The impact of atrial fibrillation on one-year mortality in patients with severe lower extremity arterial disease

Acute Limb Ischemia ◽

Lower Extremity Arterial Disease ◽

All Cause Mortality ◽

One Year ◽

Abstract Backgroundand Aims: Atrial fibrillation (Afib) is associated with the incidence of lower extremity arterial disease (LEAD), but its effect on severe LEAD prognosis remains unclear. We investigated the association between Afib and clinical outcomes.Methods and ResultsWe retrospectively enrolled consecutive severe LEAD patients receiving percutaneous transluminal angioplasty between 2013/1/1 and 2018/12/31. Patients were divided by a history of any type of Afib and followed for at least one year. The primary outcome was all-cause mortality. Secondary outcomes were cardiac-related mortality, major adverse cardiovascular events (MACEs), and major adverse limb events (MALEs). The study included 222 patients aged 74 ± 11 years (54% male), and 12.6% had acute limb ischemia. The Afib group had significantly higher rates of all-cause mortality (42.9% vs. 20.1%, P = 0.014) and MACEs (32.1% vs. 14.4%, P = 0.028) than the non-Afib group. After adjustment for confounders, Afib was independently associated with all-cause mortality (adjusted HR: 2.153, 95% CI: 1.084–4.276, P = 0.029) and MACEs (adjusted HR: 2.338, 95% CI: 1.054–2.188, P = 0.037).ConclusionsAfib was significantly associated with increased risks of one-year all-cause mortality and MACEs in severe LEAD patients. Future studies should investigate whether oral anticoagulants benefit these patients.

The impact of atrial fibrillation on one-year mortality in patients with severe peripheral artery diseases

European Heart Journal ◽

10.1093/ehjci/ehaa946.2360 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C.W Liu ◽

M.I Su

Keyword(s):

Atrial Fibrillation ◽

Heart Rate ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Peripheral Artery ◽

Cardiac Events ◽

Significant Difference ◽

All Cause Mortality ◽

One Year ◽

Abstract Background Atrial fibrillation (Afib) was associated with the incidence of peripheral artery disease (PAD), but the effect of Afib on prognosis in patients with severe PAD remains unclear. Purpose We aimed to investigate the association between Afib and clinical outcomes. Methods We retrospectively enrolled consecutive patients with severe PAD receiving percutaneous transluminal angioplasty between 2013/1/1 and 2018/12/31. The study outcomes were all-cause mortality, cardiac-related mortality, major adverse cardiac events (MACE), and major adverse limb events (MALE) at one-year. Results The study consisted of 222 patients with age 74±11 years, the stage of Rutherford classification 4.6±0.8, 54% male, and 12.6% presented with acute limb ischemia. The patients with Afib vs. without Afib had significantly greater ratios of all-cause mortality (42.9% vs. 20.1%, P=0.014) and MACE (32.1% vs. 14.4%, P=0.028). A trend toward significant association was found regarding one-year cardiac mortality (21.4% vs. 10.3%, P=0.111). No significant difference was found with respect of MALE (17.9% vs. 14.9%, P=0.778). After we adjusted for confounders in each study outcome, Afib was independently associated with all-cause mortality (adjusted HR: 2.153, 95% CI: 1.084–4.276, P=0.029) and MACE (adjusted HR: 2.338, 95% CI: 1.054–2.188, P=0.037). Other predictors associated with all-cause mortality included the presence of acute limb ischemia (adjusted HR: 2.898, 95% CI: 1.504–5.586, P=0.001), Rutherford classification (adjusted HR: 1.930, 95% CI: 1.191–3.128, P=0.008), and heart rate (adjusted HR: 1.018, 95% CI: 1.001–1.035, P=0.035). The other predictor associated with MACE was heart rate (adjusted HR: 1.020, 95% CI: 1.002–1.037, P=0.025) Conclusions Afib was significantly associated with increased risks of all-cause mortality and MACE at one year in the patients with severe PAD, and future studies may investigate whether use of oral anti-coagulants benefits to these patients. Funding Acknowledgement Type of funding source: None

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

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.223 ◽

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.

