scholarly journals Liraglutide Mortality Effect on Atrial Fibrillation Patients

2021 ◽  
Author(s):  
Justin Haloot ◽  
Mohamed Mahmoud ◽  
Auroa Badin
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Acute Coronary Syndrome ◽  
Acute Heart Failure ◽  
Lower Risk ◽  
Research Network ◽  
Coronary Syndrome ◽  
Mortality Effect ◽  
All Cause Mortality

Introduction: Liraglutide, a glucagon-like peptide 1 receptor agonist (GLP-1) utilized for management of type 2 diabetes mellitus, has been associated with reduced risk of cardiovascular events. However, it is also associated with increased heart rate and reduced heart rate variability. In this study, we investigate the effect of liraglutide in patients with atrial fibrillation (AF). Methods: TriNetX global research network provided aggregate data for this retrospective cohort study of AF patients on liraglutide that were matched to AF patients not on liraglutide from January 1, 2016, through November 13, 2021. Primary outcomes were all-cause mortality, ischemic stroke, hemorrhagic stroke, acute heart failure episode, and acute coronary syndrome episode. Results: 16,214 AF patients on liraglutide were propensity score matched to AF patients not on liraglutide. They were matched for demographics, cardiovascular procedures, cardiovascular medications, hypertension, diabetes, heart failure, ischemic heart disease, and diabetic medications. AF patients on liraglutide were found to have a significantly lower risk of all-cause mortality (HR 0.67, 95% CI 0.631 – 0.711, p < 0.001). There was a tendency toward lower risk of stroke, acute heart failure, and acute coronary syndrome but was not statistically significant. Conclusion: Liraglutide is associated with lower risk of all-cause mortality in AF patients. These findings are limited due to the retrospective nature of the study. Further examination is needed of liraglutide effect on mortality in AF patients.

P6361Prognostic value of discharge heart rate in acute heart failure patients: more relevant in atrial fibrillation?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Vidal-Perez ◽  
R Agra-Bermejo ◽  
D Pascual-Figal ◽  
F Gude Sampedro ◽  
C Abou Jokh ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Sinus Rhythm ◽  
Acute Heart Failure ◽  
Left Ventricular Ejection ◽  
Long Term Outcomes ◽  
All Cause Mortality ◽  
One Year

Abstract Background The prognostic impact of heart rate (HR) in acute heart failure (AHF) patients is not well known especially in atrial fibrillation (AF) patients. Purpose The aim of the study was to evaluate the impact of admission HR, discharge HR, HR difference (HRD) (admission- discharge) in AHF patients with sinus rhythm (SR) or AF on long- term outcomes. Methods We included 1398 patients consecutively admitted with AHF between October 2013 and December 2014 from a national multicentric, prospective registry. Logistic regression models were used to estimate the association between admission HR, discharge HR and HR difference and one- year all-cause mortality and HF readmission. Results The mean age of the study population was 72±12 years. Of these, 594 (42.4%) were female, 655 (77.8%) were hypertensive and 655 (46.8%) had diabetes. Among all included patients, 745 (53.2%) had sinus rhythm and 653 (46.7%) had atrial fibrillation. Only discharge HR was associated with one-year all-cause mortality (Relative risk (RR)= 1.182, confidence interval (CI) 95% 1.024–1.366, p=0.022) in SR. In AF patients discharge HR was associated with one-year all-cause mortality (RR= 1.276, CI 95% 1.115–1.459, p≤0.001). We did not observe a prognostic effect of admission HR or HRD on long-term outcomes in both groups. This relationship is not dependent on left ventricular ejection fraction (Figure 1) Effect of post-discharge heart rate Conclusions In AHF patients lower discharge HR, neither the admission nor the difference, is associated with better long-term outcomes especially in AF patients Acknowledgement/Funding Heart Failure Program of the Red de Investigaciόn Cardiovascular del Instituto de Salud Carlos III, Madrid, Spain (RD12/0042) and the Fondo Europeo de

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.

Does chronic kidney disease improve the predictive value of the CHADS2 and CHA2DS2-VASc stroke stratification risk scores for atrial fibrillation?

