scholarly journals Reevaluation of risk factors for time to subsequent events after first stroke occurrence using a new weighted all-cause effect measure

2020 ◽  
Author(s):  
Ann-Kathrin Ozga ◽  
Bernhard Rauch ◽  
Frederick Palm ◽  
Christian Urbanek ◽  
Armin Grau ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Atrial Fibrillation ◽  
Recurrent Stroke ◽  
Treatment Options ◽  
Composite Endpoint ◽  
Hazard Ratio ◽  
Variable Degree ◽  
One Year ◽  
The Impact

Abstract Background: Risk diseases and risk factors for stroke include atrial fibrillation, hypertension, diabetes mellitus, smoking, and elevated LDL-cholesterol. Due to modern treatment options, the impact of these risk diseases on subsequent cardiovascular events or death after a first stroke is less clear and needs to be elucidated. We therefore aimed to get insights into the persistence of adverse prognostic effects of these risk diseases and risk factors on subsequent stroke or death events one year after the first stroke by using the new weighted all-cause hazard ratio.Methods: This study evaluates the one year follow-up of 470 first ever stroke cases identified in the area of Ludwigshafen, Germany, with 23 deaths and 34 subsequent stroke events. For this purpose, the recently introduced “weighted all-cause hazard ratio” was used, which allows a weighting of the competing endpoints within a composite endpoint. Moreover, we extended this approach to allow an adjustment for covariates. Results: None of these risk factors and risk diseases, most probably being treated after the first stroke, remained to be associated with a subsequent death or stroke [weighted hazard ratios (95% confidence interval) for diabetes mellitus, atrial fibrillation, high cholesterol, hypertension, and smoking are 0.4 (0.2 - 0.9), 0.8 (0.4 - 2.2), 1.3 (0.5 - 2.5), 1.2 (0.3 - 2.7), 1.6 (0.8 - 3.6), respectively]. However, when analyzed separately in terms of death and stroke, the risk factors and risk diseases under investigation affect the subsequent event rate to a variable degree.Conclusions: Using the new weighted hazard ratio, established risk factors and risk diseases for the occurrence of a first stroke do not remain to be significant predictors for subsequent events like death or recurrent stroke. It has been demonstrated that the new weighted hazard ratio can be used for a more adequate analysis of cardiovascular risk and disease progress. The results have to be confirmed within a larger study with more events.

scholarly journals Reevaluation of risk factors for time to subsequent events after first stroke occurrence using a new weighted all-cause effect measure

2020 ◽  
Author(s):  
Ann-Kathrin Ozga ◽  
Bernhard Rauch ◽  
Frederick Palm ◽  
Christian Urbanek ◽  
Armin Grau ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Atrial Fibrillation ◽  
Recurrent Stroke ◽  
Treatment Options ◽  
Composite Endpoint ◽  
Hazard Ratio ◽  
Variable Degree ◽  
One Year ◽  
The Impact

Abstract Background: Risk diseases and risk factors for stroke include atrial fibrillation, hypertension, diabetes mellitus, smoking, and elevated LDL-cholesterol. Due to modern treatment options, the impact of these risk diseases on subsequent cardiovascular events or death after a first stroke is less clear and needs to be elucidated. We therefore aimed to get insights into the persistence of adverse prognostic effects of these risk diseases and risk factors on subsequent stroke or death events one year after the first stroke by using the new weighted all-cause hazard ratio.Methods: This study evaluates the one year follow-up of 470 first ever stroke cases identified in the area of Ludwigshafen, Germany, with 23 deaths and 34 subsequent stroke events. For this purpose, the recently introduced “weighted all-cause hazard ratio” was used, which allows a weighting of the competing endpoints within a composite endpoint. Moreover, we extended this approach to allow an adjustment for covariates. Results: None of these risk factors and risk diseases, most probably being treated after the first stroke, remained to be associated with a subsequent death or stroke [weighted hazard ratios (95% confidence interval) for diabetes mellitus, atrial fibrillation, high cholesterol, hypertension, and smoking are 0.4 (0.2 - 0.9), 0.8 (0.4 - 2.2), 1.3 (0.5 - 2.5), 1.2 (0.3 - 2.7), 1.6 (0.8 - 3.6), respectively]. However, when analyzed separately in terms of death and stroke, the risk factors and risk diseases under investigation affect the subsequent event rate to a variable degree.Conclusions: Using the new weighted hazard ratio, established risk factors and risk diseases for the occurrence of a first stroke do not remain to be significant predictors for subsequent events like death or recurrent stroke. It has been demonstrated that the new weighted hazard ratio can be used for a more adequate analysis of cardiovascular risk and disease progress. The results have to be confirmed within a larger study with more events.