Impact of rate control medications on one-year outcomes with atrial fibrillation and heart failure

European Heart Journal ◽

10.1093/eurheartj/ehab724.0493 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

R Mo ◽

Y Yang ◽

L Yu

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Adverse Events ◽

Rate Control ◽

Cardiovascular Death ◽

Control Treatment ◽

All Cause Mortality ◽

One Year ◽

Cox Analysis ◽

Abstract Purpose Atrial fibrillation (AF) and heart failure (HF) often coexist. The impact of rate-control regimens in AF and HF patients has not been well understood. Methods In this multicenter, prospective registry with one-year follow-up, 1359 persistent or permanent AF patients got enrolled. A 1:1 HF to non-HF propensity score matching was applied to adjust for confounding variables. The primary endpoint was all-cause mortality while the secondary endpoint was defined as cardiovascular death and stroke. Multivariate Cox analysis was performed to evaluate the association between different rate-control treatment and incidence of adverse events. Results Before matching, HF patients were much younger and more likely to be female. They had a much higher prevalence of previous myocardial infarction, chronic obstructive pulmonary disease and valvular heart disease. Among 1359 participants, we identified 1016 matched patients. The number of drugs did not affect the risk of all-cause mortality in both cohorts. For non-HF patients, using calcium channel blockers (CCBs) plus digoxin had a significant higher risk of all-cause death (HR=5.703, 95% CI 1.334–24.604, p=0.019) and cardiovascular death (HR=9.558, 95% CI 2.127–42.935, p=0.003) compared with patients not receiving rate-control treatment. The use of beta-blockers, CCBs, digoxin alone, other dual or triple combinations was not related to risk of adverse events in both groups. Conclusions The combined use of CCBs and digoxin was related to increase all-cause and cardiovascular mortality in AF patients without HF but not for those with HF. However, the ideal rate-control regimen for AF and HF patients has not been established and well-designed clinical trials are needed. FUNDunding Acknowledgement Type of funding sources: None. Results of multivariate Cox analysis Kaplan-Meier curves by drug numbers

Oral anticoagulation improves survival in very elderly Chinese patients with atrial fibrillation: A report from the Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry

International Journal of Stroke ◽

10.1177/17474930211046743 ◽

2021 ◽

pp. 174749302110467

Author(s):

Yutao Guo ◽

Agnieszka Kotalczyk ◽

Jacopo F Imberti ◽

Yutang Wang ◽

Gregory YH Lip ◽

...

Keyword(s):

Atrial Fibrillation ◽

Elderly Patients ◽

Oral Anticoagulant ◽

Oral Anticoagulants ◽

Chinese Patients ◽

Very Elderly ◽

Elderly Chinese ◽

All Cause Mortality ◽

The Impact ◽

New Onset

Background Advancing age is a major risk factor for ischemic stroke in atrial fibrillation. We aimed to evaluate the predictors of all-cause death/any thromboembolism and the impact of oral anticoagulant on clinical outcomes in very elderly (≥85 years) Chinese atrial fibrillation patients. Methods The ChiOTEAF is a prospective registry proceeded in 44 sites from 20 provinces in China between October 2014 and December 2018. Outcomes of interest were all-cause mortality, any thromboembolism, major bleeding, and new onset/worsening heart failure. Results The eligible cohort for this analysis included 6416 patients and 1215 (18.9%) patients were aged ≥85 years. Only 320 (26.4%) very elderly patients were treated with oral anticoagulant, of whom 205 (64.1%) received non-vitamin K antagonist oral anticoagulants, while antiplatelet therapy was used among 642 (53.1%) very elderly patients. On multivariate analysis, the use of oral anticoagulant was an independent predictor of a lower risk of the composite outcome (OR: 0.46; 95% CI: 0.32–0.66) and all-cause death (OR: 0.47; 95% CI: 0.32–0.69) among these very elderly atrial fibrillation patients. Conclusions Advanced age should not be a reason to withhold oral anticoagulant, since the use of oral anticoagulants is safe and improves survival.