2013 ◽  
Vol 109 (05) ◽  
pp. 956-960 ◽  
Author(s):  
Vanessa Roldán ◽  
Francisco Marín ◽  
Sergio Manzano-Fernández ◽  
Hermógenes Fernández ◽  
Pilar Gallego ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Acute Coronary Syndrome ◽  
Risk Factor ◽  
Stroke Risk ◽  
Risk Scores ◽  
Coronary Syndrome ◽  
All Cause Mortality

SummaryChronic Kidney Disease (CKD) constitutes an adverse risk factor in chronic anticoagulated atrial fibrillation (AF) patients, being related to adverse cardiovascular events, mortality and major bleeds. It is unclear if CKD adds independent prognostic information to stroke risk stratification schemes, as the risk factor components of the CHADS2 and CHA2DS2-VASc scores are themselves related to renal dysfunction. The aim of our study was to determine if CKD independently improves the predictive value of the CHADS2 and CHA2DS2-VASc stroke stratification scores in AF. We recruited consecutive patients (n=978) patients (49% male; median age 76) with permanent or paroxysmal AF on oral anticoagulants with acenocoumarol, from our out-patient anticoagulation clinic. After a median follow-up of 875 (IQR 706–1059) days, we recorded stroke/transient ischaemic attack (TIA), peripheral embolism, vascular events (acute coronary syndrome, acute heart failure and cardiac death) and all-cause mortality. During follow-up, 113 patients (4.82%/year) experienced an adverse cardiovascular event, of which 39 (1.66%/year) were strokes, 43 (1.83%/year) had an acute coronary syndrome and 32 (1.37%/year) had acute heart failure. Also, 102 patients (4.35%/year) died during the following up, 31 of them (1.32%/year) as a result of a thrombotic event. Based on c-statistics and the integrated discrimination improvement (IDI), CKD did not improve the prediction for stroke/systemic embolism, thrombotic events and all-cause mortality using the CHADS2 and CHA2DS2-VASc scores. In conclusion, evaluating renal function in AF patients is important as CKD would confer a poor overall prognosis in terms of thromboembolic events and all-cause mortality. Adding CKD to the CHADS2 and CHA2DS2-VASc stroke risk scores did not independently add predictive information.Note: The review process for this manuscript was fully handled by Christian Weber, Editor in Chief.

scholarly journals The role of levosimendan in acute heart failure complicating acute coronary syndrome: A review and expert consensus opinion

2016 ◽  
Vol 218 ◽  
pp. 150-157 ◽  
Author(s):  
Markku S. Nieminen ◽  
Michael Buerke ◽  
Alain Cohen-Solál ◽  
Susana Costa ◽  
István Édes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Acute Heart Failure ◽  
Expert Consensus ◽  
Coronary Syndrome ◽  
Consensus Opinion

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

scholarly journals P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

2020 ◽  
Vol 9 (6) ◽  
pp. 1657
Author(s):  
Po-Wei Chen ◽  
Wen-Han Feng ◽  
Ming-Yun Ho ◽  
Chun-Hung Su ◽  
Sheng-Wei Huang ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Primary Endpoint ◽  
Major Bleeding ◽  
Lower Risk ◽  
Coronary Intervention ◽  
P2y12 Inhibitor ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
All Cause Mortality

Background: P2Y12 inhibitor monotherapy is an alternative antiplatelet strategy in patients undergoing percutaneous coronary intervention (PCI). However, the ideal P2Y12 inhibitor for monotherapy is unclear. Methods and Results: We performed a multicenter, retrospective, observational study to compare the efficacy and safety of monotherapy with clopidogrel versus ticagrelor in patients with acute coronary syndrome (ACS) undergoing PCI. From 1 January 2014 to 31 December 2018, 610 patients with ACS who received P2Y12 monotherapy with either clopidogrel (n = 369) or ticagrelor (n = 241) after aspirin was discontinued prematurely were included. Inverse probability of treatment weighting was used to balance covariates between the groups. The primary endpoint was the composite of all-cause mortality, recurrent ACS or unplanned revascularization, and stroke within 12 months after discharge. Overall, 84 patients reached the primary endpoint, with 57 (15.5%) in the clopidogrel group and 27 (11.2%) in the ticagrelor group. Multivariate adjustment in Cox proportional-hazards models revealed a lower risk of the primary endpoint with ticagrelor than with clopidogrel (adjusted hazard ratio (aHR): 0.67, 95% confidence interval (CI): 0.49–0.93). Ticagrelor significantly reduced the risk of recurrent ACS or unplanned revascularization (aHR: 0.46, 95% CI: 0.28–0.75). No significant difference in all-cause mortality and major bleeding events was observed between the 2 groups. Conclusions: Among patients with ACS undergoing PCI who cannot complete course of dual antiplatelet therapy, a significantly lower risk of cardiovascular events was associated with ticagrelor monotherapy than with clopidogrel monotherapy. The major bleeding risk was similar in both the groups.

scholarly journals Prognostic value of discharge heart rate in acute heart failure patients: More relevant in atrial fibrillation?

2020 ◽  
Vol 26 ◽  
pp. 100444
Author(s):  
Agra Bermejo Rosa ◽  
Pascual-Figal Domingo ◽  
Gude Sampedro Francisco ◽  
Delgado Jiménez Juan ◽  
Vidal Pérez Rafael ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Acute Heart Failure ◽  
Prognostic Value ◽  
Heart Failure Patients
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