scholarly journals Differential Risk of Dementia Between Patients With Atrial Flutter and Atrial Fibrillation: A National Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Hui-Ting Wang ◽  
Yung-Lung Chen ◽  
Yu-Sheng Lin ◽  
Huang-Chung Chen ◽  
Shaur-Zheng Chong ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Oral Anticoagulants ◽  
Demographic Data ◽  
Previous History ◽  
Research Database ◽  
Subdistribution Hazard ◽  
Valvular Surgery ◽  
Increased Risk ◽  
History Of

Objectives: Atrial fibrillation (AF) is linked to an increased risk of stroke and dementia. Atrial flutter (AFL) is also linked to an increased risk of stroke but at a different level of risk as compared to AF. Little is known about the difference in the risk of dementia between AF and AFL. This study aims to investigate whether the risk of dementia is different between AF and AFL.Methods: Patients with newly diagnosed AF and AFL during 2001–2013 were retrieved from Taiwan's National Health Insurance Research Database. Patients with incomplete demographic data, aged <20 years, history of valvular surgery, rheumatic heart disease, hyperthyroidism, and history of dementia were excluded. The incidence of new-onset dementia was set as the primary outcome and analyzed in patients with AF and AFL after propensity score matching (PSM).Results: A total of 232,425 and 7,569 patients with AF and AFL, respectively, were eligible for analysis. After 4:1 PSM, we included 30,276 and 7,569 patients with AF and AFL, respectively, for analysis. Additionally, patients with AF (n = 29,187) and AFL (n = 451) who received oral anticoagulants were enrolled for comparison. The risk of dementia was higher in patients with AF compared with patients with AFL (subdistribution hazard ratio (SHR) = 1.52, 95% CI 1.39–1.66; p < 0.0001) before PSM and remained higher in patients with AF (SHR = 1.14, 95% CI 1.04–1.25; p = 0.0064) after PSM. The risk of dementia was higher in patients with AF without previous history of stroke after PSM but the risk did not differ between patients with AF and AFL with previous history of stroke. Among patients who received oral anticoagulants, the cumulative incidences of dementia were significantly higher in patients with AF than in patients with AFL before and after PSM (all P < 0.05).Conclusions: This study found that, among patients without history of stroke, the risk of dementia was higher in patients with AF than in patients with AFL, and CHA2DS2-VASc score might be useful for risk stratification of dementia between patients with AF and AFL.

scholarly journals Different implication in dementia between patients with atrial flutter and atrial fibrillation: a national cohort study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
YL Chen
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Research Database ◽  
Funding Sources ◽  
Valvular Surgery ◽  
Previous Stroke ◽  
Included Patient ◽  
National Cohort ◽  
History Of ◽  
The Difference

Abstract Funding Acknowledgements Type of funding sources: None. Importance Atrial fibrillation (AF) has been reported with increasing the risk of stroke and dementia. Atrial flutter (AFL) is also a risk of stroke with different discrepancies in clinical outcome. Little is known about the difference in the risk of dementia between AF and AFL. Objective To investigate if the risk of dementia is difference between AF and AFL. Methods The patients with newly diagnosed AF and AFL during 2001–2013 was retrieved from Taiwan’s National Health Insurance Research Database. Patients with missing information, aged <20 years, history of valvular surgery, rheumatic heart disease, hyperthyroidism, and history of dementia were excluded. Propensity score matching (PSM) between AF and AFL was performed, which included patient comorbidities, past medical history, medications, and index date stratified by age. Primary outcome was defined as dementia at follow-up. Results A total of 232,425 AF and 7,569 AFL were eligible for analysis. After 4:1 PSM, we included 30,276 AF (aged 67.3 ± 15.7 years) and 100,065 AFL (aged 67.4 ± 16.0 years) for analysis. The risk of dementia was higher in AF patients compared with AFL patients (subdistribution HR (SHR)=1.52, 95% CI 1.39 - 1.66; p <0.0001) before PSM and still higher in AF patients (SHR = 1.14, 95% CI 1.04 to 1.25; p = 0.0064). The risk was higher in AF patients without previous stroke after PSM and there was no difference between AF and AFL patients with previous stroke history. Conclusions and relevance Our finding supports that risk of dementia is higher in AF patients than AFL patients. However, the risk of dementia between patients with AF and AFL varies depending on whether there is a previous stroke history.

