scholarly journals Outcomes associated with comorbid atrial fibrillation and heart failure in medicare beneficiaries with acute coronary syndrome

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Shih-Yin Chen ◽  
Concetta Crivera ◽  
Michael Stokes ◽  
Luke Boulanger ◽  
Jeff Schein
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Medicare Beneficiaries ◽  
Coronary Syndrome

Increased 5-year risk of stroke, atrial fibrillation, acute coronary syndrome and heart failure in out-of-hospital cardiac arrest survivors relative to population controls: a nationwide register-based

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Kragholm ◽  
K Bundgaard ◽  
M Wissenberg ◽  
F Folke ◽  
F Lippert ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Cardiac Arrest ◽  
Lipid Lowering ◽  
Registration System ◽  
Coronary Syndrome ◽  
Hospital Cardiac Arrest ◽  
Population Controls ◽  
Age And Sex

Abstract Background Out-of-hospital cardiac arrest (OHCA) survivors are a selected group of patients with younger age and less comorbid conditions relative to non-survivors. Long-term risk of stroke, atrial fibrillation or flutter (AF), acute coronary syndrome (ACS) and heart failure (HF) in OHCA survivors not diagnosed with any of these conditions as part of the cardiac arrest is unknown. Purpose To examine 5-year risk of stroke, AF, ACS and HF in 30-day OHCA survivors relative to age- and sex-matched population controls. Methods OHCA 30-day survivors and age- and sex-matched population controls not previously diagnosed with stroke, AF, ACS or HF or during the first 30 days after cardiac arrest were included using Danish Cardiac Arrest Registry data from 2001–2015 as well as the Danish Civil Registration System. Characteristics are compared using totals and percentages for categorical data and median and 25–75% percentiles for continuous data. Five-year outcomes are compared using cumulative incidence plots as well as Shared Frailty Cox regression modeling, unadjusted and adjusted for potential confounders including age, sex, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), peripheral arterial disease (PAD), chronic ischemic heart disease (IHD), transient ischemic attack (TIA), thyroid disease, cholesterol-lowering, antiplatelet and anticoagulant agents. Results Of 4362 30-day survivors, 1063 were stroke-, AF-, ACS- and HF-naïve and 1051 were matched to population controls using age, sex and time of OHCA event as matching variables. The figure depicts the risk of stroke beyond day 30 to 5 years of follow-up was 4.7% versus 1.7% for OHCA survivors vs. controls. Risks of AF, ACS and HF were 7.0% vs. 2.1%, 4.7% versus 1.2% and 12.2% vs. 1.0%, respectively. OHCA 30-day survivors were significantly more likely to have PAD relative to controls, 4.9% vs. 1.1%. Differences in IHD (22.0% vs. 1.7%), hypertension (28.1% vs. 14.6%), diabetes (9.5% vs. 4.1%), lipid-lowering agents (27.6% vs. 9.5%), COPD (11.3% vs. 2.2%) were also significant. When adjusting for these comorbidities as well as for thyroid diseases, chronic kidney disease, cancer, antiplatelet and anticoagulant therapy, differences remained highly significant: HR stroke 3.33 [95% CI 2.21–5.02], HR AF 3.26 [2.28–4.66], HR ACS 3.36 [2.14–5.27] and HR HF 11.50 [8.02–16.48]. Conclusion We demonstrate an increased five-year risk of stroke, atrial fibrillation or flutter, acute coronary syndrome and heart failure in out-of-hospital cardiac arrest survivors without prior existence of any of these conditions. These results indicate that OHCA survivors continue to remain high-risk patients for cardiovascular events and prevention intervention is warranted. Funding Acknowledgement Type of funding source: None

4183New onset atrial fibrillation in acute coronary syndrome: early vs late onset

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Alves Guimaraes ◽  
F M Goncalves ◽  
S Borges ◽  
J J Monteiro ◽  
P S Mateus ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Primary Endpoint ◽  
Major Bleeding ◽  
Late Onset ◽  
Prognostic Impact ◽  
Coronary Syndrome ◽  
History Of ◽  
Onset Atrial Fibrillation

