Publications

Non-vitamin K Antagonist Oral Anticoagulant, Warfarin, and ABC Pathway Adherence on Hierarchical Outcomes: Win Ratio Analysis of the COOL-AF Registry

This Win Ratio analysis demonstrates the significant benefits of NOACs over warfarin and ABC pathway adherence over nonadherence in reducing the composite outcome in patients with AF.

Prognostic Impact and Prevalence of Cachexia in Patients With Heart Failure: A Systematic Review and Meta‐Analysis

Cachexia is an independent predictor for increased all-cause mortality among patients with HF with a notable prevalence of 31%. Interventions aiding in improving fatigue, anorexia and exercise capacity could help improve the quality of life of this clinical population.

Risk of Ischaemic Stroke in Patients with Atrial Fibrillation and Concomitant Hyperthyroidism: A Nationwide Cohort Study

ABC of atrial fibrillation

ABC of atrial fibrillation , ABC of atrial fibrillation , کتابخانه دیجیتال جندی شاپور اهواز

The Changing Landscape for Stroke Prevention in AF

The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701).

Response to a letter by Jolobe: ARISTOPHANES subgroup analysis of frail and older patients with NVAF receiving low doses of novel oral anticoagulants

Click here to view the Letter to the Editor by Jolobe et al.

Gendered social determinants of health and risk of major adverse outcomes in atrial fibrillation

Atrial fibrillation (AF) is associated with adverse outcomes and social determinants of health (SDOH), which are gendered, may predict adverse outcomes in AF. We used a registry of AF patients from 27 European countries. Multivariate logistic regressions were used to investigate the associations between gendered SDOH and the primary outcome, a composite of major adverse cardiovascular events and all-cause mortality. Several SDOH were independent predictors: no higher education (OR:1.17;95 %CI:1.05-1.28), lower health (OR:1.08;95 %CI:1.05-1.11), higher GII (OR:1.12;95 %CI:1.03-1.22 each 0.100), reduced mobility (OR:1.18;95 %CI:1.02-1.38) and reduced self-care (OR:1.35;95 %CI:1.14-1.61). Gendered SDOH are independently associated with adverse events in AF.

28Left atrial voltage predicts AF recurrence after ablation, irrespective of the rhythm during mapping, while circulating biomarkers of fibrosis do not.

Background: Circulating biomarkers potentially may be used to improve patient selection for AF ablation. Low voltage areas in the LA are known to predict arrhythmia recurrence when electrophysiological mapping is performed in sinus rhythm (SR). This study tested the predictive capabilities of type III procollagen N terminal peptide (PIIINP), galectin-3 (gal-3), fibroblast growth factor 23 (FGF-23), and type I collagen C terminal telopeptide (ICTP), and whether low voltage areas in the LA predict AF recurrence irrespective of the rhythm during mapping. Methods: 92 AF ablation patients were studied. 62 patients had paroxysmal AF, 30 had persistent or long-standing persistent AF. Biomarker levels in peripheral and intra-cardiac blood were measured with ELISA. Low voltage (<0.5mV) was expressed as a proportion of the mapped LA surface area after computer 3D reconstruction and analysis of the voltage maps. The pulmonary veins, atrial appendage, and mitral valve anulus were excluded from voltage map analysis. Follow-up was one year. The primary endpoint was recurrence of atrial arrhythmia. The secondary endpoint was designed to represent current clinical practice, and was a composite of recurrence despite 2 procedures, or after one procedure if no second procedure was undertaken. a 60-day blanking period was used. Results: The biomarkers were not predictive of either endpoint. After multivariate Cox regression analysis adjusting for age, BMI, gender, LA volume/BSA, AF classification, and AF duration, high proportion of low voltage area in the LA was found to predict the primary endpoint in SR-mapping (HR 4.323,, p 0.014) and AF mapping (HR 5.195, p 0.046). This effect was also apparent for the secondary endpoint. Conclusion: The studied biomarkers do not predict arrhythmia recurrence after catheter ablation. LA voltage is an independent predictor of recurrence, whether the LA is mapped in AF or SR. This may aid decision-making regarding suitability for further procedures in individual ablation patients.

Effectiveness and safety of intracranial events associated with the use of direct oral anticoagulants for atrial fibrillation: A systematic review and meta‐analysis of 92 studies

Our study demonstrated significant differences in the risk of ischaemic stroke, TE/stroke and ICH associated with individual DOACs compared to both other DOACs and VKA.

Dabigatran Dual Therapy Versus Warfarin Triple Therapy Post–PCI in Patients With Atrial Fibrillation and Diabetes

In this subgroup analysis, dabigatran dual therapy had a lower risk for bleeding and a comparable rate of the efficacy endpoint compared with warfarin triple therapy in patients with atrial fibrillation with or without diabetes following percutaneous coronary intervention.