scholarly journals Reevaluation of risk factors for time to subsequent events after first stroke occurrence using a new weighted all-cause effect measure

2019 ◽  
Author(s):  
Ann-Kathrin Ozga ◽  
Bernhard Rauch ◽  
Frederick Palm ◽  
Christian Urbanek ◽  
Armin Grau ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Atrial Fibrillation ◽  
Recurrent Stroke ◽  
Composite Endpoint ◽  
Hazard Ratio ◽  
Specific Effects ◽  
Index Stroke ◽  
One Year ◽  
The One

Abstract Background : Risk factors for stroke include atrial fibrillation, hypertension, diabetes mellitus, smoking, and high cholesterol. However, the role of these factors on subsequent cardiovascular events or death is less clear due to therapeutic measures. We therefore aim to get insights into the persistence of known risk factors on subsequent stroke or death one year after the first stroke and to illustrate how the new weighted all-cause hazard ratio can ease the interpretation of competing time-to-event endpoints with different clinical relevance. Methods : This study evaluates the one year follow-up of 470 first ever stroke cases identified in the area of Ludwigshafen, Germany, with 23 deaths and 34 subsequent stroke events. The recently introduced weighted all-cause hazard ratio was used which allows a weighting of the competing endpoints in a composite endpoint. We extended this approach to allow adjustment for covariates. The investigated risk factors were atrial fibrillation, hypertension, diabetes mellitus, smoking, and hypercholesterolemia adjusting for age and sex. Results : None of these meanwhile treated risk factors of which some have been modified after first stroke remained to be associated with subsequent death or stroke. Cause-specific effects point sometimes into opposite directions. Conclusions : Using the new weighted hazard ratio, we can support that well established risk factors for the occurrence of an index stroke are no good predictors of further disease progress defined by death or recurrent stroke. It has been demonstrated that the new weighted hazard ratio provides interpretation advantages over the common all-cause hazard ratio.

scholarly journals Reevaluation of risk factors for time to subsequent events after first stroke occurrence using a new weighted all-cause effect measure

2020 ◽  
Author(s):  
Ann-Kathrin Ozga ◽  
Bernhard Rauch ◽  
Frederick Palm ◽  
Christian Urbanek ◽  
Armin Grau ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Atrial Fibrillation ◽  
Recurrent Stroke ◽  
Composite Endpoint ◽  
Hazard Ratio ◽  
Diabetic Patients ◽  
High Cholesterol ◽  
Disease Progress ◽  
One Year

Abstract Background : Risk factors for stroke include atrial fibrillation, hypertension, diabetes mellitus, smoking, and high cholesterol. However, the role of these factors on subsequent cardiovascular events or death is less clear due to therapeutic measures. We therefore aim to get insights into the persistence of known risk factors on subsequent stroke or death one year after the first stroke and to illustrate how the new weighted all-cause hazard ratio can ease the interpretation of competing time-to-event endpoints with different clinical relevance. Methods : This study evaluates the one year follow-up of 470 first ever stroke cases identified in the area of Ludwigshafen, Germany, with 23 deaths and 34 subsequent stroke events. The recently introduced weighted all-cause hazard ratio was used which allows a weighting of the competing endpoints in a composite endpoint. We extended this approach to allow adjustment for covariates. The investigated risk factors were those listed above. Results : None of these risk factors, most probably being treated after the first stroke, remained to be associated with subsequent death or stroke [weighted hazard ratios (95% confidence interval) for diabetes mellitus, atrial fibrillation, high cholesterol, hypertension, and smoking are 0.4 (0.2, 0.9), 0.8 (0.4, 2.2), 1.3 (0.5, 2.5), 1.2 (0.3, 2.7), 1.6 (0.8, 3.6), respectively]. Cause-specific effects sometimes point into opposite directions. Conclusions : Using the new weighted hazard ratio, we can support that well established risk factors for the occurrence of an index stroke are no good predictors of further disease progress defined by death or recurrent stroke, e.g. in our study diabetic patients even showed a decreased risk for recurrent stroke. It has been demonstrated that the new weighted hazard ratio provides interpretation advantages over the common all-cause hazard ratio and can thus be used for a more adequate analysis of cardiovascular risk and disease progress. The results have to be confirmed within a larger study with more events.