scholarly journals Atrial fibrillation and clinical outcomes 1 to 3 years after myocardial infarction

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001726
Author(s):  
Anthony P Carnicelli ◽  
Ruth Owen ◽  
Stuart J Pocock ◽  
David B Brieger ◽  
Satoshi Yasuda ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Oral Anticoagulants ◽  
Adverse Outcomes ◽  
Increased Risk ◽  
History Of ◽  
The Impact

ObjectiveAtrial fibrillation (AF) and myocardial infarction (MI) are commonly comorbid and associated with adverse outcomes. Little is known about the impact of AF on quality of life and outcomes post-MI. We compared characteristics, quality of life and clinical outcomes in stable patients post-MI with/without AF.Methods/resultsThe prospective, international, observational TIGRIS (long Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease) registry included 8406 patients aged ≥50 years with ≥1 atherothrombotic risk factor who were 1–3 years post-MI. Patient characteristics were summarised by history of AF. Quality of life was assessed at baseline using EQ-5D. Clinical outcomes over 2 years of follow-up were compared. History of AF was present in 702/8277 (8.5%) registry patients and incident AF was diagnosed in 244/7575 (3.2%) over 2 years. Those with AF were older and had more comorbidities than those without AF. After multivariable adjustment, patients with AF had lower self-reported quality-of-life scores (EQ-5D UK-weighted index, visual analogue scale, usual activities and pain/discomfort) than those without AF. CHA2DS2-VASc score ≥2 was present in 686/702 (97.7%) patients with AF, although only 348/702 (49.6%) were on oral anticoagulants at enrolment. Patients with AF had higher rates of all-cause hospitalisation (adjusted rate ratio 1.25 [1.06–1.46], p=0.008) over 2 years than those without AF, but similar rates of mortality.ConclusionsIn stable patients post-MI, those with AF were commonly undertreated with oral anticoagulants, had poorer quality of life and had increased risk of clinical outcomes than those without AF.Trial registration numberClinicalTrials: NCT01866904.

Abstract T MP104: The Role of Antithrombotics Therapy in Recent Ischaemic Stroke Patients with Atrial Fibrillation: Analysis from VISTA

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Azmil H Abdul-Rahim ◽  
Rachael L Fulton ◽  
Frank Benedikt ◽  
Turgut Tatlisumak ◽  
Maurizio Paciaroni ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischaemic Stroke ◽  
Recurrent Stroke ◽  
Previous History ◽  
Neurological Impairment ◽  
Antithrombotic Treatment ◽  
Risk Of Mortality ◽  
Natural Progression ◽  
Increased Risk ◽  
History Of

Background and Purpose: There is uncertainty on the optimal latency after acute ischaemic stroke at which antithrombotic treatment should commence for atrial fibrillation (AF) patients, in order to prevent recurrent stroke (RS) without provoking symptomatic intracranial haemorrhage (SICH). We sought to describe the risk factors and patterns of RS and SICH in a cohort of patients with AF and recent stroke. Methods: We assessed the association of antihrombotic treatment (i.e. anticoagulants and antiplatelets) with the distribution of the modified Rankin Scale (mRS) at day 90, and the occurrence of RS and SICH. We developed statistical models for the prediction of RS and SICH in the first 90 days after stroke, using univariate and multivariate analysis. Results: Data were available for 1,644 patients. Combined antithrombotic therapy with both anticoagulation and antiplatelet (n=782) was associated with more favourable functional outcome across full scale mRS OR=1.785 (95% CI: 1.316, 2.421; P=0.0002), and significantly lower risk of mortality by day 90, SICH by day 90 and RS by day 90: Mortality day 90 OR=0.344 (95% CI: 0.235, 0.502; P<0.0001), SICH day 90 OR=0.18 (95% CI: 0.086, 0.37; P<0.0001) and RS day 90 OR=0.33 (95% CI: 0.21, 0.53; P<0.0001). Patients with ischaemic stroke who had high baseline glucose had a high risk of both RS and SICH events after stroke. Additionally, patients who had increased neurological impairment, previous history of TIA and received no antithrombotic treatment were at increased risk of RS. The relative risk of RS versus SICH appeared constant over time. Conclusions: It seems justified to initiate anticoagulation immediately the patient attains medical and neurological stability, taking into account the potential of haemorrhagic transformation as part of the natural progression in stroke and the increasing risk of recurrent stroke with time if left untreated. Antiplatelet treatment pending introduction of anticoagulation is reasonable.