Role of oxidative balance score in staging and mortality risk of cardiovascular-kidney-metabolic syndrome: Insights from traditional and machine learning approaches

This study highlights OBS as a risk stratification tool for CKM, emphasizing oxidative stress's role in CKM staging and mortality risk management.

Oral Anticoagulation Timing in Patients with Acute Ischemic Stroke and Atrial Fibrillation

Our study findings support an early OAC initiation in AF patients with mild-to-moderate AIS and a routine delayed use of OACs can be considered in those with severe AIS to avoid a serious bleeding event.

Risk of Severe Outcomes From COVID-19 in Comorbid Populations in the Omicron Era: A Meta-analysis

Abstract Importance This is the first meta-analysis to investigate risk of death and hospitalization in individuals with comorbidities, specifically during the Omicron era. Objective To assess the risk of mortality and hospitalization from COVID-19 in individuals with comorbidities in comparison with individuals without comorbidities during the Omicron era. Data Sources A systematic search of Embase, MEDLINE, PubMed, Europe PMC, Latin American and Caribbean Health Sciences Literature, Cochrane COVID-19 Study Register, and WHO COVID-19 Database was performed to identify studies published between 1 January 2022 and 13 March 2024. Study Selection Inclusion criteria were observational studies including people (all ages) with at least 1 of the following comorbidities: cardiovascular/ cerebrovascular disease, chronic lung conditions, diabetes, and obesity. In total, 72 studies were included in the review, of which 68 were meta-analyzed. Data Extraction and Synthesis Data were extracted by one reviewer and verified by a second. Studies were synthesized quantitively (meta-analysis) using random-effect models. PRISMA guidelines were followed. Main Outcomes and Measures Evaluated outcomes were the risks of death, hospitalization, intensive care unit (ICU) admission, and any combination of these outcomes. Odds ratios, hazard ratios, and rate ratios were extracted; pooled relative risk (RR) and 95% confidence intervals (CI) were calculated. Results Minimum numbers of participants per comorbidity across included studies ranged from 328 870 for thrombosis to 13 720 480 for hypertension. Risks of death, hospitalization, and the combined outcome were increased in individuals with cerebrovascular disease, COPD, diabetes, respiratory diseases, heart disease, and heart failure versus those without (pooled RRs ranged from 1.27 [heart disease, hospitalization; 95% CI, 1.17-1.38, P &lt; .001] to 1.78 [heart failure, death: 95% CI, 1.46-2.16, P &lt; .001]). Individuals with diabetes and obesity had increased risk of ICU admission (RR: 1.20; 95% CI: 1.04-1.38, P = .0141 and RR: 1.32; 95% CI: 1.11-1.57, P = .00158, respectively). Conclusions During the Omicron era, risk of death and hospitalization from COVID-19 is increased amongst individuals with comorbidities including cerebrovascular/cardiovascular conditions, chronic lung diseases, and diabetes, with the highest risk in those with heart failure. Individuals with diabetes and obesity are at increased risk of ICU admission. Key Points Question What are the risks of severe outcomes from COVID-19 in individuals with comorbidities during the Omicron era? Findings This systematic review and meta-analysis found increased risk of mortality and hospitalization among individuals with a range of comorbidities, including cerebrovascular/cardiovascular conditions, chronic lung diseases, and diabetes, with the highest risk in those with heart failure, versus those without. Risk of ICU admission was higher in individuals with obesity and diabetes. Meaning This study identified comorbid populations most at risk of severe outcomes from COVID-19. Targeting these populations with public health measures, such as vaccination, may be beneficial.

Anticoagulation for Secondary Atrial Fibrillation

This feature about a women with AF triggered by sepsis offers a case vignette accompanied by two essays, one supporting oral anticoagulant therapy after discharge and the other recommending no anticoagulant therapy.

Asymptomatic atrial fibrillation among hospitalized patients: clinical correlates and in-hospital outcomes in Improving Care for Cardiovascular Disease in China-Atrial Fibrillation

AIMS: The clinical correlates and outcomes of asymptomatic atrial fibrillation (AF) in hospitalized patients are largely unknown. We aimed to investigate the clinical correlates and in-hospital outcomes of asymptomatic AF in hospitalized Chinese patients. METHODS AND RESULTS: We conducted a cross-sectional registry study of inpatients with AF enrolled in the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation Project between February 2015 and December 2019. We investigated the clinical characteristics of asymptomatic AF and the association between the clinical correlates and the in-hospital outcomes of asymptomatic AF. Asymptomatic and symptomatic AF were defined according to the European Heart Rhythm Association score. Asymptomatic patients were more commonly males (56.3%) and had more comorbidities such as hypertension (57.4%), diabetes mellitus (18.6%), peripheral artery disease (PAD; 2.3%), coronary artery disease (55.5%), previous history of stroke/transient ischaemic attack (TIA; 17.9%), and myocardial infarction (MI; 5.4%); however, they had less prevalent heart failure (9.6%) or left ventricular ejection fractions ≤40% (7.3%). Asymptomatic patients were more often hospitalized with a non-AF diagnosis as the main diagnosis and were more commonly first diagnosed with AF (23.9%) and long-standing persistent/permanent AF (17.0%). The independent determinants of asymptomatic presentation were male sex, long-standing persistent AF/permanent AF, previous history of stroke/TIA, MI, PAD, and previous treatment with anti-platelet drugs. The incidence of in-hospital clinical events such as all-cause death, ischaemic stroke/TIA, and acute coronary syndrome (ACS) was higher in asymptomatic patients than in symptomatic patients, and asymptomatic clinical status was an independent risk factor for in-hospital all-cause death, ischaemic stroke/TIA, and ACS. CONCLUSION: Asymptomatic AF is common among hospitalized patients with AF. Asymptomatic clinical status is associated with male sex, comorbidities, and a higher risk of in-hospital outcomes. The adoption of effective management strategies for patients with AF should not be solely based on clinical symptoms.