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

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.

scholarly journals ROLE OF GOUT IN ATRIAL FIBRILLATION

2019 ◽  
Vol 31 (4) ◽  
pp. 943-945
Author(s):  
Antoniya Kisheva
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Clinical Practice ◽  
Composite Endpoint ◽  
Analysis Model ◽  
Significant Difference ◽  
Galectin 3 ◽  
One Year ◽  
The Impact

Atrial fibrillation (AF) is the most prevalent arrhythmia in clinical practice. Atrial fibrillation (AF) is the most prevalent arrhythmia in clinical practice. There is increasing evidence for the role of inflammation in the development and maintenance of AF and gout is associated with inflammation and oxidative stress. In the last years several studies were published to assess the role of gout as a risk factor for occurrence of atrial fibrillation (AF). There are not enough data on the importance of gout in patients, who already have AF. The aim of the study is to assess the impact of gout on the clinical course of AF. Overall 101 patients – 51 females and 50 males at mean age 68,02 ± 7,001, with AF after sinus rhythm restoration were included in a clinical trial of one-year placebo-controlled treatment with spironolactone. Gout was reported in 6,8% of them. They were analyzed for AF recurrence, hospitalization for AF, all-cause admissions, composite endpoint (recurrence episodes of AF, all-cause hospitalization and death) and value of biomarker Galectin-3 (Gal-3). Results: Patients with gout had double risk of recurrence of AF, even though not significant, HR=1.97, 95%CI=0,78-4.98, p=0,15. In our study presence of gout was significant predictor for hospitalization for AF in unifactor analysis (HR 4,46, 95% CI=1.51 – 13.19, p=0,007) and the only significant in multifactor analysis – model, including gender, age categories, hypertension, diabetes and use of spironolactone (HR=4,23, 95%CI=1,28–14,1, p=0,018). Gout influenced significant also the all-cause hospitalizations, HR =3.17, 95%CI 1.10-9.14, p=0.033. There was a significant difference between the value of Gal-3 in patients with gout as opposed to patients without (28,52±15 vs 16,02±5,49, р=0,002). Conclusion: We found that gout significantly influences the course of AF. Presence of gout in patients with atrial fibrillation is a risk factor for recurrence and hospitalization – cause-specific for AF and all-cause. The value of Gal-3 as a marker of fibrosis and inflammation is higher in patients with AF and gout.

Prevalence and prognostic impact of left ventricular systolic dysfunction after acute myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T.J Jernberg ◽  
E.O Omerovic ◽  
E.H Hamilton ◽  
K.L Lindmark ◽  
L.D Desta ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Risk Factor ◽  
Reperfusion Therapy ◽  
Left Ventricular ◽  
Funding Source ◽  
Additional Risk Factor ◽  
Additional Risk

Abstract Background Left ventricular dysfunction after an acute myocardial infarction (MI) is associated with poor outcome. The PARADISE-MI trial is examining whether an angiotensin receptor-neprilysin inhibitor reduces the risk of cardiovascular death or worsening heart failure (HF) in this population. The aim of this study was to examine the prevalence and prognosis of different subsets of post-MI patients in a real-world setting. Additionally, the prognostic importance of some common risk factors used as risk enrichment criteria in the PARADISE-MI trial were specifically examined. Methods In a nationwide myocardial infarction registry (SWEDEHEART), including 87 177 patients with type 1 MI between 2011–2018, 3 subsets of patients were identified in the overall MI cohort (where patients with previous HF were excluded); population 1 (n=27 568 (32%)) with signs of acute HF or an ejection fraction (EF) <50%, population 2 (n=13 038 (15%)) with signs of acute HF or an EF <40%, and population 3 (PARADISE-MI like) (n=11 175 (13%)) with signs of acute HF or an EF <40% and at least one risk factor (Age ≥70, eGFR <60, diabetes mellitus, prior MI, atrial fibrillation, EF <30%, Killip III-IV and STEMI without reperfusion therapy). Results When all MIs, population 1 (HF or EF <50%), 2 (HF or EF <40%) and 3 (HF or EF <40% + additional risk factor (PARADISE-MI like)) were compared, the median (IQR) age increased from 70 (61–79) to 77 (70–84). Also, the proportion of diabetes (22% to 33%), STEMI (38% to 50%), atrial fibrillation (10% to 24%) and Killip-class >2 (1% to 7%) increased. After 3 years of follow-up, the cumulative probability of death or readmission because of heart failure in the overall MI population and in population 1 to 3 was 17.4%, 26.9%, 37.6% and 41.8%, respectively. In population 2, all risk factors were independently associated with death or readmission because of HF (Age ≥70 (HR (95% CI): 1.80 (1.66–1.95)), eGFR <60 (1.62 (1.52–1.74)), diabetes mellitus (1.35 (1.26–1.44)), prior MI (1.16 (1.07–1.25)), atrial fibrillation (1.35 (1.26–1.45)), EF <30% (1.69 (1.58–1.81)), Killip III-IV (1.34 (1.19–1.51)) and STEMI without reperfusion therapy (1.34 (1.21–1.48))) in a multivariable Cox regression analysis. The risk increased with increasing number of risk factors (Figure 1). Conclusion Depending on definition, post MI HF is present in 13–32% of all MI patients and is associated with a high risk of subsequent death or readmission because of HF. The risk increases significantly with every additional risk factor. There is a need to optimize management and improve outcomes for this high risk population. Figure 1 Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Novartis

