Individual and Combined Risk Factors for Incident Atrial Fibrillation and Incident Stroke: An Analysis of 3 Million At‐Risk US Patients

Abstract Introduction Post-operative atrial fibrillation (POAF) is currently considered a phenomenon rather than a definite diagnosis. Nevertheless, POAF is associated with an increased rate of complications, including stroke and mortality. The incidence of POAF in acute abdominal surgery has not been reported and prediction of patients at risk has not previously been attempted. Purpose We aim to report the incidence of POAF after acute abdominal surgery and provide a POAF prediction model based on pre-surgery risk-factors. Methods Designed as a prospective, single-centre, cohort study of unselected adult patients referred for acute, general, abdominal surgery. Consecutive patients (>16 years) were included during a three month period. No exclusion criteria were applied. Follow-up was based on chart reviews, including medical history, vital signs, blood samples and electrocardiograms. Chart reviews were performed prior to surgery, at discharge, and three months after surgery. Atrial fibrillation was diagnosed either by specialists in Cardiology or Anaesthesiology on ECG or cardiac rhythm monitoring (≥30 seconds duration). Multiple logistic regression with backward stepwise selection was used for model development. Receiver operating characteristic curves (ROC) including area under the curve (AUC) was produced. The study was approved by the Regional Ethics committee (H-19033464) and comply with the principles of the Declaration of Helsinki of the World Medical Association. Results In total, 466 patients were included. Mean (±SD) age was 51.2 (20.5), 194 (41.6%) were female, and cardiovascular comorbidity was present in ≈10% of patients. Overall incidence of POAF was 5.8% (27/466) and no cases were observed in patients <60 years. Incidence was 15.7% (27/172) for patients ≥60 years. Prolonged hospitalization and death were observed in 40.7% of patients with POAF vs 8.4% patients without POAF (p<0.001). Significant age-adjusted risk-factors were previous atrial fibrillation odds ratio (OR) 6.84 [2.73; 17.18] (p<0.001), known diabetes mellitus OR 3.49 [1.40; 8.69] (p=0.007), and chronic kidney disease OR 3.03 [1.20; 7.65] (p=0.019). A prediction model, based on age, previous atrial fibrillation, diabetes mellitus and chronic kidney disease was produced (Figure 1), and ROC analysis displayed AUC 88.26% (Figure 2). Conclusions A simple risk-stratification model as the one provided, can aid clinicians in identifying those patients at risk of developing POAF in relation to acute abdominal surgery. This is important, as patients developing POAF are more likely to experience complications, such as prolonged hospitalization and death. Closer monitoring of heart rhythm and vital signs should be considered in at-risk patients older than 60 years. Model validation is warranted. FUNDunding Acknowledgement Type of funding sources: None.

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SILENT ATRIAL FIBRILLATION AS A RISK FACTOR FOR FALLS IN THE ELDERLY

Успехи геронтологии ◽

10.34922/ae.2021.34.1.016 ◽

2021 ◽

pp. 117-121

Author(s):

А.В. Турушева ◽

Е.В. Фролова ◽

Ю.М. Петросян ◽

Р.Д. Думбадзе

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

At Risk ◽

Old Age ◽

Fold Increase ◽

The Elderly ◽

Risk Of Falls ◽

Patients At Risk ◽

Risk Factors For Falls ◽

Study Participants

Падения повышают риск травм, инвалидизации и смертности пожилых людей. Фибрилляция предсердий (ФП) является одним из факторов риска падений в пожилом возрасте, тем не менее, связь между «скрытой» ФП и падениями не исследована. В исследование были включены пациенты 60 лет и старше (n=131), находившиеся на лечении в Городском гериатрическом медикосоциальном центре. Диагностированная ранее ФП была выявлена у 13,7 % (n=18) участников исследования, «скрытая» ФП - у 11,5 % (n=15). Обе формы ФП были ассоциированы с четырехкратным увеличением частоты падений в пожилом возрасте: (95 % ДИ) 4,26 (1,18-15,40) для ранее выявленной ФП и 4,56 (1,25-16,66) для «скрытой» ФП. Скрининг ФП позволил выявить на 16,9 % (95 % ДИ 6,7-26,8 %; p<0,001) больше пациентов, находящихся в группе риска падений. Таким образом, «скрытая» ФП, как и ранее диагностированная, являются независимыми факторами риска падений. Проведение скрининга ФП позволяет выявлять большее число пожилых пациентов, находящихся в группе риска падений. Falls increase the risk of injury, disability, and death in the elderly. Atrial fibrillation (AF) is one of the risk factors for falls in old age, however, the relationship between «silent» AF and falls has not been investigated. The study included patients (n=131) from 60 years and older who admitted in the City geriatric medical and social center. Previously diagnosed AF was detected in 13,7 % (n=18) of the study participants, and «silent» AF was detected in 11,5 % (n=15). Both forms of AF were associated with a 4-fold increase in the incidence of falls in old age: (95 % CI) 4,26 (1,18-15,40) for previously detected AF and 4,56 (1,25-16,66) for «silent» AF. AF screening revealed 16,9 % (95 % CI 6,7-26,8 %; p<0,001) more patients at risk of falls. Thus, «silent» AF, as well as previously diagnosed, are independent risk factors for falls. Conducting AF screening allows to identify more elderly patients who are at risk of falls.