Abstract Background The prognostic impact of the timing where new-onset Atrial Fibrillation (AF) occurs in Acute Coronary Syndrome (ACS) patients isn't well studied. Objective Evaluate the predictors and prognostic impact of early-onset AF (EAF) and late-onset AF (LAF) in ACS patients. Methods We analysed 17016 patients with ACS enrolled in a national multicenter registry from October 2010 to January 2019. Patients with history of valvular disease, valve replacement, AF present at hospital admission or those who died in the first 48 hours were excluded. EAF was defined as AF in the first 48 hours of hospitalization and LAF after 48 hours. The primary endpoint was a composite of death and readmission from cardiovascular causes at 1 year. Results The mean age was 65±13 years; 74% were males and 42% had STEMI). 324 (1.9%) had EAF and 344 (2.0%) had LAF. The predictors of EAF were age ≥75 years (OR 2.04, 95% CI 1.53–2.70, p<0.001); history of heart failure (OR 1.82, 95% CI 1.09–3.02, p=0.022), STEMI diagnosis (OR 2.74, 95% CI 2.06–3.61, p<0.001), admission Killip class (KK)≥2 (OR 2.70, 95% CI 1.98–3.69, p<0.001). The predictors of LAF were age ≥75 years (OR 3.15, 95% CI 2.36–4.19, p<0.001), history of stable angina (OR 1.42, 95% CI 1.06–1.90, p=0.018), cerebrovascular disease (OR 1.68, 95% CI 1.14–2.46, p=0.008), COPD (OR 2.33, 95% CI 1.58–3.44, p<0.001), STEMI diagnosis (OR 2.31, 95% CI 1.77–3.03, p<0.001), admission KK ≥2 (OR 2.06, 95% CI 1.54–2.76, p<0.001) and stress hyperglycemia (OR 1.54, 95% CI 1.15–2.05, p=0.003) In STEMI patients only those with LAF had higher symptoms time (245 (IQR 165–400) minutes vs 284 (IQR 200–425) min; p=0.02). During hospitalization, LAF patients had a worse prognosis with a higher rate of heart failure, re-infarction, stroke, major bleeding and death (Table 1). In the follow-up, in multivarite analysis, only LAF was a predictor of the primary endpoint (EAF: HR 0.79, 95% CI 0.50–1.25, p=0.314; LAF: HR 1.45, 95% CI 1.05–2.00, p<0.025). Complications during hospitalization No AF EAF LAF p Death 1.3 6.5 12.5 <0.001 Heart Failure 11.4 38.3 50.3 <0.001 Re-enfarction 1.0 0.9 3.5 <0.001 Stroke 0.5 0.9 3.8 <0.001 Major bleeding 1.3 4.3 4.1 <0.001 Kaplan Meier curve Conclusion Patients with EAF and LAF have different characteristics and outcomes with LAF patients having a worse in-hospital and long term prognosis.

P5656Heart failure clinical phenotypes and outcomes in patients with atrial fibrillation: an analysis from the eurobservational research programme in atrial fibrillation long-term general registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Proietti ◽  
C Laroche ◽  
A Tello-Montoliu ◽  
R Lenarczyk ◽  
G A Dan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Regression Analysis ◽  
Cox Regression ◽  
Adverse Outcomes ◽  
Cox Regression Analysis ◽  
Coronary Syndrome

