scholarly journals Atrial Fibrillation: Pathogenesis, Predisposing Factors, and Genetics

2021 ◽  
Vol 23 (1) ◽  
pp. 6
Author(s):  
Marios Sagris ◽  
Emmanouil P. Vardas ◽  
Panagiotis Theofilis ◽  
Alexios S. Antonopoulos ◽  
Evangelos Oikonomou ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Health Care ◽  
Dietary Habits ◽  
Preventive Measures ◽  
Health Care Cost ◽  
Predisposing Factors ◽  
Risk Of Death ◽  
Increased Risk ◽  
Genetic Burden ◽  
High Health Care Cost

Atrial fibrillation (AF) is the most frequent arrhythmia managed in clinical practice, and it is linked to an increased risk of death, stroke, and peripheral embolism. The Global Burden of Disease shows that the estimated prevalence of AF is up to 33.5 million patients. So far, successful therapeutic techniques have been implemented, with a high health-care cost burden. As a result, identifying modifiable risk factors for AF and suitable preventive measures may play a significant role in enhancing community health and lowering health-care system expenditures. Several mechanisms, including electrical and structural remodeling of atrial tissue, have been proposed to contribute to the development of AF. This review article discusses the predisposing factors in AF including the different pathogenic mechanisms, sedentary lifestyle, and dietary habits, as well as the potential genetic burden.

Atrial Fibrillation Detected After Stroke and Increased Risk of Death

Neurology ◽  
2021 ◽  
Vol 96 (12) ◽  
pp. 557-559
Author(s):  
Luciano A. Sposato ◽  
David J. Seiffge
Keyword(s):  
Atrial Fibrillation ◽  
Risk Of Death ◽  
Increased Risk

Risk Factors for Myocardial Infarction and Stroke Among Sepsis Survivors: A Competing Risks Analysis

2019 ◽  
Vol 35 (1) ◽  
pp. 34-41
Author(s):  
Yueh-Che Hsieh ◽  
Po-Yang Tsou ◽  
Yu-Hsun Wang ◽  
Christin Chih-Ting Chao ◽  
Wan-Chien Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Hospital Discharge ◽  
Preventive Measures ◽  
Risk Model ◽  
Cerebrovascular Diseases ◽  
Competing Risk ◽  
Research Database ◽  
Risk Of Death ◽  
Increased Risk

Objectives: Predictors for post-sepsis myocardial infarction (MI) and stroke are yet to be identified due to the competing risk of death. Methods: This study included all hospitalized patients with sepsis from National Health Insurance Research Database of Taiwan between 2000 and 2011. The primary outcome was the first occurrence of MI and stroke requiring hospitalization within 180 days following hospital discharge from the index sepsis episode. The association between predictors and post-sepsis MI and stroke were analyzed using cumulative incidence competing risk model that controlled for the competing risk of death. Results: Among 42 316 patients with sepsis, 1012 (2.4%) patients developed MI and stroke within 180 days of hospital discharge. The leading 5 predictors for post-sepsis MI and stroke are prior cerebrovascular diseases (hazard ratio [HR]: 2.02, 95% confidence interval [CI]: 1.74-2.32), intra-abdominal infection (HR: 1.94, 95% CI: 1.71-2.20), previous MI (HR: 1.81, 95% CI: 1.53-2.15), lower respiratory tract infection (HR: 1.62, 95% CI: 1.43-1.85), and septic encephalopathy (HR: 1.61, 95% CI: 1.26-2.06). Conclusions: Baseline comorbidities and sources of infection were associated with an increased risk of post-sepsis MI and stroke. The identified risk factors may help physicians select a group of patients with sepsis who may benefit from preventive measures, antiplatelet treatment, and other preventive measures for post-sepsis MI and stroke.

scholarly journals Prolapse of colostomy in children; characteristics, predisposing factors and preventive measures in four health facilities in Southern Nigeria

2019 ◽  
Vol 9 (5) ◽  
pp. 440-446
Author(s):  
Okoro Philemon E*,Onyesoh Chinyeaka
Keyword(s):  
Preventive Measures ◽  
Positive Association ◽  
Predisposing Factors ◽  
Abdominal Pressure ◽  
Common Complication ◽  
Significant Morbidity ◽  
Increased Risk ◽  
Southern Nigeria ◽  
Hirschsprungs Disease ◽  
Colostomy Prolapse

