Atrial Fibrillation: Epidemiologic Considerations and Rationale for Conversion and Maintenance of Sinus Rhythm

2003 ◽  
Vol 8 (1_suppl) ◽  
pp. S13-S26 ◽  
Author(s):  
Bramah N. Singh
Keyword(s):  
United States ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Disease ◽  
Sinus Rhythm ◽  
Surgical Techniques ◽  
Hypertensive Heart Disease ◽  
Fold Increase ◽  
The United States ◽  
Lone Atrial Fibrillation

Atrial fibrillation is now the most common cardiac arrhythmia for which a patient is hospitalized. Clinically, it presents in a form that is paroxysmal, persistent, or permanent and may be symptomatic or asymptomatic, occurring in the setting of either no cardiac disease (“lone atrial fibrillation”) or, most often, in association with an underlying disease. Atrial fibrillation is associated with a 2-fold increase in mortality and, in the United States alone, causes over 75,000 cases of stroke per year. The annual prevalence of stroke is 5% to 7%, but the use of adequate anticoagulation can reduce this to less than 1%. Atrial fibrillation is a disorder of the elderly, with almost equal prevalence in men and women. In the United States, 80% of atrial fibrillation occurs in patients over the age of 65 years, and its prevalence tracks that of heart failure, which may be the cause, as well as the result, of the arrhythmia. Both conditions are increasing in epidemic proportions in the aging population. The most common causes of atrial fibrillation are hypertensive heart disease, coronary artery disease, and heart failure with a miscellany of lesser conditions, with about 10% lacking structural heart disease. Unlike other supraventricular arrhythmias, cure by the use of catheter ablation and surgical techniques has not been a reality except in a relatively small number of cases. However, restoration and maintenance of sinus rhythm remain the initial goal of therapy for most patients. Pharmacologic approaches remain the mainstay of therapy for rate control and anticoagulation as well as for maintenance of sinus rhythm following pharmacological or electrical conversion. The changing epidemiology of atrial fibrillation is highlighted, with the focus on its conversion by the use of newer and novel antifibrillatory agents relative to the mechanisms of the arrhythmia, to restore the stability of sinus rhythm.

Abstract 2157: Racial Differences in Hospitalizations for Atrial Fibrillation in the United States

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Paul B Tabereaux ◽  
Todd M Brown ◽  
Jose Osorio ◽  
G. N Kay ◽  
Dawn M Bravada
Keyword(s):  
Diabetes Mellitus ◽  
United States ◽  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
The United States ◽  
Principal Diagnosis ◽  
Common Risk Factors

Introduction: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the United States; however a paucity of population-based data about nonwhite individuals exist. The objectives of this study were to compare hospitalizations among Whites and African Americans (AA) and to determine whether race is an independent predictor of hospitalization for AF in the United States. Methods: Data was obtained from the National Hospital Discharge Survey (years 1996 –2005) and included hospitalizations with a principal diagnosis of AF for patients aged ≥18 yrs and race designated as either White or AA. Codes from the International Classification of Diseases -9th revision were used to define AF (427.31), hypertension (401– 405), ischemic heart disease (410 – 414), diabetes mellitus (250), heart failure (425,428) and valvular heart disease (424). Multivariable analysis with logistic regression was used to identify factors that were independently associated with AF hospitalizations Results: Among 297,962,043 hospitalizations between 1996 –2005, 3,676,787 (1.2%) had a principal diagnosis of AF. Among the hospitalizations for AF, white race was more common than AA race (2,393,659/186,904,962 of whites (1.3% of white’s hospitalized) and 209,788/33,972,665 of African Americans (0.6% of AA’s hospitalized), p<0.0001). After adjusting for the most common risk factors for AF (age, sex, hypertension, ischemic heart disease, diabetes mellitus, heart failure and valvular heart disease) AA race was independently associated with a decreased odds of hospitalizations for AF (Table 1 : adjusted OR=0.49, 95%CI 0.46 – 0.51). Conclusions: After adjusting for the most common risk factors for AF, the odds of hospitalization for AF in AA’s remained half that of whites. Race may be a novel and unaccounted risk factor for atrial fibrillation.

scholarly journals Heart failure in real world

2015 ◽  
Vol 9 (4) ◽  
pp. 356
Author(s):  
Claudio Giumelli ◽  
Azio Reverzani ◽  
Riccardo Volpi ◽  
Giuseppe Chesi
Keyword(s):  
Public Health ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Disease ◽  
Pleural Effusion ◽  
Total Population ◽  
Systolic Function ◽  
Heart Diseases ◽  
Hypertensive Heart Disease ◽  
The Mean