scholarly journals Effects of ertugliflozin on kidney composite outcomes, renal function and albuminuria in patients with type 2 diabetes mellitus: an analysis from the randomised VERTIS CV trial

Diabetologia ◽  
2021 ◽  
Author(s):  
David Z. I. Cherney ◽  
◽  
Bernard Charbonnel ◽  
Francesco Cosentino ◽  
Samuel Dagogo-Jack ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Renal Dialysis ◽  
Composite Endpoint ◽  
Composite Outcome ◽  
The Impact

Abstract Aims/hypothesis In previous work, we reported the HR for the risk (95% CI) of the secondary kidney composite endpoint (time to first event of doubling of serum creatinine from baseline, renal dialysis/transplant or renal death) with ertugliflozin compared with placebo as 0.81 (0.63, 1.04). The effect of ertugliflozin on exploratory kidney-related outcomes was evaluated using data from the eValuation of ERTugliflozin effIcacy and Safety CardioVascular outcomes (VERTIS CV) trial (NCT01986881). Methods Individuals with type 2 diabetes mellitus and established atherosclerotic CVD were randomised to receive ertugliflozin 5 mg or 15 mg (observations from both doses were pooled), or matching placebo, added on to existing treatment. The kidney composite outcome in VERTIS CV (reported previously) was time to first event of doubling of serum creatinine from baseline, renal dialysis/transplant or renal death. The pre-specified exploratory composite outcome replaced doubling of serum creatinine with sustained 40% decrease from baseline in eGFR. In addition, the impact of ertugliflozin on urinary albumin/creatinine ratio (UACR) and eGFR over time was assessed. Results A total of 8246 individuals were randomised and followed for a mean of 3.5 years. The exploratory kidney composite outcome of sustained 40% reduction from baseline in eGFR, chronic kidney dialysis/transplant or renal death occurred at a lower event rate (events per 1000 person-years) in the ertugliflozin group than with the placebo group (6.0 vs 9.0); the HR (95% CI) was 0.66 (0.50, 0.88). At 60 months, in the ertugliflozin group, placebo-corrected changes from baseline (95% CIs) in UACR and eGFR were −16.2% (−23.9, −7.6) and 2.6 ml min−1 [1.73 m]−2 (1.5, 3.6), respectively. Ertugliflozin was associated with a consistent decrease in UACR and attenuation of eGFR decline across subgroups, with a suggested larger effect observed in the macroalbuminuria and Kidney Disease: Improving Global Outcomes in Chronic Kidney Disease (KDIGO CKD) high/very high-risk subgroups. Conclusions/interpretation Among individuals with type 2 diabetes and atherosclerotic CVD, ertugliflozin reduced the risk for the pre-specified exploratory composite renal endpoint and was associated with preservation of eGFR and reduced UACR. Trial registration ClinicalTrials.gov NCT01986881 Graphical abstract

scholarly journals Association of proteinuria and incident atrial fibrillation in patients with diabetes mellitus: a population-based senior cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Juntae Kim ◽  
Pil-Sung Yang ◽  
Byoung-Eun Park ◽  
Tae Soo Kang ◽  
Seong-Hoon Lim ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Confidence Interval ◽  
Population Based ◽  
Hazard Ratio ◽  
Diabetic Patients ◽  
Dependent Manner ◽  
Dipstick Test ◽  
Patients With Diabetes ◽  
Urine Dipstick Test

