scholarly journals Exercise‐Based Cardiac Rehabilitation and All‐Cause Mortality Among Patients With Atrial Fibrillation

2021 ◽  
Author(s):  
Benjamin J. R. Buckley ◽  
Stephanie L. Harrison ◽  
Elnara Fazio‐Eynullayeva ◽  
Paula Underhill ◽  
Deirdre A. Lane ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Propensity Score ◽  
Cardiac Rehabilitation ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Research Network ◽  
Lower Odds ◽  
All Cause Mortality ◽  
Long Term Impact

Background There is limited evidence of long‐term impact of exercise‐based cardiac rehabilitation (CR) on clinical end points for patients with atrial fibrillation (AF). We therefore compared 18‐month all‐cause mortality, hospitalization, stroke, and heart failure in patients with AF and an electronic medical record of exercise‐based CR to matched controls. Methods and Results This retrospective cohort study included patient data obtained on February 3, 2021 from a global federated health research network. Patients with AF undergoing exercise‐based CR were propensity‐score matched to patients with AF without exercise‐based CR by age, sex, race, comorbidities, cardiovascular procedures, and cardiovascular medication. We ascertained 18‐month incidence of all‐cause mortality, hospitalization, stroke, and heart failure. Of 1 366 422 patients with AF, 11 947 patients had an electronic medical record of exercise‐based CR within 6‐months of incident AF who were propensity‐score matched with 11 947 patients with AF without CR. Exercise‐based CR was associated with 68% lower odds of all‐cause mortality (odds ratio, 0.32; 95% CI, 0.29–0.35), 44% lower odds of rehospitalization (0.56; 95% CI, 0.53–0.59), and 16% lower odds of incident stroke (0.84; 95% CI, 0.72–0.99) compared with propensity‐score matched controls. No significant associations were shown for incident heart failure (0.93; 95% CI, 0.84–1.04). The beneficial association of exercise‐based CR on all‐cause mortality was independent of sex, older age, comorbidities, and AF subtype. Conclusions Exercise‐based CR among patients with incident AF was associated with lower odds of all‐cause mortality, rehospitalization, and incident stroke at 18‐month follow‐up, supporting the provision of exercise‐based CR for patients with AF.

Cardiac rehabilitation and all-cause mortality in patients with heart failure: A retrospective cohort study

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
B Buckley ◽  
S Harrison ◽  
E Fazio-Eynullayeva ◽  
P Underhill ◽  
R Sankaranarayanan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cohort Study ◽  
Propensity Score ◽  
Cardiac Rehabilitation ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Lower Odds ◽  
Patients With Heart Failure ◽  
All Cause Mortality

Abstract Funding Acknowledgements Type of funding sources: None. Background Despite the benefits of exercise training in the secondary prevention of cardiovascular disease, there are conflicting findings for the impact of exercise-based cardiac rehabilitation (CR) on mortality for patients with heart failure (HF). Methods A retrospective cohort study was conducted which utilised a global federated health research network. Patients with a diagnosis of HF were compared between those with and without an electronic medical record of exercise-based CR within 6-months of a HF diagnosis. Patients with HF undergoing exercise-based CR were propensity score matched to HF patients without exercise-based CR by age, sex, race, co-morbidities, medications, and procedures. We ascertained 2-year incidence of all-cause mortality, hospitalisation, stroke, and atrial fibrillation. Results Following propensity score matching, a total of 40,364 patients with HF were identified. Exercise-based CR was associated with 42% lower odds of all-cause mortality (odds ratio 0.58, 95% confidence interval (CI): 0.54-0.62), 26% lower odds of hospitalisation (0.74, 95% CI 0.71-0.77), 37% lower odds of incident stroke (0.63, 95% CI 0.51-0.79), and 53% lower odds of incident atrial fibrillation (0.47, 95% CI 0.4-0.55) compared to matched controls. The beneficial association of exercise-based CR on all-cause mortality was consistent across stratification for sex, older age, included comorbidities, and HF subtype (all P < 0.0001), including patients with HFpEF (0.65, 95% CI 0.60-0.71). Conclusions Exercise-based CR was associated with lower odds of all-cause mortality, hospitalisations, incident stroke and incident atrial fibrillation at 2-years follow-up for patients with HF. The beneficial association of CR and lower mortality was consistent for patients with HFrEF and HFpEF.

