scholarly journals Incident Strokes Among American Indian Individuals With Atrial Fibrillation

2021 ◽  
Author(s):  
José M. Sanchez ◽  
Stacey E. Jolly ◽  
Thomas A. Dewland ◽  
Zian H. Tseng ◽  
Gregory Nah ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
American Indian ◽  
Race And Ethnicity ◽  
Ambulatory Surgery ◽  
Prescribing Patterns ◽  
Hospital Unit ◽  
Obstructive Sleep ◽  
Artery Disease ◽  
The Relationship ◽  
Insurance Payer

BACKGROUND American Indian individuals experience a relatively high risk for cardiovascular disease and have exhibited a higher risk of stroke compared with other racial and ethnic minorities. Although this population has the highest incidence of atrial fibrillation (AF) compared with other groups, the relationship between AF and nonhemorrhagic stroke among American Indian individuals compared with other groups has not been thoroughly studied. METHODS and RESULTS We used the Healthcare Cost and Utilization Project to evaluate risk of nonhemorrhagic stroke among American Indian individuals, with comparisons to White, Black, Hispanic, and Asian individuals, among all adult California residents receiving care in an emergency department, inpatient hospital unit, or ambulatory surgery setting from 2005 to 2011. Of 16 951 579 patients followed for a median 4.1 years, 105 822 (0.6%) were American Indian. After adjusting for age, sex, income level, insurance payer, hypertension, diabetes mellitus, coronary artery disease, congestive heart failure, cardiac surgery, valvular heart disease, chronic kidney disease, smoking, obstructive sleep apnea, pulmonary disease, and alcohol use, American Indian individuals with AF exhibited the highest risk of nonhemorrhagic stroke when compared with either non‐American Indian individuals with AF (hazard ratio, 1.38; 95% CI, 1.23–1.55; P <0.0001) or to each race and ethnicity with AF. American Indian individuals also experienced the highest overall risk for stroke, with no evidence that AF disproportionately heightened that risk in interaction analyses. CONCLUSIONS American Indian individuals experienced the highest risk of nonhemorrhagic stroke, whether in the presence or absence of AF. Our findings likely suggest an opportunity to further study, if not immediately address, guideline‐adherent anticoagulation prescribing patterns among American Indian individuals with AF.

scholarly journals Obstructive Sleep Apnea in Heart Failure: Review of Prevalence, Treatment with Continuous Positive Airway Pressure, and Prognosis

2018 ◽  
Vol 45 (3) ◽  
pp. 151-161 ◽  
Author(s):  
Himad K. Khattak ◽  
Faisal Hayat ◽  
Salpy V. Pamboukian ◽  
Harvey S. Hahn ◽  
Brian P. Schwartz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Preserved Ejection Fraction ◽  
Obstructive Sleep ◽  
Artery Disease ◽  
The Relationship

Obstructive sleep apnea is a sleep-related breathing disorder that has a major impact on cardiovascular function. It has been associated with hypertension, coronary artery disease, cardiac arrhythmias, sudden cardiac death, and heart failure. This review focuses on the relationship between obstructive sleep apnea and heart failure with either reduced or preserved ejection fraction. We discuss the pathophysiology of obstructive sleep apnea, as well as its prevalence, treatment outcomes with continuous positive airway pressure, and prognosis in these 2 distinct types of heart failure. We also identify areas in which further work is needed to improve our understanding of this association in heart failure patients.

scholarly journals Obstructive Sleep Apnea and Coronary Artery Disease: From Pathophysiology to Clinical Implications

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Fernando De Torres-Alba ◽  
Daniele Gemma ◽  
Eduardo Armada-Romero ◽  
Juan Ramón Rey-Blas ◽  
Esteban López-de-Sá ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Obstructive Sleep Apnea ◽  
Coronary Artery ◽  
Sleep Apnea ◽  
Subclinical Atherosclerosis ◽  
Clinical Problem ◽  
Clinical Implications ◽  
Obstructive Sleep ◽  
Artery Disease ◽  
The Relationship