The implications of catheter ablation for solitary atrial flutter in preventing stroke risk: a nationwide population-based cohort study

EP Europace ◽  
2020 ◽  
Vol 22 (10) ◽  
pp. 1558-1566
Author(s):  
Yu-Sheng Lin ◽  
Victor Chien-Chia Wu ◽  
Hui-Ting Wang ◽  
Huang-Chung Chen ◽  
Mien-Cheng Chen ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
Primary Outcome ◽  
Stroke Risk ◽  
Population Based ◽  
Research Database ◽  
Confounding Factors ◽  
Subdistribution Hazard ◽  
Taiwan National Health Insurance ◽  
History Of

Abstract Aims The implications of ablation for atrial fibrillation in preventing stroke are controversial, and no studies have investigated whether ablation prevents ischaemic stroke (IS) in atrial flutter (AFL). Methods and results This study analysed data contained in the Taiwan National Health Insurance Research Database for 16 765 patients with a first diagnosis of solitary AFL during 2001–2013. Eligible patients were divided into two groups according to whether or not they had received ablation. Propensity score matching (PSM) was performed to mitigate the effects of potential confounding factors. The primary outcome was occurrence of IS during follow-up. After 1:2 PSM, the analysis included 1037 patients in the ablation group and 2074 patients in the non-ablation group. The incidence of IS was lower in the ablation group compared to the non-ablation group [subdistribution hazard ratio (SHR) 0.61, 95% confidence interval (CI) 0.41–0.90] during the 2-year follow-up period but not thereafter (SHR 1.03, 95% CI 0.72–1.48). When grouping by stroke history, it revealed that ablation affected the incidence of stroke in patients without history of stroke (SHR 0.59, 95% CI 0.38–0.91) but not in patients with history of stroke. When each group was stratified by CHA2DS2-VASc score, ablation lowered the incidence of stroke in patients with CHA2DS2-VASc ≤3 (SHR 0.31, 95% CI 0.16–0.60) but not in patients with CHA2DS2-VASc ≥4 in the initial 2-year follow-up. Conclusion The different incidence of IS in patients with/without ablation indicates that ablation reduces the risk of IS in AFL patients.

scholarly journals Prevalence of previous history of atrial fibrillation in patients referred for ablation of atrial flutter

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P4119-P4119
Author(s):  
B. Brembilla-Perrot ◽  
J. M. Sellal ◽  
J. Schwartz ◽  
A. Olivier ◽  
D. Beurrier ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Previous History ◽  
History Of

P3345Stroke and death in atrial fibrillation patients newly treated by oral anticoagulants in France: a national cohort study 2012–2016

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Gabet ◽  
E Chatignoux ◽  
Y Bejot ◽  
V Olie
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulants ◽  
National Level ◽  
Subdistribution Hazard ◽  
Stroke Incidence ◽  
Coronary Syndrome ◽  
Number Of Patients ◽  
Incidence And Mortality ◽  
History Of