What is the effect of lockdown upon hospitalisation due to COVID-19 amongst patients from a heart failure registry?

Abstract Introduction Coronavirus disease 2019 (COVID-19) is associated with a high risk of mortality especially in patients with cardiovascular conditions such as heart failure. The UK government announced a national lockdown last year to curb the spread of the virus. We conducted this study primarily to ascertain the impact of lockdown upon the incidence of COVID-19 hospitalisation amongst patients with a known diagnosis of heart failure (HF) Methods This was a retrospective cohort study of 1097 patients from our HF registry who had presented with acute decompensated HF in 2018 and 2019. Incidence and outcomes of hospitalisation due to COVID-19 were analysed in this cohort both during the 1 st UK lockdown as well as after the lockdown period. Co-morbidities, frailty index, clinical features, blood results, and heart failure treatments were compared between the 2 groups (COVID versus no-COVID) and between the group of patients who died versus survivors. Results 50 out of 801 surviving (6.2%) HF patients required hospitalisation due to COVID-19 from March to November 2020; 24 patients (3.1%) during the first lockdown and 26 (3.5%) in the post-lockdown period; p=0.7. In comparison to patients not hospitalised with COVID-19 (“no-COVID group), there was a significantly higher prevalence of co-morbidities amongst HF patients who were hospitalised with COVID-19, such as hypertension (p&lt;0.001), diabetes (p=0.005), ischaemic heart disease (p=0.01) and increased body mass index. 30 day mortality amongst HF patients hospitalised due to COVID-19 was 52%. Rockwood Frailty Score ≥6 (OR 6.530695 % CI:1.8958 to 22.4961; p=0.003) and diabetes (OR 3.82;95% CI 1.13 to 12.95; p=0.03) were independent predictors of 30 day mortality. Conclusion Our data suggests that the incidence of hospitalisation due to COVID-19 was similar both during as well as post lockdown amongst patients from our HF registry. HF patients with cardiovascular co-morbidities such as obesity, hypertension, diabetes and ischaemic heart disease have a higher risk of hospitalisation due to COVID-19. Diabetes and Rockwood Frailty score are independent predictors of short term mortality. Co-morbidity and frailty scores should be incorporated during initial assessment to help risk-prediction.

The Burden of Inpatient Hospitalizations with Cardiac and Cerebrovascular Diseases in Patients with Type 1 Diabetes: Insights from the National Inpatient Sample in the US

Background: This study aimed to evaluate the burden and impact of cardiac and cerebrovascular disease (CCD) on hospital inpatients with type 1 diabetes mellitus (T1DM). Methods: This is a retrospective nationwide cohort study of people with T1DM with or without CCD in the US National Inpatient Sample between 2016 to 2019. The in-hospital mortality rates, length of stay (LoS) and healthcare costs were determined. Results: A total of 59,860 T1DM patients had a primary diagnosis of CCD and 1,382,934 did not. The median LoS was longer for patients with CCD compared to no CCD (4.6 vs. 3 days). Patients with T1DM and CCD had greater in-hospital mortality compared to those without CCD (4.1% vs. 1.1%, p&amp;amp;lt;0.001). The estimated total care cost for all patients with T1DM with CCD was approximately US $326 million. The adjusted odds of mortality compared to patients with non-CCD admission was greatest for intracranial hemorrhage (OR 17.37, 95%CI 12.68-23.79), pulmonary embolism (OR 4.39, 95%CI 2.70-7.13), endocarditis (OR 3.46, 95%CI 1.22-9.84), acute myocardial infarction (OR 2.31, 95%CI 1.92-2.77) and stroke (OR 1.47, 95%CI 1.04-2.09). Conclusions: The burden of CCD in patients with T1DM is substantial and significantly associated with increased hospital mortality and high healthcare expenditures.

Relationship between obesity severity, metabolic status and cardiovascular disease in obese adults

Both elevated obesity severity and MUO were significantly associated with increased risks of CVD in adults with obesity, while metabolic status could modify the relationship between obesity severity and CVD risk. More research is needed to further clarify the relationship.