The heart failure (HF) is one of the greatest problems of public health with increasing epidemiological importance. In the present study we analyzed a population of 299 patients, consecutively admitted to hospital, whose diagnosis of HF was verified retrospectively. In our analysis we considered underlying heart diseases, comorbidities, ejection fraction, presence of atrial fibrillation and pleural effusion, values of NT pro-BNP and causes of destabilization precipitating HF. The mean age of our population was 81 years. Patients with preserved systolic function were 145 (61% of the total, 59 male and 86 female). 166 patients (69% of the total) had hypertensive heart disease and 211 had hypertension (88% of the total). Patients with pleural effusion were 108 (46% of total). In the total population 102 patients (43%) had from 3 to 5 comorbidities, 169 patients (71%) had at least 2 comorbidities and only 4 patients (1.7%) had no comorbidities. The collected data highlight the complexity of patients with HF, often due to advanced age and a high number of comorbidities.

Outcomes of Heart Failure-Related Hospitalization in Adults with Congenital Heart Disease in the United States

2012 ◽  
Vol 8 (6) ◽  
pp. 513-519 ◽  
Author(s):  
Fred H. Rodriguez ◽  
Douglas S. Moodie ◽  
Dhaval R. Parekh ◽  
Wayne J. Franklin ◽  
David L.S. Morales ◽  
...  
Keyword(s):  
United States ◽  
Heart Failure ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
The United States

Heart Failure Related Hospitalizations in Children With Single Ventricle Heart Disease in the United States: Costly and Getting More Expensive

2012 ◽  
Vol 18 (8) ◽  
pp. S73 ◽  
Author(s):  
J.W. Rossano ◽  
D.J. Goldberg ◽  
A.R. Mott ◽  
K.Y. Lin ◽  
R.E. Shaddy ◽  
...  
Keyword(s):  
United States ◽  
Heart Failure ◽  
Heart Disease ◽  
Single Ventricle ◽  
The United States

scholarly journals Rural-Urban Differences in Mortality From Ischemic Heart Disease, Heart Failure, and Stroke in the United States

2021 ◽  
Vol 14 (4) ◽  
Author(s):  
Muhammad Shahzeb Khan ◽  
Pankaj Kumar ◽  
Jayakumar Sreenivasan ◽  
Safi U. Khan ◽  
Khurram Nasir ◽  
...  
Keyword(s):  
United States ◽  
Heart Failure ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
The United States ◽  
Ischemic Heart

scholarly journals TRENDS AND FACTORS ASSOCIATED WITH PLACE OF DEATH AMONG INDIVIDUALS WITH CARDIOVASCULAR DISEASE IN THE UNITED STATES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S132-S133 ◽  
Author(s):  
Sarah H Cross ◽  
Brystana G Kaufman ◽  
Haider Warraich
Keyword(s):  
United States ◽  
Cardiovascular Disease ◽  
Heart Disease ◽  
College Education ◽  
Hypertensive Heart Disease ◽  
The United States ◽  
Place Of Death ◽  
Home Death ◽  
Factors Associated ◽  
At Home

Abstract While most patients prefer to die at home, trends and factors associated with place of death for patients dying of cardiovascular disease (CVD) remain unknown. Using data from the National Center for Health Statistics from 2003-2017, we described trends and conducted multivariable logistic regression to evaluate associations between demographic characteristics and place of death among CVD patients in the United States. From 2003-2017, the rate of CVD deaths occurring at home increased from 21.3% to 30.9%, and rate of hospice facility deaths increased from practically none to 6.0%. Over the same period, the rate of hospital deaths decreased from 36.5% to 27.3%, and nursing facility deaths decreased from 25.1% to 20.6%. With the exception of conduction disorders, temporal trends in place of death were consistent across CVD diagnosis subgroups: ischemic heart disease, hypertensive heart disease, heart failure/cardiomyopathy, cerebrovascular disease, aortic stenosis, and all other CVDs. Differences between demographic groups persisted over the study period, with reduced odds of home death among Hispanic versus non-Hispanic (OR=.942; 95% CI .929-.955) decedents, Black versus White (OR=.837; CI .809-.866) decedents and greater odds of home death among decedents with some college education or more (OR=1.08; CI 1.06-1.09) versus decedents with a high-school education or less. In 2014, home surpassed hospital as the most common place of death for CVD patients. CVD patients often have acute and intense needs at the end of life that are challenging to manage in the home and the quality of care these patients receive should be further investigated.