IntroductionThe protrusion of the bowel through the stoma in a colostomy is one of thecommon complications of colostomy. Though it rarely gets secondarilycomplicated, it causes significant morbidity by virtue of the increasing bowel massoutside. The predisposing factors and progression in children are not well reportedin our region.AimTo evaluate the characteristics and occurrence of colostomy prolapse in childrenand to identify any factors predisposing to this complication in our practice.Patients and MethodsThis is a five year prospective study of paediatric colostomy in the authors’ servicebetween March 2013 and April 2018. Patients were categorized into those thatdeveloped prolapse (Pro group), and those that did not (Non Pro group). Othervariables investigated were gender, age at creation of colostomy, indication, type,and duration of colostomy, presence of raised intra abdominal pressure. Statisticswas with SPSS 21.ResultsTwenty seven (28.4%) of 95 children who had colostomy during the study perioddeveloped prolapsed. Prolapse occurred more in patients who had their colostomyat a relatively older age. There was a positive association of prolapse andHirschsprungs disease but no association with the gender or duration of stoma.ConclusionColostomy prolapse is a common complication seen in our practice. Cases ofneglected Hirschsprungs disease in children have increased risk of thiscomplication. Extra caution is therefore needed in forming colostomy in this groupof patients.

scholarly journals Telehealth: A Useful Tool for the Management of Nutrition and Exercise Programs in Pediatric Obesity in the COVID-19 Era

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 3689
Author(s):  
Valeria Calcaterra ◽  
Elvira Verduci ◽  
Matteo Vandoni ◽  
Virginia Rossi ◽  
Elisabetta Di Di Profio ◽  
...  
Keyword(s):  
Health Care ◽  
Children And Adolescents ◽  
Health Care Professionals ◽  
Pediatric Obesity ◽  
Dietary Habits ◽  
Critical Factor ◽  
Sedentary Behaviors ◽  
Exercise Programs ◽  
Modern Approach ◽  
Increased Risk

The COVID-19 pandemic has led to the implementation of policies that mandate various restrictions on daily life, including social distancing, the closure of public services and schools, and movement limitations. Even though these restrictive measures decreased the COVID-19 spread, they may have detrimental effects on various lifestyle components such as physical inactivity, sedentary behavior, and dietary habits, influencing the maintenance of weight and contributing to obesity among children and adolescents. The coexistence of childhood obesity and COVID-19 and changes in the bioecological environment have put children and adolescents at increased risk for developing obesity and exacerbating the severity of this disorder. The use of telehealth technology is a modern approach useful for the delivery of health care services by health care professionals, where distance is a critical factor. Telehealth is effective in promoting increased self-monitoring and behavioral change, and provides the opportunity to perform online nutritional support and exercise training programs to promote a healthy lifestyle and reduce sedentary behaviors in children and adolescents. Telehealth, including tele-exercise and tele-nutrition, has the potential to address many of the key challenges in providing health services, including in patients with obesity during the COVID-19 outbreak. This narrative review aims to describe the role of telehealth as an opportunity in the management of pediatric obesity in the COVID-19 era, and to deliver nutrition and exercise programs for the maintenance of health.

P662Association of baseline disability and major adverse outcomes in patients with atrial fibrillation: an analysis from the SPORTIF trials

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Proietti ◽  
G Y H Lip
Keyword(s):  
Atrial Fibrillation ◽  
Regression Analysis ◽  
Controlled Trial ◽  
Linear Regression Analysis ◽  
Cumulative Risk ◽  
Adverse Outcomes ◽  
Rank Test ◽  
Composite Outcome ◽  
Risk Of Death ◽  
Increased Risk