Abstract Introduction Heart failure (HF) is a well-known risk factor for atrial fibrillation (AF). Moreover, HF is associated with worse clinical outcomes in patients with known AF. Recently, phenotypes of HF have been redefined according to the level of ejection fraction (EF). New data are needed to understand if a differential risk for outcomes exists according to the new phenotypes' definitions. Purpose To evaluate the risk of major adverse outcomes in patients with AF and HF according to HF clinical phenotypes. Methods We performed a subgroup analysis of AF patients enrolled in the EORP-AF Long-Term General Registry with a history of HF at baseline, available EF and follow-up data. Patients were categorized as follows: i) EF<40%, i.e. HF reduced EF [HFrEF]; ii) EF 40–49%, i.e. HF mid-range EF [HFmrEF]; iii) EF ≥50%, i.e. HF preserved EF [HFpEF]. Any thromboembolic event (TE)/acute coronary syndrome (ACS)/cardiovascular (CV) death, CV death and all-cause death were recorded. Results A total of 3409 patients were included in this analysis: of these, 907 (26.6%) had HFrEF, 779 (22.9%) had HFmrEF and 1723 (50.5%) had HFpEF. An increasing proportion with CHA2DS2-VASc ≥2 was found across the three groups: 90.4% in HFrEF, 94.6% in HFmrEF and 97.3% in HFpEF (p<0.001), while lower proportions of HAS-BLED ≥3 were seen (28.0% in HFrEF, 26.3% in HFmrEF and 23.6% in HFpEF, p=0.035). At discharge patients with HFpEF were less likely treated with antiplatelet drugs (22.0%) compared to other classes and were less prescribed with vitamin K antagonists (VKA) (57.0%) and with any oral anticoagulant (OAC) (85.7%). No differences were found in terms of non-vitamin K antagonist oral anticoagulant use. At 1-year follow-up, a progressively lower rate for all study outcomes (all p<0.001), with an increasing cumulative survival, was found across the three groups, with patients with HFpEF having better survival (all p<0.0001 for Kaplan-Meier curves). After full adjustment, Cox regression analysis showed that compared to HFrEF, HFmrEF and HFpEF were associated with risk of all study outcomes (Table). Cox Regression Analysis HR (95% CI) Any TE/ACS/CV Death CV Death All-Cause Death HFmrEF 0.65 (0.49–0.86) 0.53 (0.38–0.74) 0.55 (0.41–0.74) HFpEF 0.50 (0.39–0.64) 0.42 (0.31–0.56) 0.45 (0.35–0.59) ACS = Acute Coronary Syndrome; CI = Confidence Interval; CV = Cardiovascular; EF = Ejection Fraction; HF = Heart Failure; HR = Hazard Ratio. Conclusions In this cohort of AF patients with HF, HFpEF was the most common phenotype, being associated with a profile related to an increased thromboembolic risk. Compared to HFrEF, both HFmrEF and HFpEF were associated with a lower risk of all major adverse outcomes in AF patients.

scholarly journals Clinical and economic burden of atrial fibrillation in medicare beneficiaries with acute coronary syndrome

2013 ◽  
Vol 16 (3) ◽  
pp. A185
Author(s):  
S.Y. Chen ◽  
C. Crivera ◽  
M. Stokes ◽  
L. Boulanger ◽  
J. Schein
Keyword(s):  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Economic Burden ◽  
Medicare Beneficiaries ◽  
Coronary Syndrome

scholarly journals New‐onset atrial fibrillation in patients with acute coronary syndrome may be associated with worse prognosis and future heart failure

2019 ◽  
Vol 35 (2) ◽  
pp. 182-189 ◽  
Author(s):  
Mizuyoshi Nagai ◽  
Tomonori Itoh ◽  
Masaru Ishida ◽  
Tetsuya Fusazaki ◽  
Takashi Komatsu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Coronary Syndrome ◽  
Onset Atrial Fibrillation ◽  
Worse Prognosis ◽  
New Onset

scholarly journals Association of vitamin D and cardiovascular health

2018 ◽  
Vol 15 (1) ◽  
pp. 17-21
Author(s):  
Hridaya Bibhu Ghimire ◽  
Chandra Mani Adhikari
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Vitamin D ◽  
Acute Coronary Syndrome ◽  
Elderly Population ◽  
Cardiovascular Health ◽  
Sun Exposure ◽  
Vitamin D Insufficiency ◽  
Coronary Syndrome ◽  
The Relationship

Vitamin D insufficiency or deficiency is highly prevalent due to limited sun exposure especially in urban and elderly population. Vitamin D is now increasingly recognized as a hormone responsible for numerous physiologic functions in different cells and tissues of the human body including heart. Vitamin D has been shown to be linked with hypertension, acute coronary syndrome, heart failure, and atrial fibrillation. This review briefly overviews the relationship between vitamin D deficiency, its supplementation and outcome in cardiovascular health.Nepalese Heart Journal 2018; 15(1): 17-21.

scholarly journals Editor’s Choice– Impact of identifying precipitating factors on 30-day mortality in acute heart failure patients

2019 ◽  
Vol 8 (7) ◽  
pp. 667-680 ◽  
Author(s):  
Xavier Rossello ◽  
Víctor Gil ◽  
Rosa Escoda ◽  
Javier Jacob ◽  
Alfons Aguirre ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Acute Heart Failure ◽  
Prognostic Value ◽  
Precipitating Factors ◽  
Time Pattern ◽  
Heart Failure Patients ◽  
Coronary Syndrome ◽  
Gender And Age

