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

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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At risk or not at risk – the contribution of clinical and genetic risk factors to atrial fibrillation

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2021.01.025 ◽

2021 ◽

Author(s):

Brenda Gerull

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

At Risk ◽

Genetic Risk ◽

Genetic Risk Factors ◽

Not At Risk

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Risk Factors for Atrial Fibrillation following a Cardiac Surgery

10.22541/au.163256940.04888608/v1 ◽

2021 ◽

Author(s):

Ibrahim Marai ◽

Wiaam Khatib ◽

Liza Grosman-Rimon ◽

Shemy Carasso ◽

Ali Sakhnini ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Cardiac Surgery ◽

Cox Regression ◽

Medical Center ◽

Clinical Impact ◽

Cox Regression Analysis ◽

History Of ◽

Vascular Accidents ◽

Preoperative Factors

Background: Atrial fibrillation (AF) following cardiac surgery is common and has clinical impact on morbidity. The preoperative and intraoperative risk factors are still not well defined. The objective of the study was to examine preoperative and intraoperative risk factors for AF following cardiac surgery. Methods: A retrospective analysis of a database of cardiac surgeries was performed during 2017-2019 at Poriya Medical Center. Preoperative factors and intraoperative were recorded. Results: 208 patients were included in this analysis. Overall AF following cardiac surgery was detected in 50 (24%) patients. Of 175 patients who did not have history of AF prior to surgery, 27 (15.5%) had post-operative AF. In the 33 patients with previous AF, AF following surgery was detected in 23 (70%). Patients with AF following surgery who were older (66.2±8.0 vs. 60.7± 11.4 years, p=0.002), were treated more with anti-arrhythmic drugs (18.9% vs 4.5, p<0.001), and had higher rates of pre-operative AF (46% vs 6.3%, p=0.0001), prior cerebral vascular accidents (14% vs 4.4%, p=0.019), and prior valve replacement (10% vs 1.9%, p=0.009) compared to patients without AF following surgery. In multivariate Cox regression analysis, age (HR 1.04, CI 1.01-1.07, P=0.006) and history of preoperative AF (HR 6.01, CI 3.42-10.57, P<0.001) were predictors of AF following cardiac surgery. The probability of being free of postsurgical AF was 80% among patients without history of AF compared to 30% in patients with previous AF history (p<0.001). Conclusion: Preoperative AF and age were predictors of AF following cardiac surgery

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A protocol implementation to determine aspiration risk in patients with multiple risk factors for gastroparesis

Journal of Perioperative Practice ◽

10.1177/1750458921996925 ◽

2021 ◽

pp. 175045892199692

Author(s):

Sarah Schwisow ◽

Christian Falyar ◽

Susan Silva ◽

Virginia C Muckler

Keyword(s):

Risk Factors ◽

At Risk ◽

Solid Food ◽

Convenience Sample ◽

Aspiration Risk ◽

Physical Status Classification ◽

Increased Risk ◽

Gastric Contents ◽

American Society ◽

American Society Of Anesthesiologists

Patients with risk factors for gastroparesis are at increased risk for aspiration into the tracheobronchial tree. Current American Society of Anesthesiologists fasting guidelines use subjective measures to determine aspiration risk. A gastric ultrasound protocol can identify patients with risk factors for gastroparesis and determine the need to perform a point-of-care gastric ultrasound to objectively assess gastric antral contents. This enables the anaesthesia provider to assess patients at increased risk for aspiration. Additionally, many patients who present for surgery with risk factors for gastroparesis have an empty gastric antrum. Thus, the gastric ultrasound protocol checklist saves time and manpower requirements of anaesthesia staff without impacting patient safety or perioperative efficiency. A convenience sample of 40 patients consented for surgery was assessed using a screening tool to identify those at risk for gastroparesis and possible aspiration. Patients deemed at risk received a gastric ultrasound examination to evaluate for the presence of gastric contents. Over 12% of these patients had solid food gastric contents on exam. All patients with solid food gastric contents had an American Society of Anesthesiologists Physical Status Classification of 3 or higher, and two or more risk factors for gastroparesis.