scholarly journals Associations of exercise-based cardiac rehabilitation with all-cause mortality among patients with atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
B Buckley ◽  
S Harrison ◽  
E Fazio-Eynullayeva ◽  
P Underhill ◽  
D Lane ◽  
...  
Keyword(s):  
Heart Failure ◽  
Propensity Score ◽  
Research Network ◽  
Lower Odds ◽  
Clinical Endpoints ◽  
Funding Sources ◽  
All Cause Mortality ◽  
Exercise Programmes ◽  
Long Term Impact

Abstract Funding Acknowledgements Type of funding sources: None. Background There is limited evidence of long-term impact of exercise-based CR on clinical endpoints for patients with AF. We therefore compared 18-month all-cause mortality, hospitalisation, stroke, and heart failure in patients with AF and an electronic medical record (EMR) of exercise-based CR to matched controls. Methods and Results This retrospective cohort study included patient data obtained on 11 December 2020, from a global federated health research network. AF patients undergoing exercise-based CR were propensity score matched to AF patients without exercise-based CR by age, sex, race, medication, and co-morbidities. We ascertained 18-month incidence of all-cause mortality, hospitalisation, stroke, and heart failure. Of 1,350,886 patients with AF, 10,625 patients had an EMR of exercise-based CR within 6-months of incident AF. The propensity score matched cohort of 21,250 patients with AF demonstrated that exercise-based CR was associated with 64% lower odds of all-cause mortality (odds ratio 0.36, 95% confidence interval (CI) 0.33-0.40), 41% lower odds of hospitalisation (0.59, 95% CI 0.56-0.63), and 17% lower odds of incident stroke (0.83, 95% CI 0.71-0.98) compared to propensity score matched controls. No significant associations were shown for heart failure at 18-months (0.92, 95% CI 0.81-1.02). The beneficial association of exercise-based CR on all-cause mortality was independent of sex, older age, comorbidities, and AF subtype. CONCLUSIONS Exercise-based CR among patients with incident AF was associated with lower odds of all-cause mortality, hospitalisation, and stroke at 18-months follow-up. The longitudinal nature of this retrospective follow-up study strongly supports the provision of exercise programmes for patients with incident AF.

The prognostic impact of catheter ablation for atrial fibrillation after heart failure hospitalization on long-term mortality – Propensity-score matching analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Iwanami ◽  
K Jujo ◽  
S Higuchi ◽  
T Abe ◽  
M Shoda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Propensity Score ◽  
Left Ventricular ◽  
Lower Mortality ◽  
Left Ventricular Ejection ◽  
Prognostic Impact ◽  
Ventricular Ejection Fraction ◽  
All Cause Mortality

Abstract Background In the last two decades, catheter ablation (CA) for atrial fibrillation (AF) including pulmonary vein isolation (PVI) has been developed as a standard and effective treatment for atrial fibrillation (AF). In patients with chronic heart failure with reduced left ventricular ejection fraction (LVEF) (HFrEF), PVI CA for AF dramatically improves LVEF, resulting in better clinical prognoses. On the contrary, there still has been no data that PVI CA for AF improves the prognosis in heart failure patients with preserved LVEF (HFpEF). Purpose The aim of this study was to evaluate the prognostic impact of PVI CA for AF after the hospitalization due to decompensation of heart failureHF, focusing on LVEF. Methods From the database including 1,793 consecutive patients who were hospitalized due to congestive HF, we ultimately analyzed 624 AF patients who were discharged alive. They were assigned into two groups due that PVI CA for AF procedure done after the index hospitalization for HF; the PVI CA group (n=62) and Non-PVI CA group (n=562). For the two groups, we performed propensity-score (PS) matching using variables as follows: age, sex, LVEF, brain natriuretic peptide (BNP), blood urea nitrogen (BUN) and estimated glomerular filtration rate (eGFR) at discharge. Further analysis was performed separately in HFrEF (LVEF <50%) and HFpEF (LVEF >50%). The primary endpoint of this study was death from any cause. Results In unmatched patients, Kaplan-Meier analysis showed that patients in the PVI CA group had a significantly lower all-cause mortality than those in the Non-PVI CA group during 678 median follow-up period (Log-rank test: P=0.003, Figure A). In 96 PS-matched patients, patients in the PVI CA group still had lower mortality rate than those in the Non-PVI CA group (hazard ratio 0.28, 95% confidence interval 0.09–0.86, p=0.018, Figure B). When the whole study population was classified into HFrEF and HFpEF, HFrEF patients who received PVI showed a significantly lower mortality than those who did not (p=0.007); whereas, in HFpEF patients, PVI CA for AF did not make statistical difference in all-cause mortality (p=0.061). Conclusions In this observational study, PVI CA for AF may improve the mortality in HF patients with reduced LVEF. However, the prognostic impact of PVI CA for AF was not observed in HF patients with preserved LVEF. Funding Acknowledgement Type of funding source: None

scholarly journals Effects of cardiac rehabilitation on the two-year prognosis of patients with heart failure: a multicentre prospective cohort study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
T Adachi ◽  
N Iritani ◽  
K Kamiya ◽  
K Iwatsu ◽  
K Kamisaka ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cohort Study ◽  
Propensity Score ◽  
Ejection Fraction ◽  
Cardiac Rehabilitation ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Landmark Analysis ◽  
All Cause Mortality

