysmal/persistent AF and 498 with permanent AF). In women, an SBP of 180 mmHg was associated with an HR of 2.10 (95% confidence interval [CI] 1.60–2.76) for paroxysmal/persistent AF and an HR of 1.80 (95% CI 1.33–2.44) for permanent AF. In men, an SBP of 180 mmHg was associated with an HR of 1.90 (95% CI 1.46–2.46) for paroxysmal/persistent AF, while there was no association with the risk of permanent AF. In conclusion, increasing SBP was associated with an increased risk of both paroxysmal/persistent AF and permanent AF in women, but only paroxysmal/persistent AF in men. Our findings highlight the importance of sex-specific risk stratification and optimizing blood pressure management for the prevention of AF subtypes in clinical practice.

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