Abstract Background Introduction of new oral anticoagulants (OAC) lead to an increase in atrial fibrillation (AF) patients treated with those drugs. Few epidemiological data on outcomes are available in France or abroad in this population. There is an important need to follow up patients newly diagnosed for AF and treated by OAC, and estimate stroke and mortality outcomes at national level in unselected patients' population. The French “Système national des données de santé” (SNDS) gathered enough medical information on the overall French population, with complete follow-up until patient's death. Purpose The objective of this study was to analyze stroke and death outcomes and their determinants in a cohort of AF patients newly treated by OAC in France between 2012 and 2016. Methods All AF patients aged over 20 years old, residing in France, and newly treated by OAC between 2012 and 2016 were included in a cohort. The date of OAC delivery was considered as the inclusion date. Patients were followed till 31 of December 2017. Main outcomes studied were the first hospitalisation for stroke or death. We used a Fine and Gray regression model to estimate subdistribution hazard ratio (SHR) for stroke. Cox regression models were used to compute cause-specific hazard ratios (CSHR) for stroke and death respectively. Analyses were adjusted for main confounders. Results The total number of patients enrolled in the study for the period 2012–2016 was 662,298. Mean age at inclusion was 74.9 years old. Women accounted for 47.8% of the study population. Globally, 3.8% of patients experienced stroke after initiation of OAC and 13.9% of patients died over the study period with 1.1% of death occurring after a stroke. The median follow-up for stroke or death events was 1094 days, 1208 days for stroke and 1123 days for death. Incidence rates of stroke or death reached 53.3 [53.0–53.6] per 1,000 person-year and, 11.3 [11.2–11.5] and 44.0 [43.7–44.3] for stroke and death respectively. Advanced age, history of stroke, acute coronary syndrome (ACS), chronic kidney disease (CKD), treated hypertension, diabetes and to be included during the first year of the study period were associated with an increase in the subdistribution hazard of stroke. Significant differences were found by age group such as an increase in SHR for stroke in women aged over 85 years compared to men of the same age. Cause-specific analyzes gave similar results for stroke. History of heart failure, ACS, CKD, hemorrhages, treated hypertension and diabetes were associated with increased hazard of death. On the contrary, female sex was associated with a significant decrease in the hazard of death only. Conclusion Stroke incidence and mortality rate in AF patients newly treated by OAC were high. Several factors were associated with increased hazard of stroke and death but differed according to patient's age.

P3526Heart Failure hospitalization and mortality in non-valvular Atrial Fibrillation: The ENGAGE-AF TIMI 48 Trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R M Inciardi ◽  
R Giugliano ◽  
F Nordio ◽  
C Ruff ◽  
E Antman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Troponin I ◽  
Risk Estimation ◽  
Previous History ◽  
Factor Xa ◽  
Composite Endpoint ◽  
Heart Valve Disease ◽  
Clinical Predictors ◽  
Increased Risk ◽  
History Of

Abstract Introduction Atrial Fibrillation (AF) is associated with increased risk of cardiovascular (CV) morbidity and mortality. Heart Failure (HF) represents the most common CV complication, more common than thromboembolic events. Purpose We aimed to determine clinical factors associated with HF hospitalization and mortality in a contemporary cohort of patients with AF without previous history of HF. Methods The Effective Anticoagulation with Factor Xa Next Generation in AF–Thrombolysis in Myocardial Infarction 48 (ENGAGE-AF TIMI 48) study tested the oral factor Xa inhibitor edoxaban in comparison with warfarin for the prevention of stroke or systemic embolism, in 21,105 patients with AF. We assessed the composite endpoint of HF hospitalization, death due to HF or sudden cardiac death in 8981 patients without a history of HF. Cox proportional hazard models were used to evaluate the significant clinical predictors associated with the endpoint of interest. Results Over a median follow-up of 2.8 years, 589 patients (6.5%) experienced the composite endpoint. Older patients, cardiovascular risk factors (hypertension, diabetes, heart valve disease), history of stroke and coronary artery disease, impaired renal function (ClCr ≤50 ml/min), heart rate at baseline and diuretic use were associated with increased risk of the composite endpoint (model c-statistic 0.66) (Figure 1). Outcomes were not affected by randomization to edoxaban or warfarin. In patients with available cardiac-derived biomarkers, elevated levels of both NT-proBNP and Troponin I were significantly associated with the endpoint after adjustment for the clinical predictors (Figure 1). The addition of the biomarkers to clinical predictors enhanced risk estimation (c-statistics 0.69, NRI 0.40, IDI 0.01, all p<0.001 for NT-proBNP and c-statistics 0.70, NRI 0.43, IDI 0.03, all p<0.001 for Troponin I). Figure 1 Conclusions HF hospitalization and mortality are important complications in AF patients without a history of HF. The addition of cardiac biomarkers to clinical characteristics enhances risk estimation. These findings may improve risk stratification.