Abstract Background Cardiac rehabilitation (CR) is a comprehensive disease management program highly recommended by heart failure (HF) guidelines. However, the prognostic effects of outpatient CR are inconsistent among recent meta-analyses which enrolled mainly younger HF with reduced ejection fraction (HFrEF). With an aging population, an increased importance of CR has been put on patients with HF with preserved ejection fraction (HFpEF). Purpose This study aimed to examine the prognostic effects of regularly undergoing CR for 6 months after discharge analysing nationwide cohort data including older population with HFrEF and HFpEF. Methods We analysed 2876 patients who hospitalised for acute HF or worsening chronic HF and capable of walking at discharge in the multicentre prospective cohort study. Frequency of outpatient CR participation of each patient was collected using medical records. We assessed CR frequency within 6 months of discharge since most collaborating hospitals conducted final follow-up examinations at 6 months. The CR group was defined as patients who underwent outpatient CR once or more per week for 6 months after discharge. The main study endpoint was a composite of all-cause mortality and HF rehospitalisation during a 2-year follow-up. We performed a propensity score-matched analysis to compare survival rates between the CR and non-CR groups. Propensity scores for each patient were produced by a logistic regression analysis with the CR group as the dependent variable and 33 potential confounders as independent variables. To evaluate events beyond 6 months, we also conducted landmark analyses at 6 months. Results Of the 2876 enrolled patients, 313 underwent CR for 6 months. After propensity score matching using confounding factors, 626 patients (313 pairs) were included in the survival analysis (median age: 74 years, men: 59.6%, median left ventricular ejection fraction [LVEF]: 42%). During 1006.1 person-years of follow-up, 137 patients were rehospitalised due to HF exacerbation, and 50 patients died in the matched cohort. In Cox proportional hazards model (Figure 1), CR was associated with a reduced risk of composite outcomes (hazard ratio [HR] 0.66; 95% confidence interval [CI] 0.48–0.91), all-cause mortality (HR 0.53; 95% CI 0.30–0.95), and HF rehospitalisation (HR 0.66; 95% CI 0.47–0.92). A subgroup analysis showed similar CR effects in patients with HFpEF (LVEF ≥50%) and HFrEF (LVEF <40%). However, in a landmark analysis, CR did not reduce the adverse outcomes beyond 6 months after discharge (Figure 2). Conclusions The findings of this study demonstrate the needs that CR should become a standard treatment for HF regardless of HF type and the necessity of periodical follow-up after completing CR program to maintain its prognostic effects. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Grant-in-Aid for Scientific Research (A) from the Japan Society for the Promotion of Science Figure 1. Prognostic effects of CR Figure 2. Landmark analysis

scholarly journals Atrial Fibrillation in Patients With Cardiomyopathy: Prevalence and Clinical Outcomes From Real‐World Data

2021 ◽  
Author(s):  
Benjamin J. R. Buckley ◽  
Stephanie L. Harrison ◽  
Dhiraj Gupta ◽  
Elnara Fazio‐Eynullayeva ◽  
Paula Underhill ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Restrictive Cardiomyopathy ◽  
The United States ◽  
Research Network ◽  
Real World Data ◽  
All Cause Mortality ◽  
Incident Heart Failure ◽  
The Impact