Abstract Introduction The modified Rankin Scale (mRS) is usually used to evaluate the degree of disability in patients who have suffered a stroke. Some data suggest that pre-stroke mRS may be associated with clinical outcomes. No data exist about atrial fibrillation (AF) patients. Purpose To evaluate if baseline level of disability, evaluated as mRS, is associated with major adverse outcomes in patients with AF Methods Data from the SPORTIF III and V trials were used to evaluate study aims. mRS was categorized as follows: i) mRS 0 = No Disability; ii) mRS 1 = Operational Limitation; iii) mRS ≥2 = Disability. Stroke/systemic embolism (SE), death and composite of stroke/SE/acute myocardial infarction (AMI)/death were considered as major adverse outcomes. Results Among 7329 patients enrolled in SPORTIF trials, 7325 (99.9%) had data about baseline mRS, with 5587 (76.3%) with mRS 0, 1156 (15.8%) with mRS 1 and 582 (7.9%) with mRS ≥2. Mean (SD) and median [IQR] CHA2DS2-VASc was progressively higher across the three mRS categories (both p<0.001). An adjusted linear regression analysis confirmed that mRS was associated with an increasing CHA2DS2-VASc (unstandardized B: 0.354, 95% confidence interval [CI]: 0.317–0.390, p<0.001]. After a mean (SD) 1.55 (0.40) years of follow-up 184 (2.5%) stroke/SE, 392 (5.4%) death and 597 (8.2%) composite events were recorded. Log-rank test showed that cumulative risk of stroke/SE (p=0.005), death (p<0.001) and composite outcome (p<0.001) was progressively higher across the mRS categories [Figure]. Cox adjusted regression analysis found no independent association between mRS categories and stroke/SE occurrence, but baseline disability (mRS ≥2) was independently associated with death (hazard ratio [HR]: 2.17, 95% CI: 1.65–2.86 compared with no disability). Both operational limitation (mRS 1) and disability (mRS ≥2) were associated with the composite outcome (HR: 1.28, 95% CI: 1.04–1.59 and HR: 1.91, 95% CI: 1.51–2.42, respectively) compared to no disability. Kaplan-Meier curves Conclusions In a large cohort of AF patients derived from a randomized controlled trial, baseline disability was associated with an increased risk of death and composite outcome of stroke/SEAMI/death. Acknowledgement/Funding None

Abstract P161: Self-Management Resources in Heart Failure: A Prospective Community Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Matteo Fabbri ◽  
Sheila Manemann ◽  
Cynthia Boyd ◽  
Jennifer Wolff ◽  
Alanna Chamberlain ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Self Management ◽  
Health Care Resources ◽  
International Classification Of Disease ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Increased Risk

Introduction: Little is known about the characteristics and resources that enable patients with heart failure (HF) to engage in effective self-management. To address this gap in knowledge, we measured personal and health care resources for self-management and examined associations with mortality among patients with HF. Methods: We surveyed 5543 residents of 11 counties in Southeast Minnesota with a first-ever code for HF [International Classification of Disease, Ninth Revision code 428 or Tenth Revision code I50] between 1/1/2013 and 3/31/2016. Self-management resources were measured with the health care and personal subscales of the Chronic Illness Resources Survey (CIRS), both of which included 3 questions on a 5-point scale. The responses were averaged and participants were categorized as low if the mean score was below the median of the distribution (range from 1 to 5). The survey was returned by 2866 participants (response rate 52%) and those with complete data on the main items of interest were retained for analysis (N=2212). Cox proportional hazards regression was used to determine the association between each subscale and mortality. Results: Among 2212 participants (mean age 72.8 years, 54.1% men) the median health care score was 4, while the personal score was 3. Those with low health care resources were older and less educated than those with a higher score (p<0.05), while those with low personal resources had less comorbidities and lower education attainment compared to those with a higher score (p<0.05). After a mean (SD) follow-up of 1.3 ± 0.6 years, 207 deaths occurred. Low levels of both self-management resources were associated with an increased risk of death compared with patients with high levels (Table). Conclusions: Having limited self-management resources is associated with an increased risk of mortality among patients with HF. Thus, interventions aimed at supporting self-management among patients with HF may improve outcomes.