Coronary artery disease (CAD) and obstructive sleep apnea (OSA) are both complex and significant clinical problems. The pathophysiological mechanisms that link OSA with CAD are complex and can influence the broad spectrum of conditions caused by CAD, from subclinical atherosclerosis to myocardial infarction. OSA remains a significant clinical problem among patients with CAD, and evidence suggesting its role as a risk factor for CAD is growing. Furthermore, increasing data support that CAD prognosis may be influenced by OSA and its treatment by continuous positive airway pressure (CPAP) therapy. However, stronger evidence is needed to definitely answer these questions. This paper focuses on the relationship between OSA and CAD from the pathophysiological effects of OSA in CAD, to the clinical implications of OSA and its treatment in CAD patients.

scholarly journals 184 The presence of atrial fibrillation in acute myocardial infarction patients and hyperglycaemia

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Michele Fabrizio ◽  
Pasquale Paolisso ◽  
Luca Bergamaschi ◽  
Francesco Angeli ◽  
Sebastiano Toniolo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Acute Myocardial Infarction ◽  
Hospital Admission ◽  
Hospital Stay ◽  
Independent Predictor ◽  
Serum Glucose ◽  
Artery Disease ◽  
The Relationship

Abstract Aims In patients with acute myocardial infarction (AMI), hyperglycaemia is a common feature determining a worse prognosis. Few studies have examined the relationship between hyperglycemic status and atrial fibrillation in-hospital stay. To evaluate the relationship between admission hyperglycaemia (aHGL) and occurrence of atrial fibrillation (AF) in-hospital stay in patients with AMI, categorized as myocardial infarction with obstructive coronary artery disease (MIOCA) and myocardial infarction with nonobstructive coronary artery disease (MINOCA). Methods and results Hyperglycaemia was defined as a serum glucose level ≥140 mg/dl at the time of hospital admission. AF was defined as a beat-to-beat variability in cycle length and morphology with irregular fibrillatory waves on surface ECG. Among 2702 patients (32.1% were female, mean age was 70.1 ± 13.4 years), 24.2% were diabetic. Out of 2702 patients, 2457 were MIOCA and 245 (9.1%) were MINOCA patients. At admission, the mean value of serum glucose levels was 146 ± 66 mg/dl. At hospital admission, hyperglycemic status was present in 37.7% of patients and 8.3% presented atrial fibrillation. At hospital admission, atrial fibrillation (aAF) was significantly frequent in hyperglycemic than normoglycaemic patients (11.5% vs. 6.3%, respectively; P &lt; 0.001). In aHGL MIOCA patients had a higher rate of aAF (10.7%) than normoglycaemic MIOCA (6.4%; P &lt; 0.001). In aHGL MINOCA patients had 31% aAF than normoglycaemic MINOCA patients (7.5%; P &lt; 0.001). During the hospital stay, the new onset of atrial fibrillation was higher in aHGL than normoglycaemic status in total population (6.3% vs. 2.9%, P &lt; 0.001), in MIOCA subgroup (6.3% vs. 3.1%, P &lt; 0.001) and MINOCA subgroup (7.3% vs. 1.5%, P = 0.003). Multivariate analysis adjusted for age, sex, and diabetes revealed that the presence of hyperglycaemia was an independent predictor for the onset of atrial fibrillation (OR: 1.7; 95% CI: 1.1–2.6; P = 0.02). Conclusions Hyperglycaemia was an independent predictor of new atrial fibrillation during hospitalization in patients with AMI. Moreover, at hospital admission, patients with hyperglycemic status presented a higher incidence of atrial fibrillation, both in MIOCA and MINOCA subgroups. Further studies are needed to understand the biological mechanisms involved in these associations.

scholarly journals Sleep Disorders and Atrial Fibrillation: Current Situation and Future Directions

2018 ◽  
Vol 7 ◽  
pp. e1416
Author(s):  
Alireza Sepehri Shamloo ◽  
Arash Arya ◽  
Nikolas Dagres ◽  
Gerhard Hindricks
Keyword(s):  
Atrial Fibrillation ◽  
Obstructive Sleep Apnea ◽  
Risk Factor ◽  
Sleep Disorders ◽  
Incidence Rates ◽  
Future Directions ◽  
Related Literature ◽  
Obstructive Sleep ◽  
Hypopnea Syndrome ◽  
The Relationship

