It is suggested that AF remains a risk factor for OHCA, even after adjustments for ischemic heart disease and heart failure, even after adjustments for ischemic heart disease and heart failure.
Abstract
Background
Atrial fibrillation (AF) is an impending global epidemic, and out-of-hospital cardiac arrest (OHCA) is associated with high mortality. Although emerging evidence links AF with OHCA, research has been challenged by shared risk factors, especially ischemic heart disease and heart failure.
Objectives
This study aimed to investigate the association between AF and OHCA in light of risk factors for ischemic heart disease and heart failure.
Methods
This was a Danish, nationwide matched cohort study using the Danish Cardiac Arrest Registry (June 1, 2001, to December 31, 2022) in individuals aged 18 to 85 years. Exposure was an AF diagnosis, and outcomes were OHCA and all-cause mortality. A 1:4 matching of AF patients with non-AF patients upon sex, birth year, ischemic heart disease, heart failure, diabetes, cancer, hypertrophic cardiomyopathy, dilated cardiomyopathy, and statin usage was performed. Multivariable Cox regression models were used and results presented as cumulative incidences from time of AF diagnosis/matching and HRs of OHCA and all-cause mortality.
Results
The study included 6.47 million individuals, of whom 368,639 had AF. A total of 309,010 patients with AF (only newly diagnosed in the time period) were matched to 1,236,040 non-AF patients. Adjusted HRs of OHCA and all-cause mortality were higher in AF patients vs non-AF patients (1.66 [95% CI: 1.62-1.70] and 1.79 [95% CI: 1.78-1.81], respectively).
Conclusions
Findings suggest that AF remains a risk factor for OHCA, even after adjustments for ischemic heart disease and heart failure. Future studies should explore subsets of patients with AF at highest risk of OHCA to tailor preventive efforts toward this patient group.
Socioeconomic factors are associated with cardiovascular morbidity. We investigated the association between education level and incident heart failure (HF), acute coronary events (AMI), and cerebrovascular events (stroke) following hospitalization with first-detected atrial fibrillation (AF).
In this nationwide retrospective observational cohort study using linked Swedish national registers, we included patients who received a first diagnosis of AF during hospitalization from 1995 to 2008. Education levels were categorized as primary, secondary, or academic, and patients were followed for up to five years. Outcomes were first hospitalization for HF, AMI, or stroke. Associations were assessed using cause-specific Cox proportional hazard models, for men and women separately. Models were adjusted for age, calendar year of AF diagnosis, whether AF was the primary or secondary admission diagnosis, comorbidity diagnoses and thromboembolic risk.
The cohort comprised 263,172 patients (mean age 72.5 ± 10.4 years; 56.2% male). Compared with primary education, secondary and academic education levels were associated with lower adjusted risks of HF and AMI in both females and males. For HF, adjusted hazard ratios (HR) were 0.96 (95% CI 0.93–1.00) for secondary and 0.82 (95% CI 0.77–0.87) for academic education in females, and 0.93 (95% CI 0.90–0.96) and 0.76 (95% CI 0.72–0.80), respectively, in males. For AMI, adjusted HRs were 0.89 (95% CI 0.85–0.93) and 0.71 (95% CI 0.65–0.77) in females, and 0.91 (95% CI 0.87–0.94) and 0.75 (95% CI 0.71–0.80) in males. For stroke, lower adjusted risks were observed only in the academic education group. Baseline comorbidity burden and thromboembolic risk were higher in lower education groups.
In this large nationwide cohort of patients hospitalized with AF, higher education level was associated with lower adjusted hazards of incident HF and AMI over five years, while the association with stroke was weaker. Education level may be considered a risk marker when planning follow-up and preventive care after hospitalization with AF.
Á. Sztaniszláv, A. Björkenheim, A. Magnuson et al.· BMC Cardiovascular Disorders· 0 citations
A supervised machine learning algorithm for AF in a Western Pacific population was derived and demonstrated that higher risk was associated with hospitalisation for other cardio-renal diseases and death.
J. Hsu, C. Hayward, Tobin Joseph et al.· Heart, Lung and Circulation· 0 citations
The findings are best interpreted as evidence of cardiovascular and multimorbidity complexity, not as proof of a COVID-specific, temporal, or causal AF–HF effect.