P4747Impact of different estimates of renal function on cardiovascular mortality and major bleeding in patients with atrial fibrillation on oral anticoagulation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Z Hijazi ◽  
C B Granger ◽  
S H Hohnloser ◽  
J Westerbergh ◽  
J Lindback ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
New York ◽  
Cystatin C ◽  
Major Bleeding ◽  
Discriminatory Ability ◽  
Risk Of Death ◽  
Model Based ◽  
Increased Risk ◽  
Individual Variables ◽  
The Individual

Abstract Background Renal dysfunction is associated with increased risk of cardiovascular events in atrial fibrillation (AF). Estimated glomerular filtration rate (eGFR) can be calculated by different equations based on creatinine or cystatin C. We compared different methods of assessing eGFR and their association with cardiovascular (CV) death and major bleeding in 14,980 AF patients in the ARISTOTLE trial. Methods eGFR was calculated using equations based on creatinine (Cockcroft-Gault, MDRD, and CKD-EPI) and/or cystatin C (CKD-EPIcys and CKD-EPIcys+crea). In total five eGFR equations as well as a model based on the variables within the equations were assessed. Associations were evaluated by Spearman correlation, and discriminatory ability for CV-death and major bleeding by Harrell's c-index. Results Median age was 70.0 years, and 35.6% were women. Median eGFR (mL/min) were: Cockcroft-Gault 74.1, MDRD 66.5, CKD-EPI 68.5, CKD-EPIcys 74.2, and CKD-EPIcys+crea 72.6. Correlation ranged from 0.49 (Cockroft-Gault and CKD-EPIcys) to 0.99 (MDRD and CKD-EPI). Among the eGFR equations, those based on cystatin C yielded the highest c-indices for CV-death and major bleeding, 0.628 (CKD-EPIcys) and 0.612 (CKD-EPIcys+crea), respectively. A model based on the variables within the eGFR equations (age, sex, weight, creatinine, and cystatin C) yielded the highest discriminatory value for both outcomes, 0.673 and 0.656, respectively. Figure 1 Conclusions In patients with AF on anticoagulation, correlation between eGFR methods varied greatly. Cystatin C-based eGFR seem to provide the most robust balance in reflecting the risk of death and bleeding. However, a model based on the individual variables within the eGFR equations provided the highest discriminatory value. Acknowledgement/Funding The ARISTOTLE trial was funded by Bristol-Myers Squibb, Co Princeton, NJ and Pfizer Inc., New York, NY.

scholarly journals Atrial Fibrillation, Oral Anticoagulants, and Concomitant Active Cancer: Benefits and Risks

TH Open ◽  
2021 ◽  
Vol 05 (02) ◽  
pp. e176-e182
Author(s):  
Adriano Atterman ◽  
Leif Friberg ◽  
Kjell Asplund ◽  
Johan Engdahl
Keyword(s):  
Atrial Fibrillation ◽  
Cancer Patients ◽  
Lower Risk ◽  
Cox Regression ◽  
Oral Anticoagulants ◽  
Bleeding Events ◽  
Risk Of Death ◽  
Cerebrovascular Events ◽  
Increased Risk ◽  
Active Cancer

Abstract Aim To determine to what extent active cancer influences the benefit–risk relationship among patients with atrial fibrillation receiving oral anticoagulants for stroke prevention. Methods In this cohort study of all patients with atrial fibrillation in the Swedish Patient register during 2006 to 2017, 8,228 patients with active cancer and 323,394 without cancer were followed up to 1 year after initiation of oral anticoagulants. Cox regression models, adjusting for confounders and the competing risk of death, were used to assess risk of cerebrovascular and bleeding events. Results Among patients treated with oral anticoagulants, the risk for cerebrovascular events did not differ between cancer patients and noncancer patients (subhazard ratio [sHR]: 1.12, 95% confidence interval [CI]: 0.98–1.29). Cancer patients had a higher risk for bleedings (sHR: 1.69, CI: 1.56–1.82), but not for fatal bleedings (sHR: 1.17, CI: 0.80–1.70). Use of nonvitamin K oral anticoagulants was associated with lower risk of both cerebrovascular events and bleedings compared with warfarin. Conclusion Patients with atrial fibrillation and active cancer appear to have similar net cerebrovascular benefit of oral anticoagulant treatment to patients without cancer, despite an increased risk of nonfatal bleedings. Use of nonvitamin K oral anticoagulants was associated with lower risk of all studied outcomes.

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