Abstract 3432: Patients with Upper Extremity Arterial Disease Have Similar Major Adverse Clinical Events as Those with Lower Extremity Arterial Disease

Circulation ◽

10.1161/circ.116.suppl_16.ii_775-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Yung-Wei Chi ◽

T. Cooper Woods

Keyword(s):

Lower Extremity ◽

Upper Extremity ◽

Smoking Status ◽

Arterial Disease ◽

Lower Extremity Arterial Disease ◽

Clinical Events ◽

Vascular Laboratory ◽

Ischemic Attack ◽

Peripheral Arterial

Introduction: Upper extremity arterial disease, although it occurs less frequently compared to lower extremity arterial disease, negatively impacts one’s lifestyle. Most studies on peripheral arterial disease have been focused on the lower extremities and the clinical impact of upper extremity arterial disease remains less well known. Hypothesis: Patients with upper extremity arterial disease have similar major adverse cardiovascular events (MACE) as those with lower extremity arterial disease. Methods: Sixty-seven consecutive patients with upper extremity arterial studies and 359 consecutive patients with lower extremity arterial studies performed in 2004 by an accredited vascular laboratory were followed for at least 2 years. MACE including death, stroke, transient ischemic attack (TIA), myocardial infarction (MI) and unstable angina (USA) were tabulated and compared between the 2 groups. Final results were adjusted for diabetes mellitus, hypertension, hyperlipidemia, smoking status, and renal insufficiency. One-tailed t test was used. Results: Eight events (28%) occurred in 29 patients with abnormal upper extremity arterial study compared to 24 events (21%) in 112 patients with abnormal lower extremity arterial study, p=NS. Five events (13%) occurred in 38 patients with normal upper extremity arterial study compared to 8 events (28%) in those with abnormal upper extremity arterial study, p=0.02. Twenty events (8%) occurred in 247 patients with normal lower extremity arterial study compared to 24 events (21%) in those with abnormal lower extremity arterial study, p<0.0001. Conclusion: Patients with upper extremity arterial disease defined by abnormal upper extremity arterial study have similar MACE to those with lower extremity arterial disease (28% versus 21%, p=NS). In addition, those with either upper or lower extremity arterial disease have statistically more MACE than those without disease. Major Adverse Clinical Events

Lower Extremity Arterial Disease as a Predictor of Incident Atrial Fibrillation and Cardiovascular Events

Mayo Clinic Proceedings ◽

10.1016/j.mayocp.2020.07.036 ◽

2021 ◽

Vol 96 (5) ◽

pp. 1175-1183

Author(s):

Andrew S. Tseng ◽

Marlene Girardo ◽

Christine Firth ◽

Shubhang Bhatt ◽

David Liedl ◽

...

Keyword(s):

Atrial Fibrillation ◽

Lower Extremity ◽

Cardiovascular Events ◽

Arterial Disease ◽

Lower Extremity Arterial Disease

3480 Association of Clopidogrel Resistance Determinants and MACE Ocurrence in Peripheral Arterial Disease

Journal of Clinical and Translational Science ◽

10.1017/cts.2019.83 ◽

2019 ◽

Vol 3 (s1) ◽

pp. 34-34

Author(s):

Hector Jose Nunez Medina

Keyword(s):

Puerto Rico ◽

Antiplatelet Therapy ◽

Limb Ischemia ◽

Arterial Disease ◽

Standard Test ◽

Acute Limb Ischemia ◽

Clopidogrel Resistance ◽

Cyp2c19 Polymorphism ◽

OBJECTIVES/SPECIFIC AIMS: The study aims to identify the short and long-term associations of HTPR and presence of CYP2C19 polymorphism in the occurrence of major adverse cardiovascular events (MACE). The primary outcome of the study will be the presence of MACE including stent thrombosis, need for revascularization, acute limb ischemia events, myocardial infarction and death in relation to the presence of HTPR and CYP2C19 polymorphism. Secondary outcomes will include the prevalence of HTPR and CYP2C19 polymorphism in patients with PAD, and association with other medications including aspirin and cilostazol. METHODS/STUDY POPULATION: Patients above 21 years of age with the diagnosis of PAD using clopidogrel therapy for at least for seven days will be recruited at the University of Puerto Rico District Hospital and Cardiovascular Hospital of Puerto Rico and the Caribbean. RESULTS/ANTICIPATED RESULTS: A total of 200 patients from Puertorrican, Dominican and Cuban ethnicity will be expected to be recruited. The most common comorbidities will include, coronary artery disease, hypertension, dyslipidemia, and diabetes mellitus type 2. No significant distr DISCUSSION/SIGNIFICANCE OF IMPACT: The status quo as it pertains to resistance to clopidogrel in PAD patients is to improve antiplatelet resistance using antiplatelet therapy guided by platelet assays in order to reduce MACE occurrence. Although HTPR and presence of CYP2C19 polymorphisms have been studied on the PAD population, currently there is no gold standard test for measuring antiplatelet resistance. In that regard, this study will expect to identify the contribution that HTPR and CYP2C19 polymorphism might have on MACE in patients with PAD. In this way, the results will allow identification of abnormality parameters in HTPR and CYP2C19 testing in relation to the impact on risk of having MACE. Once the association of these variables with MACE is established, testing for clopidogrel resistance could become a potential strategy to optimize antiplatelet therapy and reduce the impact that MACE have in this population.

