Faculty Opinions recommendation of Incidence of Previously Undiagnosed Atrial Fibrillation Using Insertable Cardiac Monitors in a High-Risk Population: The REVEAL AF Study.

Abstract Background The antithrombotic treatment is the main goal of management on atrial fibrillation (AF). However, the optimal thrombophylaxis still remains the problem in the “high-risk” population, such as the elderly, with renal/liver dysfunction, malignancy, stent implantation, etc. Objectives The present study aims to explore the optimal antithrombotic strategy in a “high-risk” population with multiple comorbidities. Methods The ChiOTEAF (Ethic approval number of Central Medical Ethic Committee of General PLA Hospital: S2014–065–01) is a prospectively, multi-center (44 research centers), real-world registry across China. The protocol was seen in BMJ Open (Guo Y, et al. 2018). A Cox proportional hazard model analysis was performed for the outcome of antithrombotic therapy among this high-risk population. Results 6148 patients with AF (mean age 74 years old, female 39.4%), were enrolled into ChiOTEAF study between Oct 2014 to Dec 2018. The use of non-vitamin K antagonist oral anticoagulants (NOACs), warfarin, and antiplatelet were 1444 (23.5%), 1300 (21.1%), and 2521 (41.0%), respectively, in this high-risk AF population. During one-year follow-up, there were 186 (3.0%) all-cause death. In this AF cohort, the patients with chronic kidney disease (CKD)/liver disease were 878 (14.3%), with malignancy were 555 (9.0%), with prior thromboembolism (TE) were 1538 (25%), with prior haemorrhage were 348 (5.7%), and current anemia were 859 (14.0%), respectively. Stent implantation (coronary artery, aortic or peripheral artery) were 671 (10.9%). CHA2DS2-VASc and HAD-BLED scores (mean±standard deviation) were 3.8±1.7, and 2.0±1.1, respectively. Among the above “clinical dilemma”, the antiplatelet use was common in patients with CKD/Liver disease and stent implantation (43.5%, 56.9%, respectively, p<0.05), the oral anticoagulants (OACs) combined with antiplatelet was most seen in patients with stent implantation (15.4%, p<0.05), OACs alone were highest in patients with prior TE (38.1%, p<0.05), while patients with malignancy and prior bleeding far less received any antithrombotic drugs (41.8%, 31.3%, respectively, p<0.05) (Figure 1). However, after adjusting baseline characteristics, OACs reduced the risk for all-cause death (hazard ratio, HR, 95% confidential interval, CI) for the patients with CKD/liver disease (HR, 95% CI, 0.28, 0.11–0.69, p=0.006), and for patients with prior TE (HR, 95% CI, 0.43, 0.21–0.91, p=0.028), respectively. Conclusion Although suboptimal anticoagulants were common in the “high-risk” AF patients, OACs demonstrated the benefit for AF patients with CKD/liver disease, etc., while more evidences would be needed to optimise the antithrombotic strategy in different complex clinical settings. Acknowledgement/Funding The study was supported by Beijing Natural Science Foundation (Z1411ehz745.11462114050) and National Natural Science Foundation of China (H2501)

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Prevalence of early stages of heart failure in an elderly risk population: the Copenhagen Heart Failure Risk Study

Open Heart ◽

10.1136/openhrt-2018-000840 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000840 ◽

Cited By ~ 5

Author(s):

Freja Stoltze Gaborit ◽

Caroline Kistorp ◽

Thomas Kümler ◽

Christian Hassager ◽

Niels Tønder ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Risk Factor ◽

High Risk ◽

Troponin I ◽

Plasma Concentrations ◽

High Risk Population ◽

Risk Population ◽

Early Stages ◽

Increased Risk

AimsTo describe the prevalence of heart failure (HF) stages in elderly outpatients with risk factors for HF but without known HF, and characterise the clinical, biochemical and echocardiographic findings in each stage.BackgroundEarly stages of HF are underdiagnosed; nevertheless, they are associated with an increased risk of hospitalisation and increased mortality. The prevalence of HF stages in elderly high-risk patients is unknown.MethodsA total of 400 patients were consecutively included: ≥60 years old, ≥1 risk factor for HF (diabetes, chronic kidney disease, cardiovascular disease, atrial fibrillation, hypertension), and without known or suspected HF. HF stages were defined as the following: stage A (risk factor for HF, normal echocardiography), stage B (abnormal echocardiography, without symptoms of HF) and stage C (abnormal echocardiography, symptoms of HF, clinical signs/increased plasma aminoterminal pro-B-type natriuretic peptide [NT-proBNP] concentrations).ResultsAfter thorough examination 44.25% of patients were categorised as HF stage A, 37.5% were HF stage B and 18.25% HF stage C. Those with higher stages of HF were older (p<0.001) and more often had atrial fibrillation (p=0.006). The median plasma NT-proBNP concentrations (pg/mL) were 132.5 for HF stage A, 275.5 for HF stage B and 400.0 for HF stage C (p<0.001). Detectable plasma troponin-I was more frequent with abnormal echocardiography: HF stage A 9.7%, HF stage B 27.3% and HF stage C 30.1% (p<0.001). HF stage C reported higher score on the Minnesota Living with Heart Failure Questionnaire (p<0.001).ConclusionsIn an elderly high-risk population without known or suspected HF, more than half were HF stage B or C. Higher stages of HF had increased plasma concentrations of NT-proBNP and troponin-I, besides a reduced quality of life. Focus on symptoms and signs of HF in this population are warranted.

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