A. Pah, C. A. Avram, Maria Rada et al.· Journal of Clinical Medicine· 0 citations
BACKGROUND
Post-operative atrial fibrillation is a common complication following coronary-artery-bypass-grafting (CABG). Comparative outcome studies amongst patients following CABG with post-operative AF (POAF), pre-existing/background-AF, and no-AF are scarce.
METHODS
Patients undergoing CABG between 1-January-2004 and 31-December-2017 were identified from a statewide Admitted-Patient-Data-Collection database. Patients <18yo or with concomitant cardiac valve surgery were excluded. Patients were stratified into no-AF, background-AF and POAF during index CABG using a look-back linkage methodology. Primary outcome was incidence of ischaemic stroke/transient-ischaemic-attack (TIA) requiring hospitalisation. Secondary outcomes included all-cause mortality and hospitalisation with AF, heart failure (HF), haemorrhagic stroke. Competing risk and Cox regression methods were used to assess risk for cardiovascular endpoints and death respectively.
RESULTS
Among 46032 patients, 8.0% had background-AF, 27.4% developed new-onset POAF during index CABG and 64.7% had no-AF. During follow-up (median 6.6 years), POAF was associated with increased risk of hospitalisation for ischaemic stroke/TIA compared to no-AF cohort (adjusted subdistribution hazard ratio [adj.sHR]=1.14, 95% confidence interval [CI]=1.04-1.24, P=0.004). The risk appears greater in patients with background-AF (adj.sHR=1.41, 95%CI=1.25-1.60, P<0.001). A graded association was observed across AF groups with highest morbidities (AF and HF hospitalisations) and mortality risks post-CABG in background-AF patients followed by those with POAF, with no-AF cohort having lowest event rates.
CONCLUSIONS
This large retrospective observational study suggests AF status during CABG surgery is associated with a graded increase hospitalisation risk for ischaemic stroke/TIA, AF, HF and death. These findings highlight an under-recognised high-risk population and underscore need for renewed clinical focus on patients with pre-existing AF undergoing CABG.
Aimy Yan, Jayant Ravindran, V. Chow et al.· Canadian Journal of Cardiolo...· 0 citations
Prediabetes was associated with a modestly increased risk of new-onset AF, particularly persistent AF, and was associated with HF development among individuals without established arrhythmia.
K. Ukita, Lotta Nowak, F. Schmelter et al.· Clinical Research in Cardiol...· 0 citations
AIMS
Left ventricular non-compaction (LVNC) is a genetic cardiomyopathy with presentations ranging from asymptomatic disease to heart failure, stroke, and sudden cardiac death. LVNC-related structural and functional abnormalities may increase atrial fibrillation (AF) risk, but data are limited. We assessed AF incidence in LVNC and compared outcomes in patients with versus without AF.
METHODS AND RESULTS
Two cohorts of patients were identified using the TriNetX platform: (i) patients with LVNC without a prior history of AF or stroke; and (ii) patients with LVNC and AF without a prior history of stroke. The primary objective was to assess the 3-year risk of a composite of all-cause mortality, stroke, acute myocardial infarction, and heart failure in the two cohorts. Hazard ratios (HRs) were derived from univariable cox proportional models before and after propensity score matching (PSM). Matching was conducted using a greedy nearest-neighbour approach with a caliper of 0.1.Patients with LVNC and AF (N=29,356) were older and exhibited a higher burden of comorbidities compared with LVNC patients without AF (N=39,339). In this observational analysis, after PSM, AF in patients with LVNC was associated with higher risks of stroke (HR 1.466, 95% CI 1.359-1.581), new-onset heart failure (HR 1.439, 95% CI 1.358-1.526), all-cause death (HR 1.255, 95% CI 1.200-1.312), and the composite outcome (HR 1.301, 95% CI 1.269-1.334) compared with LVNC patients without AF. The 1-year incidence of AF in patients with LVNC was 36 per 1000 person-years.
CONCLUSION
In this observational cohort, LVNC was associated with a high incidence of AF, and the presence of AF was associated with higher risks of stroke, heart failure, and all-cause death. Further prospective studies are warranted to assess the prognostic impact of AF in patients with LVNC.
A. Askarinejad, Thomas F. Lüscher, G. Y. Lip· Cardiovascular Research· 1 citation