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The effectiveness of atrial fibrillation screening with the MyDyagnostick 1001R device in a population and in a group at risk

Russian Family Doctor ◽

10.17816/rfd18929 ◽

2020 ◽

Vol 23 (4) ◽

pp. 41-48

Author(s):

Yurij M. Petrosyan ◽

Rauli D. Dumbadze ◽

Ekaterina O. Bakshanskaya ◽

Viktoriya A. Korogodina ◽

Iulianiya P. Koval’ ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

At Risk ◽

Medical Center ◽

Continuous Selection ◽

Preventive Health ◽

Portable Device ◽

Heart Activity ◽

Convenience Sample ◽

The City

Due to the low detectability of atrial fibrillation (AF), more attention is paid to AF screening. Screening procedure requires new diagnostic devices that allow immediate assessment of heart activity. One such portable device is the MyDyagnostick 1001R. The aim. Сomparison of the clinical effectiveness of screening in people who participated in the preventive health examinations and in patients with AF risk factors admitted to the City geriatric medical hospital. Materials and methods. 101 patients hospitalized to City geriatric medical center were included using the method of continuous selection. Another sample of patients included 102 volunteers who participated in a preventive health examinations organized by the City center for medical prevention in St. Petersburg (convenience sample). Heart activity was registered with portable device MyDyagnostick 1001R. Results. AF was diagnosed in 25 (24.8%) patients from geriatric medical center were. Of these, 12 patients were not suspected of having AF. Among the volunteers undergoing a routine examination, AF was found in 5 people, 3 of whom had paroxysmal AF in anamnesis. Conclusions. In a population of individuals with risk factors, AF was detected in 24.8% of cases; in 48%, AF was not previously detected using standard registration methods, which is in favor of periodic screening of AF in a population with risk factors for its development. In the population of participants of preventive health examinations, AF was found in 5 people, which indicates a low detectability of AF not at risk. Significant signs indicating possible AF were a feeling of palpitations and a history of stroke, which may confirm the need for screening for AF of persons with such symptoms. In screening purposes portable device MyDyagnostick 1001R may be used effectively.

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Researchers examine the risk factors for sudden cardiac death and management of at-risk patients

PsycEXTRA Dataset ◽

10.1037/e556542006-002 ◽

2002 ◽

Keyword(s):

Risk Factors ◽

At Risk ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Risk Patients

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Optimizing Heart Rate and Controlling Symptoms in Atrial Fibrillation

US Cardiology Review ◽

10.15420/usc.2016.10.1.26 ◽

2016 ◽

Vol 10 (1) ◽

pp. 26

Author(s):

Pragnesh Parikh ◽

◽

KL Venkatachalam ◽

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Rate Control ◽

Stroke Risk ◽

Symptom Control ◽

Review Article ◽

Rhythm Control ◽

Ventricular Rate ◽

Control Methods ◽

Novel Approaches

Atrial fibrillation (AF) is the most common arrhythmia noted in clinical practice and its incidence and prevalence are on the rise. The single most important intervention is the evaluation and treatment of stroke risk. Once the risk for stroke has been minimized, controlling the ventricular rate and treating symptoms become relevant. In this review article, we emphasize the importance of confirming and treating the appropriate arrhythmia and correlating symptoms with rhythm changes. Furthermore, we evaluate some of the risk factors for AF that independently result in symptoms, underlining the need to treat these risk factors as part of symptom control. We then discuss existing and novel approaches to rate control in AF and briefly cover rhythm control methods.

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