Thromboembolism and Mortality in the Tasmanian Atrial Fibrillation Study

Journal of Cardiovascular Pharmacology and Therapeutics ◽

10.1177/1074248418769638 ◽

2018 ◽

Vol 23 (4) ◽

pp. 329-336

Author(s):

Endalkachew Admassie ◽

Leanne Chalmers ◽

Luke R. Bereznicki

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Incidence Rates ◽

Public Hospitals ◽

All Cause Mortality ◽

Mortality Incidence ◽

Time Periods ◽

Ischemic Attack ◽

Background: Although utilization of anticoagulation in patients with atrial fibrillation (AF) has increased in recent years, contemporary data regarding thromboembolism and mortality incidence rates are limited outside of clinical trials. This study aimed to investigate the impact of the direct oral anticoagulants (DOACs) on the clinical outcomes of patients with AF included in the Tasmanian Atrial Fibrillation Study. Methods: The medical records of all patients with a primary or secondary diagnosis of AF who presented to public hospitals in Tasmania, Australia, between 2011 and 2015, were retrospectively reviewed. We investigated overall thromboembolic events (TEs), ischemic stroke/transient ischemic attack (IS/TIA), and mortality incidence rates in patients admitted to the Royal Hobart Hospital, the main teaching hospital in the state. We compared outcomes in 2 time periods: prior to the availability of DOACs (pre-DOAC; 2011 to mid-2013) and following their general availability after government subsidization (post-DOAC; mid-2013 to 2015). Results: Of the 2390 patients with AF admitted during the overall study period, 942 patients newly prescribed an antithrombotic medication (465 and 477 from the pre-DOAC and post-DOAC time periods, respectively) were followed. We observed a significant decrease in the incidence rates of overall TE (3.2 vs 1.7 per 100 patient-years [PY]; P < .001) and IS/TIA (2.1 vs 1.3 per 100 PY; P = .022) in the post-DOAC compared to the pre-DOAC period. All-cause mortality was significantly lower in the post-DOAC period (2.9 vs 2.2 per 100 PY, P = .028). Increasing age, prior stroke, and admission in the pre-DOAC era were all risk factors for TE, IS/TIA, and mortality in this study population. The risk of IS/TIA was more than doubled (hazard ratio: 2.54; 95% confidence interval: 1.17-5.52) in current smokers compared to ex- and nonsmokers. Conclusion: Thromboembolic event and all-cause mortality rates were lower following the widespread availability of DOACs in this population.

464Optimal timing of invasive coronary angiography following NSTEMI

European Heart Journal ◽

10.1093/eurheartj/ehz747.0123 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Mahendiran ◽

D Nanchen ◽

D Meier ◽

B Gencer ◽

R Klingenberg ◽

...