Background: The aim of this study was to describe the prevalence and prognostic value of the most common triggering factors in acute heart failure. Methods: Patients with acute heart failure from 41 Spanish emergency departments were recruited consecutively in three time periods between 2011 and 2016. Precipitating factors were classified as: (a) unrecognized; (b) infection; (c) atrial fibrillation; (d) anaemia; (e) hypertension; (f) acute coronary syndrome; (g) non-adherence; and (h) two or more precipitant factors. Unadjusted and adjusted logistic regression models were used to assess the association between 30-day mortality and each precipitant factor. The risk of dying was further evaluated by week intervals over the 30-day follow-up to assess the period of higher vulnerability for each precipitant factor. Results: Approximately 69% of our 9999 patients presented with a triggering factor and 1002 died within the first 30 days (10.0%). The most prevalent factors were infection and atrial fibrillation. After adjusting for 11 known predictors, acute coronary syndrome was associated with higher 30-day mortality (odds ratio (OR) 1.87; 95% confidence interval (CI) 1.02–3.42), whereas atrial fibrillation (OR 0.75; 95% CI 0.56–0.94) and hypertension (OR 0.34; 95% CI 0.21–0.55) were significantly associated with better outcomes when compared to patients without precipitant. Patients with infection, anaemia and non-compliance were not at higher risk of dying within 30 days. These findings were consistent across gender and age groups. The 30-day mortality time pattern varied between and within precipitant factors. Conclusions: Precipitant factors in acute heart failure patients are prevalent and have a prognostic value regardless of the patient’s gender and age. They can be managed with specific treatments and can sometimes be prevented.

Cardiology

2013 ◽  
Author(s):  
Victoria Stacey
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Infective Endocarditis ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Loss Of Consciousness ◽  
Pericardial Disease ◽  
Coronary Syndrome ◽  
Transient Loss

Acute coronary syndrome (ACS) - Investigations in ACS - Management of ACS - Management of STEMI/new LBBB - Atrial fibrillation - Arrhythmias - Transient loss of consciousness - Sudden cardiac death (SCD) - Heart failure - Hypertensive emergencies - Infective endocarditis - Pericardial disease - SAQs

Abstract 158: Heart Failure and Outcomes after Acute Coronary Syndrome in a Representative Medicare Population

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Shih-Yin Chen ◽  
Concetta Crivera ◽  
Michael Stokes ◽  
Luke Boulanger ◽  
Jeff Schein
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Patient Characteristics ◽  
Comorbid Condition ◽  
Sample Population ◽  
Medicare Beneficiaries ◽  
Coronary Syndrome ◽  
Medicare Population ◽  
Multi Stage ◽  
Increased Risk

Background: Heart failure (HF) is a common comorbid condition of elderly patients with acute coronary syndrome (ACS). The objective of this study is to compare the incidence of death and cardiovascular (CV) events among Medicare beneficiaries hospitalized for ACS) with and without comorbid HF. Methods: Patients hospitalized for ACS between 3/1/2002 - 12/31/2006 were identified from the Medicare Current Beneficiary Survey (date of first such admission denoted as the index date). Incident patients were selected defined as those with no ACS event in the 6 month pre-index period. Patients were stratified based on the presence (HF+) or absence (HF-) of medical claims for HF during the 6 months pre-index period. Comparisons of incidence of death and CV-related hospitalization were made between HF+ and HF-cohorts descriptively via Kaplan Meier curves and also with Cox proportional regressions adjusting for differences in patient characteristics. Sample population weights were applied accounting for multi-stage sampling design to obtain nationally representative estimates for the US Medicare population. Results: A final sample of 795 incident ACS patients were included (mean age 76 years; 49% male), of which 198 were HF+ (weighted prevalence=24.9% from the 2.5 million beneficiaries that these patients represent). The incidence of death after ACS admission among HF+ and HF- patients was 580 and 240 per 1,000 person years, respectively (p<0.01). If patients were discharged alive, HF+ patients had a significantly higher risk of subsequent CV events (812 vs. 355 cases; p<0.01) when 1,000 patients were followed for 6 months. After regression adjustment, there was a significant increased risk of mortality (HR=1.45; 95% CI: 1.09 - 1.93) and CV events (HR=1.72; 95% CI: 1.35 - 2.19) associated with comorbid HF. Conclusion: Our real-world findings suggest significantly poorer outcomes associated with HF among Medicare beneficiaries hospitalized for ACS. Personalized interventions targeting patients with both HF and ACS may improve the outcomes and quality of care.

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