Background Cardiomyopathy is a common cause of atrial fibrillation (AF) and may also present as a complication of AF. However, there is a scarcity of evidence of clinical outcomes for people with cardiomyopathy and concomittant AF. The aim of the present study was therefore to characterize the prevalence of AF in major subtypes of cardiomyopathy and investigate the impact on important clinical outcomes. Methods and Results A retrospective cohort study was conducted using electronic medical records from a global federated health research network, with data primarily from the United States. The TriNetX network was searched on January 17, 2021, including records from 2002 to 2020, which included at least 1 year of follow‐up data. Patients were included based on a diagnosis of hypertrophic, dilated, or restrictive cardiomyopathy and concomitant AF. Patients with cardiomyopathy and AF were propensity‐score matched for age, sex, race, and comorbidities with patients who had a cardiomyopathy only. The outcomes were 1‐year mortality, hospitalization, incident heart failure, and incident stroke. Of 634 885 patients with cardiomyopathy, there were 14 675 (2.3%) patients with hypertrophic, 90 117 (7.0%) with restrictive, and 37 685 (5.9%) with dilated cardiomyopathy with concomitant AF. AF was associated with significantly higher odds of all‐cause mortality (odds ratio [95% CI]) for patients with hypertrophic (1.26 [1.13–1.40]) and dilated (1.36 [1.27–1.46]), but not restrictive (0.98 [0.94–1.02]), cardiomyopathy. Odds of hospitalization, incident heart failure, and incident stroke were significantly higher in all cardiomyopathy subtypes with concomitant AF. Among patients with AF, catheter ablation was associated with significantly lower odds of all‐cause mortality at 12 months across all cardiomyopathy subtypes. Conclusions Findings of the present study suggest AF may be highly prevalent in patients with cardiomyopathy and associated with worsened prognosis. Subsequent research is needed to determine the usefulness of screening and multisdisciplinary treatment of AF in this population.

scholarly journals Renin–angiotensin system inhibitors and clinical outcomes in patients with atrial fibrillation and heart failure: a propensity score-matched study from the Chinese Atrial Fibrillation Registry

2021 ◽  
Vol 49 (9) ◽  
pp. 030006052110414
Author(s):  
Jing Lin ◽  
Liu He ◽  
Qing Qiao ◽  
Xin Du ◽  
Chang-Sheng Ma ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Sensitivity Analysis ◽  
Propensity Score ◽  
Cox Regression ◽  
Renin Angiotensin System ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
All Cause Mortality ◽  
Β Blocker

Objective The effect of renin–angiotensin system inhibitors (RASIs) in patients with heart failure (HF) and atrial fibrillation (AF) remains unclear. This study aimed to investigate associations between RASI use and all-cause mortality and cardiovascular outcomes in patients with AF and HF. Methods Using data from the China Atrial Fibrillation Registry study, we included 938 patients with AF and HF with a left ventricular ejection fraction <50%. Cox regression models for RASIs vs. non-RASIs with all-cause mortality as the primary outcome were fitted in a 1:1 propensity score-matched cohort. A sensitivity analysis was performed by using a multivariable time-dependent Cox regression model. As an internal control, we assessed the relation between β-blocker use and all-cause mortality. Results During a mean follow-up of 35 months, the risk of all-cause mortality was similar in RASI users compared with non-users (hazard ratio: 0.92; 95% confidence interval: 0.67–1.26). Similar results were obtained in the sensitivity analysis. In contrast, β-blocker use was associated with significantly lower all-cause mortality in the same population. Conclusions RASI use was not associated with better outcomes in patients with AF and HF in this prospective cohort, which raises questions about their value in this specific subset. Trail Registration: ChiCTR-OCH-13003729.

scholarly journals Exercise-Based Cardiac Rehabilitation Associates with Lower Major Adverse Cardiovascular Events in People with Stroke

2021 ◽  
pp. 1-5
Author(s):  
Benjamin J.R. Buckley ◽  
Stephanie L. Harrison ◽  
Elnara Fazio-Eynullayeva ◽  
Paula Underhill ◽  
Deirdre A. Lane ◽  
...  
Keyword(s):  
Propensity Score ◽  
Cardiac Rehabilitation ◽  
Cardiovascular Events ◽  
Recurrent Stroke ◽  
Routine Care ◽  
Research Network ◽  
Major Adverse Cardiovascular Events ◽  
Cardiac Events ◽  
Lower Odds

<b><i>Background:</i></b> The risk of major adverse cardiovascular events is substantially increased following a stroke. Although exercise-based cardiac rehabilitation has been shown to improve prognosis following cardiac events, it is not part of routine care for people following a stroke. We therefore investigated the association between cardiac rehabilitation and major adverse cardiovascular events for people with stroke. <b><i>Methods:</i></b> This retrospective analysis was conducted on June 20, 2021, using anonymized data within TriNetX, a global federated health research network with access to electronic medical records from participating healthcare organizations, predominantly in the USA. All participants were aged ≥18 years with cerebrovascular disease and at least 2 years of follow-up. People with stroke and an electronic medical record of exercise-based cardiac rehabilitation were 1:1 propensity score matched to people with stroke but without cardiac rehabilitation using participant characteristics, comorbidities, cardiovascular procedures, and cardiovascular medications. <b><i>Results:</i></b> Of 836,923 people with stroke and 2-year follow-up, 2,909 met the inclusion for the exercise-based cardiac rehabilitation cohort. Following propensity score matching (<i>n</i> = 5,818), exercise-based cardiac rehabilitation associated with 53% lower odds of all-cause mortality (odds ratio 0.47, 95% confidence interval: 0.40–0.56), 12% lower odds of recurrent stroke (0.88, 0.79–0.98), and 36% lower odds of rehospitalization (0.64, 0.58–0.71), compared to controls. No significant association between cardiac rehabilitation and incident atrial fibrillation was observed. <b><i>Conclusion:</i></b> Exercise-based cardiac rehabilitation prescribed for people following a stroke associated with significantly lower odds of major adverse cardiovascular events at 2 years, compared to usual care.