scholarly journals MP37: Adherence to Canadian Cardiovascular Society guidelines for prescribing oral anticoagulants to patients with atrial fibrillation in the emergency department

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S55-S56
Author(s):  
D. Hung ◽  
M. Butler ◽  
S. Campbell
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Ischemic Stroke ◽  
Oral Anticoagulants ◽  
Previous History ◽  
Retrospective Chart Review ◽  
Prescribing Patterns ◽  
Prescribing Practices ◽  
Increased Risk ◽  
New Onset

Introduction: Atrial fibrillation (AF) is the most common arrhythmia treated in the emergency department (ED) and is associated with an increased risk of ischemic stroke. Studies have shown that only oral anticoagulant (OAC) therapy reduces risk of AF related stroke. Our objective was to measure the prescribing practices for OACs for new onset AF at a tertiary ED and two surrounding community EDs, and identify rates of adverse effects within 90 days. The findings of this study will provide quality assurance information for the management of patients with new onset AF. This information has the potential to promote adherence to prescribing guidelines for AF in the ED and the reduction of common adverse events such as ischemic stroke. Methods: We conducted a retrospective chart review of 385 patients with new onset AF who presented to the ED between November 2014 to Mach 2018. We defined new onset as symptoms &lt;48 hours and had AF confirmed with electrocardiogram. We recorded the selected therapy choice of cardioversion and/or rate control, gender, age, and assessed CHADS-65 score. We recorded who was prescribed OAC and those who were referred to cardiology, family medicine, or did not have a documented follow up plan. Patients with a previous history of AF or current anticoagulant therapy were excluded. We recorded if any patients returned to the ED within 90 days with ischemic stroke, AF recurrence, myocardial infarction, other embolic disease or death. Results: 86 of 294 (29.5%) of patients who qualified under CHADS-65 received OACs appropriately. 64 of 66 (97.0%) of patients who did not qualify under CHADS-65 did not receive OACs appropriately. 5 patients overall returned within 90 days with ischemic stroke, 4 of those were not prescribed OACs, however this was not statistically significant (P = 0.999). Conclusion: This data suggests that physicians in the study are under-prescribing OACs relative to published guidelines. A larger study is necessary to elucidate the effect of ED OAC prescribing patterns on long-term patient outcome.

P4787Use of direct oral anticoagulants in patients with atrial fibrillation having a history of intracranial hemorrhage

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T F Chao ◽  
S A Chen
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Research Database ◽  
Bleeding Events ◽  
Risk Of Mortality ◽  
Taiwan National Health Insurance ◽  
History Of

Abstract Background Patients with atrial fibrillation (AF) having a history of intracranial hemorrhage (ICH) were excluded from the pivotal randomized trials comparing direct oral anticoagulants (DOACs) and warfarin. We aimed to compare the effectiveness and safety of DOACs and warfarin among AF patients having a history of ICH. Method A total of 4,540 AF patients having a CHA2DS2-VASc score ≥1 for males and ≥2 for females who had a history of ICH and received oral anticoagulants (DOACs in 3,493 and warfarin in 1,047) were identified from the Taiwan National Health Insurance Research Database. A propensity matching analysis was performed to balance the baseline differences, and 973 patients were finally identified in each groups. Results The risk of ischemic stroke did not differ significantly between warfarin and DOACs (4.41%/yr vs 4.87%/yr; HR 0.985, p=0.927). The risks of bleeding events were lower with DOACs compared to warfarin with a HR (95% CI) of 0.752 (0.573–0.986, p=0.040) for major bleeding and 0.614 (0.379–0.995, p 0.048) for ICH. The risk of mortality was also lower in patients treated with DOACs (HR = 0.539; 95% CI = 0.453–0.642, p<0.001). The cumulative incidence curves of each events for 2 groups are shown in Figure. Conclusion Compared to warfarin, DOACs were associated with a similar risk of ischemic stroke and better safety profiles among AF patient with a history of ICH.

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