Abstract 163: High Burden of Valvulopathy in Heart Failure: A Moving Target

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Enoch Agunanne ◽  
Aamer Abbas ◽  
Debabrata Mukherjee
Keyword(s):  
United States ◽  
Heart Failure ◽  
Heart Disease ◽  
Valvular Heart Disease ◽  
Heart Diseases ◽  
Medical Center ◽  
Care Facility ◽  
The United States ◽  
Study Objective ◽  
Valvular Heart Diseases

Background: The lifetime risk of developing Heart Failure (HF) is 20% for Americans ≥40 years of age. In the United States, greater than 650,000 new HF cases are diagnosed annually. About 5.1 million persons in the United States have clinically manifest HF. Additionally, HF has high absolute mortality rates of approximately 50% within 5 years of diagnosis. HF carries substantial health and economic burden. It is the primary diagnosis in >1 million hospitalizations annually. Patients hospitalized for HF are at high risk for all-cause re hospitalization. The total cost of HF care in the United States exceeds $30 billion annually. Objective: The study objective was to investigate the prevalence of valvular heart disease among patients hospitalized for HF in a largely Hispanic population. Methods: This is a retrospective study with aims inclusive of: analyzing the hospitalization and 4 months, 6 months, 2 year- re-hospitalization rates of HF in University Medical Center between Oct 2010 and Oct 2013; evaluating the association between valvular heart disease and hospitalizations for HF. Inclusion criteria were: admission/re hospitalizations with HF (with reduced, preserved and borderline EF). Echocardiographic determination of at least moderate valvular disease was utilized in this study as significant. Exclusion criteria were: patients lost to follow-up, death in hospital, transfer to another acute care facility, and discharge against medical advice. Demographics were also collected. Results: Hospitalizations involving 195 patients (120 men and 75 women) were randomly analyzed. The racial spread showed 77.4% (151 of 195) Hispanics and 22.6% (44 of 195) non-Hispanics. Out of the 195 index hospitalizations, the 4 month, 6 months and 2 years rehospitalization visits were 17.4% (34 of 195), 22.5% (44 of 195) and 38.5% (75 of 195) respectively. The prevalence of significant valvular heart disease was 45.9% (90 of 195), while the prevalence of no valvular heart disease was 54.1% (105 of 195) (p < 0.05). Conclusion: Multiple, prior studies have shown that valvular heart diseases have a comparatively low association with clinical Heart Failure. This study raises a valid point that in some population groups (the Hispanic), the burden of valvular heart disease may be greater than has been published in other groups. This calls for more studies, and has lots of potential implications in Heart Failure management.

scholarly journals Outpatient Management of Heart Failure in the United States, 2006–2008

2014 ◽  
Vol 41 (3) ◽  
pp. 253-261 ◽  
Author(s):  
Kailash Mosalpuria ◽  
Sunil K. Agarwal ◽  
Sirin Yaemsiri ◽  
Bredy Pierre-Louis ◽  
Samir Saba ◽  
...  
Keyword(s):  
United States ◽  
Heart Failure ◽  
Heart Disease ◽  
The United States ◽  
Primary Reason ◽  
Outpatient Management ◽  
Heart Failure Management ◽  
Visit Duration ◽  
Β Blocker ◽  
Β Blockers

Better outpatient management of heart failure might improve outcomes and reduce the number of rehospitalizations. This study describes recent outpatient heart-failure management in the United States. We analyzed data from the National Ambulatory Medical Care Survey of 2006–2008, a multistage random sampling of non-Federal physician offices and hospital outpatient departments. Annually, 1.7% of all outpatient visits were for heart failure (51% females and 77% non-Hispanic whites; mean age, 73 ± 0.5 yr). Typical comorbidities were hypertension (62%), hyperlipidemia (36%), diabetes mellitus (35%), and ischemic heart disease (29%). Body weight and blood pressure were recorded in about 80% of visits, and health education was given in about 40%. The percentage of patients taking β-blockers was 38%; the percentage taking angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) was 32%. Medication usage did not differ significantly by race or sex. In multivariate-adjusted logistic regression models, a visit to a cardiologist, hypertension, heart failure as a primary reason for the visit, and a visit duration longer than 15 minutes were positively associated with ACEI/ARB use; and a visit to a cardiologist, heart failure as a primary reason for the visit, the presence of ischemic heart disease, and visit duration longer than 15 minutes were positively associated with β-blocker use. Chronic obstructive pulmonary disease was negatively associated with β-blocker use. Approximately 1% of heart-failure visits resulted in hospitalization. In outpatient heart-failure management, gaps that might warrant attention include suboptimal health education and low usage rates of medications, specifically ACEI/ARBs and β-blockers.

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