Atrial fibrillation (AF) is a growing health problem worldwide. In recent years, there has been a rising interest in the relationship between sleep disorders and AF. Several studies have reported higher prevalence and incidence rates of AF in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). However, some believe that OSAHS is not a risk factor for AF; but AF, by itself, is regarded as one of the possible triggers for OSAHS. In this study, the related literature investigating the association between OSAHS and AF was reviewed, and then the possible mechanisms of this interplay were discussed. To conclude, recommendations for further research in this field were presented to researchers and some points were highlighted for physicians.[GMJ.2018;7:e1416]

scholarly journals Relationship Among Atrial Fibrillation, CHADS2 Score and Ischaemic Stroke in Patients With Coronary Artery Disease: A Propensity Score Matching Study

2020 ◽  
Author(s):  
Boqun Shi ◽  
Demin Liu ◽  
Qian Wang ◽  
Xue Geng ◽  
Qian Hou ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Propensity Score ◽  
Ischaemic Stroke ◽  
Propensity Score Matching ◽  
Stroke Patients ◽  
Stroke Group ◽  
Artery Disease ◽  
The Relationship

Abstract Objective: The purpose of this study was to investigate the relationship among atrial fibrillation (AF), CHADS2 score and ischaemic stroke in patients with coronary artery disease.Methods: A total of 2335 patients with coronary artery disease were included. They were divided into a nonischaemic stroke group (n=1997) and an ischaemic stroke group (n=388). Propensity score matching (PSM) was used to match ischaemic stroke patients with nonischaemic stroke patients in a 1:4 ratio. The relationship between AF, CHADS2 score and ischaemic stroke was evaluated using a univariate generalized linear model in different age, body mass index, and coronary artery disease subgroups. Univariate and multivariate generalized linear models were used to evaluate the relationship between AF and ischaemic stroke in different models.Results: Compared with the nonischaemic stroke group, the rate of AF (8.81% vs. 14.20%, P=0.002) in the ischaemic stroke group was higher. The proportion of patients with ischaemic stroke was significantly different between the AF group and the non-AF group (19.04% vs. 28.74%, P=0.003). With increasing CHADS2 score, the incidence of AF gradually increased (P for trend <0.001). With increasing AF burden, the rate of ischaemic stroke increased continuously (P for trend <0.001). Subgroup analysis showed that the trend towards increased stroke risk in the AF group was consistent across the various subgroups. Multivariate analysis demonstrated that paroxysmal and nonparoxysmal AF were not associated with ischaemic stroke compared with the absence of AF.Conclusion: After adjusting for confounding factors, the correlation between AF and ischaemic stroke decreased. Atherosclerotic factors may play an important role in ischaemic stroke in patients with coronary heart disease.

scholarly journals The Relationship between Obstructive Sleep Apnea and Atrial Fibrillation: A Complex Interplay

2013 ◽  
Vol 2013 ◽  
pp. 1-11 ◽  
Author(s):  
Jacqueline M. Latina ◽  
N. A. Mark Estes ◽  
Ann C. Garlitski
Keyword(s):  
Atrial Fibrillation ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Treatment Strategies ◽  
Public Health Problem ◽  
Obesity Epidemic ◽  
Obstructive Sleep ◽  
Sleep Breathing Disorder ◽  
All Cause Mortality ◽  
The Relationship

In recent years, growing evidence suggests an association between obstructive sleep apnea (OSA), a common sleep breathing disorder which is increasing in prevalence as the obesity epidemic surges, and atrial fibrillation (AF), the most common cardiac arrhythmia. AF is a costly public health problem increasing a patient’s risk of stroke, heart failure, and all-cause mortality. It remains unclear whether the association is based on mutual risk factors, such as obesity and hypertension, or whether OSA is an independent risk factor and causative in nature. This paper explores the pathophysiology of OSA which may predispose to AF, clinical implications of stroke risk in this cohort who display overlapping disease processes, and targeted treatment strategies such as continuous positive airway pressure and AF ablation.

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