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Predicting atrial fibrillation after acute abdominal surgery

European Heart Journal ◽

10.1093/eurheartj/ehab724.2795 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

C V Madsen ◽

B Leerhoey ◽

L Joergensen ◽

C S Meyhoff ◽

A Sajadieh ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Atrial Fibrillation ◽

Chronic Kidney Disease ◽

At Risk ◽

Kidney Disease ◽

Abdominal Surgery ◽

Prediction Model ◽

Vital Signs ◽

Patients At Risk

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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P127: A prospective study of the management and outcomes of patients with symptomatic atrial fibrillation and/or flutter presenting to emergency departments

CJEM ◽

10.1017/cem.2018.325 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S101-S102

Author(s):

B. H. Rowe ◽

P. Duke ◽

S. Patrick ◽

K. Lobay ◽

M. Haager ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Emergency Departments ◽

Chronic Atrial Fibrillation ◽

Prior History ◽

Fee For Service ◽

Chi Square ◽

Convenience Sample ◽

University Of Alberta ◽

Common Prior

Introduction: Patients with new onset and chronic atrial fibrillation and/or flutter (AFF) present to emergency departments (ED) with symptoms requiring acute management decisions. Most research has focused on patients with acute (<48 hours and/or <7 days with adequate anticoagulation) presentations of AFF and for whom rhythm control is considered safe. This study explored the demographic characteristics, risk factors, anticoagulant/anti-platelet prescription, and outcomes for patients with symptomatic AFF. Methods: A convenience sample of adult patients presenting to the one of three hospitals affiliated with the University of Alberta with symptoms of acute AFF were enrolled, within a fee-for-service billing environment. Following informed consent, a trained researcher administered a survey to each patient, recorded administrative details (e.g., triage, times, laboratory tests) from the ED information system, a chart review on treatments was conducted and patients were contacted for follow-up at 7 days via telephone. Descriptive (median and interquartile range {IQR} and proportions) and simple (t-tests, chi-square) statistics are presented for continuous and dichotomous outcomes, respectively. Results: Overall, 217 patients were enrolled; the median age was 64 (IQR: 55, 73) and 132 (61%) were male. Overall, 42 (19.4%) patients arrived by ambulance; 8 (4%) spontaneously converted or were diagnosed with another arrhythmia between arrival and obtaining an ECG. A prior history of AFF was common 152 (71%), as were the following cardiovascular and other risk factors: 176 (81.1%) consumed alcohol, 104 (48%) were current or former smokers, 86 (39.6%) had hypertension, 22 (10%) had CAD, and 10 (5%) had COPD. These patients most commonly reported palpitations 183 (84%) as their dominant symptom. Anti-platelets and anticoagulants were common prior to the ED 145 (67%), and 36 (17%) of patients were discharged from the ED without one of these medications. Overall, 80 (37%) patients had chronic AFF or an unknown timeline; no efforts were made to restore NSR in these patients. A dominant pattern for electrical cardioversion was observed; of 129 cases where cardioversion was attempted, 84 (65%) had electrical first and 45 (35%) had chemical first cardioversion attempts. Overall, 22 (49%) of 45 patients receiving chemical first were successfully converted to NSR. Patients with AFF history who were cardioverted were less likely hospitalized than those not-cardioverted (3% vs. 16%, p=0.006); 21 (10%) were admitted to hospital. Conclusion: In this center, patients with AFF often present to the ED with high acuity, with severe symptoms and receive aggressive care. The use of anticoagulants suggests an appreciation of thrombo-embolic risks, both in the community and ED settings. Like many EDs, this center appears to have a signature for AFF management, related to evidence gaps, physician preferences, and perhaps funding models.

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RISK FACTORS IN PATIENTS WITH ISCHEMIC STROKE ACCORDING TO THE HOSPITAL REGISTRY IN NALCHIK

Ulyanovsk Medico-biological Journal ◽

10.34014/2227-1848-2019-2-34-41 ◽

2019 ◽

pp. 34-41

Author(s):