AbstractDiabetes mellitus (DM) is considered an independent risk factor for atrial fibrillation (AF). The excess risk in relation to the presence of proteinuria has not been well elucidated. Our aim was to determine the association between the incidence of AF and proteinuria in diabetic population. A total of 240,499 individuals aged ≥ 60 years from the Korea National Health Insurance Service-Senior cohort from 2004 to 2014 were included. 4.2% of individuals with DM and 3.7% of controls were diagnosed with AF during a median follow-up period of 7.2 years. Amongst controls (participants without proteinuria and DM), DM only, proteinuria only, and DM with proteinuria groups, the crude incidences of AF were 0.58, 0.70, 0.96, 1.24 per 100 person-years respectively. Compared with controls, the weighted risk of AF was increased by 11% (hazard ratio = 1.11, 95% confidence interval = 1.02–1.20, P = .001), 48% (hazard ratio = 1.48, 95% confidence interval = 1.30–1.69, P < .001), and 66% (hazard ratio = 1.66, 95% confidence interval = 1.26–2.18, P < .001) in the DM only, proteinuria only, and DM with proteinuria groups, respectively (P for trend < .001). Degree of proteinuria in diabetic patients was associated with a significantly higher rate of incident AF in dose dependent manner. Thus, assessing proteinuria by a simple urine dipstick test could provide a useful adjunct to risk assessment for AF in elderly population with DM.

scholarly journals Mechanism of and Therapeutic Strategy for Atrial Fibrillation Associated with Diabetes Mellitus

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Yubi Lin ◽  
Hairui Li ◽  
Xianwu Lan ◽  
Xianghui Chen ◽  
Aidong Zhang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Renin Angiotensin System ◽  
Hypoglycemic Agents ◽  
Angiotensin System ◽  
Low Levels ◽  
Upstream Therapy

Diabetes mellitus (DM) is one of the most important risk factors for atrial fibrillation (AF) and is a predictor of stroke and thromboembolism. DM may increase the incidence of AF, and when it is combined with other risk factors, the incidence of stroke and thromboembolism may also be higher; furthermore, hospitalization due to heart failure appears to increase. Maintenance of well-controlled blood glucose and low levels of HbA1c in accordance with guidelines may decrease the incidence of AF. The mechanisms of AF associated with DM are autonomic remodeling, electrical remodeling, structural remodeling, and insulin resistance. Inhibition of the renin-angiotensin system is suggested to be an upstream therapy for this type of AF. Studies have indicated that catheter ablation may be effective for AF associated with DM, restoring sinus rhythm and improving prognosis. Catheter ablation combined with hypoglycemic agents may further increase the rate of maintenance of sinus rhythm and reduce the need for reablation.

Abstract 223: Impact of Differences in Once- vs Twice-Daily Medications Adherence on the Risk of Bleed and Stroke in Non-Valvular Atrial Fibrillation: Analysis of Randomized Trials and Claims Data Sources

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Colleen A McHorney ◽  
Eric D Peterson ◽  
Mike Durkin ◽  
Veronica Ashton ◽  
François Laliberté ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Risk ◽  
Claims Data ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Once Daily ◽  
Cardiovascular Medications ◽  
One Year ◽  
The Impact ◽  
Similar Risk

Background: In non-valvular atrial fibrillation (NVAF) patients, those receiving once-daily (QD) versus twice-daily (BID) non vitamin-K antagonist oral anticoagulants (NOACs) may have better medication adherence. The impact on stroke and bleed risk is not known. Objective: To estimate the impact of adherence differences between QD vs BID therapies on bleed and stroke risks in NVAF patients. Methods: The relation between adherence (proportion of days covered [PDC]) for QD vs BID NOACs and one year bleed risk was modeled using claims data from Truven Health Analytics MarketScan databases (7/2012-10/2015). Next, the relation between adherence and bleeding was calibrated to match that seen in the placebo and NOAC arms of previous randomized controlled trials (RCTs). Finally, we used adherence rates for QD (PDC=0.849) and BID (PDC=0.738) cardiovascular medications from a meta-analysis (Coleman et al.). These rates were used in the calibrated model to estimate bleeds. An analogous method was applied to evaluate the impact of QD vs BID adherence on stroke risk. Results: The relation between PDC and risks of bleed and stroke was modeled using claims data (N=65,022) and calibrated using RCTs. In the calibrated model, compared with BID dosing, QD dosing was associated with 81 fewer strokes (34% reduction) and 14 more bleeds (6% more) per 10,000 patients/year (Figure). Conclusion: Among NVAF patients, better adherence to QD dosing was associated with a significantly lower stroke risk of QD but similar risk of bleed.

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