Keyword(s):

Myocardial Infarction ◽

Real World ◽

Invasive Coronary Angiography ◽

Cox Proportional Hazards ◽

Significant Difference ◽

All Cause Mortality ◽

One Year ◽

The Impact ◽

Grace Score

Abstract Introduction Current guidelines recommend angiography within 24 hours of hospitalisation for patients with non-ST elevation myocardial infarction (NSTEMI). The recent VERDICT study found that angiography within 12 hours of hospitalisation was associated with improved cardiovascular outcomes among high-risk patients. We aimed to obtain a real-world perspective of the impact of angiography timing on one-year outcomes of patients admitted with NSTEMI. Methods Data was obtained from the SPUM-ACS registry, a cohort of consecutive patients hospitalised with acute coronary syndromes in four university hospitals in Switzerland between 2009 and 2017. Patients without a door-to-catheter (DTC) time and those with life-threatening features were excluded. Cox proportional hazards models evaluated the impact of DTC time on the primary endpoint, defined as one-year major adverse cardiovascular events (MACE: cardiovascular mortality, myocardial infarction, stroke), and on one-year all-cause mortality. Results Of 2,672 NSTEMI patients, 1,832 met the inclusion criteria. Among them, 1,464 patients underwent angiography within 12 hours of admission (12h group) while 368 patients underwent angiography between 12 and 24 hours (12–24h group). After 2:1 propensity score matching, 736 patients from the 12h group and 368 patients from the 12–24h group were deemed equivalent in terms of main baseline clinical characteristics. Multiple logistic regression identified admission out-of-hours (night or weekend) as the most significant factor associated with delayed angiography. Cox models found no significant association between early angiography and one-year MACE (12h group: n=57 (7.7%) vs. 12–24h group: n=27 (7.3%), HR: 1.050, 95% CI 0.637- 1.733, p=0.847), or one-year all-cause mortality (12h group: n=25 (3.4%) vs. 12–24h group: n=17 (4.6%), HR: 1.514, 95% CI 0.774- 2.962, p=0.225) (Figure 1A). After stratification based on GRACE score (>140 vs. ≤140), there was no significant difference in one-year MACE or one-year all-cause mortality in the 12h group compared with the 12–24h group (p for interaction=0.601 and 0.463, respectively) (Figure 1A + 1B). Figure 1 Conclusion In an unselected real-world cohort of NSTEMI patients, angiography within 12 hours of hospitalisation was not associated with improved one-year outcomes when compared with angiography between 12 and 24 hours, even among patients with an elevated GRACE score.

Transient atrial fibrillation and risk of stroke after acute myocardial infarction

Thrombosis and Haemostasis ◽

10.1160/th11-05-0343 ◽

2011 ◽

Vol 106 (11) ◽

pp. 877-884 ◽

Cited By ~ 16

Author(s):

Rema Bishara ◽

Gregory Telman ◽

Fadel Bahouth ◽

Jonathan Lessick ◽

Doron Aronson

Keyword(s):

Myocardial Infarction ◽

Atrial Fibrillation ◽

Acute Myocardial Infarction ◽

Ischaemic Stroke ◽

Hospital Discharge ◽

Oral Anticoagulants ◽

Antiplatelet Agents ◽

Increased Risk ◽

One Year ◽

SummaryAtrial fibrillation (AF) is a frequent complication of acute myocardial infarction (AMI). In the AMI setting, AF is frequently brief and attributed to acute haemodynamic changes, inflammation or ischaemia. However, it remains uncertain whether transient AF episodes are associated with a subsequent increased risk of ischaemic stroke. We studied the impact of transient new-onset AF on the one-year risk of ischaemic stroke or transient ischaemic attack (TIA) in a retrospective cohort of 2,402 patients with AMI. Patients with previous AF or AF at hospital discharge were excluded. Transient AF occurred in 174 patients (7.2%) during the initial hospitalisation. During one year follow-up after hospital discharge, stroke or TIA occurred in 16 (9.2%) and 58 (2.6%) patients with and without transient AF, respectively (p< 0.0001). Compared with patients without transient AF, the adjusted hazard ratio for stroke or TIA in patients with transient AF was 3.03 (95% CI 1.73–5.32; p< 0.0001). Stroke or TIA occurred in 2.6% of patients without AF, 6.3% of patients with transient AF treated with oral anticoagulants, and 9.9% of patients with transient AF treated with antiplatelet agents. The incidence of recurrent AF after hospital discharge was markedly higher in patients with transient AF during the index hospitalisation (22.8% vs. 2.0%, p< 0.0001). In conclusion, transient AF complicating AMI is associated with an increased future risk of ischaemic stroke and TIA, particularly in patients treated with antiplatelet agents alone. High AF recurrence rates in these patients also suggest that oral anticoagulants should be strongly considered.