scholarly journals Liraglutide Mortality Effect on Atrial Fibrillation Patients

2021 ◽  
Author(s):  
Justin Haloot ◽  
Mohamed Mahmoud ◽  
Auroa Badin
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Acute Coronary Syndrome ◽  
Acute Heart Failure ◽  
Lower Risk ◽  
Research Network ◽  
Coronary Syndrome ◽  
Mortality Effect ◽  
All Cause Mortality

Introduction: Liraglutide, a glucagon-like peptide 1 receptor agonist (GLP-1) utilized for management of type 2 diabetes mellitus, has been associated with reduced risk of cardiovascular events. However, it is also associated with increased heart rate and reduced heart rate variability. In this study, we investigate the effect of liraglutide in patients with atrial fibrillation (AF). Methods: TriNetX global research network provided aggregate data for this retrospective cohort study of AF patients on liraglutide that were matched to AF patients not on liraglutide from January 1, 2016, through November 13, 2021. Primary outcomes were all-cause mortality, ischemic stroke, hemorrhagic stroke, acute heart failure episode, and acute coronary syndrome episode. Results: 16,214 AF patients on liraglutide were propensity score matched to AF patients not on liraglutide. They were matched for demographics, cardiovascular procedures, cardiovascular medications, hypertension, diabetes, heart failure, ischemic heart disease, and diabetic medications. AF patients on liraglutide were found to have a significantly lower risk of all-cause mortality (HR 0.67, 95% CI 0.631 – 0.711, p < 0.001). There was a tendency toward lower risk of stroke, acute heart failure, and acute coronary syndrome but was not statistically significant. Conclusion: Liraglutide is associated with lower risk of all-cause mortality in AF patients. These findings are limited due to the retrospective nature of the study. Further examination is needed of liraglutide effect on mortality in AF patients.

scholarly journals Mortality in patients with atrial fibrillation with or without heart failure following hospital discharge

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Kartas ◽  
A Samaras ◽  
D Vasdeki ◽  
G Dividis ◽  
G Fotos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Primary Endpoint ◽  
Cox Regression ◽  
Cross Sectional ◽  
Tertiary Center ◽  
All Cause Mortality ◽  
Endpoint Event ◽  
Secondary Endpoints ◽  
Sectional Analysis

Abstract Background The association of heart failure (HF) with the prognosis of atrial fibrillation (AF) remains unclear. OBJECTIVES To assess all-cause mortality in patients following hospitalization with comorbid AF in relation to the presence of HF. Methods We performed a cross-sectional analysis of data from 977 patients discharged from the cardiology ward of a single tertiary center between 2015 and 2018 and followed for a median of 2 years. The association between HF and the primary endpoint of death from any cause was assessed using multivariable Cox regression. Results HF was documented in 505 (51.7%) of AF cases at discharge, including HFrEF (17.9%), HFmrEF (16.5%) and HFpEF (25.2%). A primary endpoint event occurred in 212 patients (42%) in the AF-HF group and in 86 patients (18.2%) in the AF-no HF group (adjusted hazard ratio [aHR] 2.27; 95% confidence interval [CI], 1.65 to 3.13; P&lt;0.001). HF was associated with a higher risk of the composite secondary endpoint of death from any cause, AF or HF-specific hospitalization (aHR 1.69; 95% CI 1.32 to 2.16 p&lt;0.001). The associations of HF with the primary and secondary endpoints were significant and similar for AF-HFrEF, AF-HFmrEF, AF-HFpEF. Conclusions HF was present in half of the patients discharged from the hospital with comorbid AF. The presence of HF on top of AF was independently associated with a significantly higher risk of all-cause mortality than did absence of HF, irrespective of HF subtype. Funding Acknowledgement Type of funding source: None

Sign in / Sign up

Export Citation Format

Share Document