A.A. Bykova ◽

V.M. Alifirova ◽

N.G. Brazovskaya

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

Arterial Hypertension ◽

Mortality Risk ◽

Recurrent Stroke ◽

Clinical Hospital ◽

Hospital Registry ◽

The City

The problem of stroke is currently one of the most urgent both in our country and abroad. Every year more than 6 million people are down with stroke worldwide. In the United States stroke is the third leading cause of mortality, in Europe it is the second, and in Russia – the first. In Russia, 450 000 patients are diagnosed with stroke annually. The prevalence of this disease among able-bodied people under 65 increases the cost of the health care budget [1–3]. Currently, ischemic strokes (IS) prevail, their proportion is 80 %. In 2 % of patients, a recurrent stroke develops by the end of the first year after the previous one, in 30 % of patients it happens by the end of the fifth year. In case of a recurrent stroke, the mortality rate increases by 1.5 times. The main task is stroke prevention in order to reduce morbidity, mortality and disability [4]. The purpose of the paper is to study IS risk factors (RF), their frequency, contribution to the disease development and prediction of outcomes of acute cerebrovascular events. Materials and Methods. The authors studied the prevalence of risk factors in 696 patients. They used the hospital registry in the patient cohort in the Kabardino-Balkar Republic (KBR), the city of Nalchik, during 2016–2017. They analyzed the data from the current registration of IS over the period of two years in patients over 25 years of age, hospitalized to the primary vascular department of the City clinical hospital No. 1 and the Regional Vascular Center of the Republican Clinical Hospital. In general, the authors analyzed 696 cases of ischemic stroke in patients over 25 years of age, and created an electronic data bank. Results. By means of hospital registry method the most significant risk factors for ischemic stroke were identified in the studied patient cohort. Their effect on the lethal outcome was determined. Conclusions. The authors identified the risk factors that increased the mortality risk. These are chronic heart failure, atrial fibrillation, asequence, cardiac arrhythmias, diabetes mellitus, and dyslipidemia. Smoking, arterial hypertension, angina pectoris alone do not affect the mortality risk. Keywords: ischemic stroke, risk factors, atrial fibrillation, arterial hypertension, diabetes mellitus. Проблема инсульта в настоящее время является одной из приоритетных как у нас в стране, так и во всем мире. Ежегодно в мире инсультом заболевает более 6 млн чел. Церебральный инсульт в США является третьей по частоте причиной смерти, в Европе – второй, в России – первой. В России инсульт случается у 450 тыс. пациентов в год. Распространенность этого заболевания среди лиц трудоспособного возраста до 65 лет повышает затраты бюджета здравоохранения [1–3]. Преобладают ишемические инсульты (ИИ), доля которых составляет 80 %. У 2 % пациентов повторный инсульт развивается к концу первого года с момента инсульта, у 30 % – к концу пятого. При повторном инсульте отмечается повышение показателя смертности в 1,5 раза. Основополагающей задачей является профилактика инсульта в целях снижения заболеваемости, смертности и инвалидизации [4]. Цель исследования – изучить частоту встречаемости факторов риска (ФР) ИИ, их вклад в развитие заболевания и прогнозирование исходов острых нарушений мозгового кровообращения. Материалы и методы. Изучена распространенность факторов риска у 696 пациентов по данным госпитального регистра в когорте больных по Кабардино-Балкарской Республике (КБР) на примере г. Нальчик за период 2016–2017 гг. Использованы данные, полученные при текущей регистрации случаев ИИ на протяжении двух лет у лиц старше 25 лет, госпитализированных в первичное сосудистое отделение городской клинической больницы № 1 и Региональный сосудистый центр Республиканской клинической больницы. Проанализировано 696 случаев ИИ у лиц старше 25 лет, создан электронный банк данных. Результаты. В исследуемой когорте больных методом госпитального регистра определены наиболее значимые факторы риска ишемического инсульта. Определено их влияние на развитие смертельного исхода. Выводы. Были выявлены факторы риска, которые повышают риск развития смертельного исхода. Такими являются хроническая сердечная недостаточность, фибрилляция предсердий, нарушения проводимости и нарушения сердечного ритма, сахарный диабет, дислипидемия. Курение, артериальная гипертония, стенокардия изолированно не оказывают влияния на риск развития смертельного исхода. Ключевые слова: ишемический инсульт, факторы риска, фибрилляция предсердий, артериальная гипертония, сахарный диабет.

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Risk factors for delayed speech development in children of early and preschool age

Российский педиатрический журнал ◽

10.46563/1560-9561-2021-24-5-323-327 ◽

2021 ◽

Vol 24 (5) ◽

pp. 323-327

Author(s):

Tatyana A. Kryuchkova

Keyword(s):

Risk Factors ◽

Rural Areas ◽

Medical Center ◽

Speech Development ◽

Preschool Age ◽

Premature Babies ◽

Pregnancy And Delivery ◽

The Central Nervous System ◽

Complicated Pregnancy ◽

The City

Speech is the most critical component of the neuropsychic development of a child. Over the past decade, an increase in the prevalence of delayed speech development (DSD) in children has been recorded worldwide. Timely diagnosis and correction of DSD at the early stages can lead to good results and minor violations of speech development in the future. Objective. To execute a comparative analysis of risk factors and the leading causes of the DSD development in children of early and preschool age in the Belgorod region from 2019 to 2021. Materials and methods. The analysis of 165 medical records of children examined and treated at the Belgorod Medical Center for the period from 2019 to 2021 was carried out. Results. DSD was found to be more common in children aged 1.5 to 3 years (79.5%), much less common in children over the age of 4 years (6.6%).DSD in boys (69.7%) occurs more than two times more common than girls (30.9%). The average age of mothers of DSD children ranged from 30 to 35 years. More than 50% of all DSD children are premature babies. All mothers of the examined patients had a complicated pregnancy and delivery in their history. Children living in the city (62.5%) had a 25% higher probability of DSD occurrence than children from rural areas (37.5%). According to the results of the study, lesions of the visual organs, residual and perinatal lesions of the central nervous system were the most common forms of pathology in DSD children. Conclusion. It is necessary to improve the early diagnosis and prevention of the DSD in children. Early detection of deviations in the child’s speech development will allow timely drug therapy and comprehensive systematic corrective work.

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