Publications

National Science Center and Medical University of Bialystok, Poland.

In real-world practice among a high-risk Asian atrial fibrillation population, all 3 NOACs demonstrated similar risk of ischemic stroke and lower risk of ICH compared with warfarin. All-cause mortality was significantly lower only with dabigatran and apixaban.

The off-label underdosed apixaban group showed higher risks of ischaemic stroke, all-cause death, and composite clinical outcomes than the on-label standard dose apixaban group, but both showed comparable risks of MB. Label adherence to apixaban dosing should be emphasized to achieve the best clinical outcomes for Asian patients with AF.

In Chinese AF patients, the benefits of warfarin therapy for stroke prevention and ICH reduction depend on TTR. Of the treatments compared, dabigatran, as well as rivaroxaban 20 mg daily, was associated with lowest ischemic stroke and ICH rates.

Abstract Introduction Regular exercise is known to decrease the risk of dementia. There is a paucity of information about the impact of the change of exercise habit on cardiovascular outcomes after a new diagnosis of atrial fibrillation (AF). We aimed to investigate whether regular exercise is associated with the risk of developing dementia in patients with AF. Methods Using the Korean National Health Insurance Service database, we enrolled patients with newly diagnosed AF who had undergone health screening between 2010 and 2016. The study population was divided into four groups based on the consistency of regular exercise before and after AF diagnosis: (1) persistent non-exerciser, (2) exercise starter, (3) exercise quitter, and (4) exercise maintainer. We investigated the association between exercise and the risk of dementia. Results A total of 126,555 patients were included (mean age 62.7 years, male 62.0%, and mean CHA2DS2-VASc Score 2.7). During a median follow-up duration of 3.0 years, 5,943 patients were newly diagnosed as dementia (1.57 per 100 person-years). Among patients with incident dementia, 4,410 patients had Alzheimer's dementia and 951 patients had vascular dementia (1.16 and 0.25 per 100 person-years, respectively). Persistent non-exerciser, exercise starter, quitter, and maintainer groups were 65.1%, 12.8%, 12.7%, and 9.4%, respectively. After multivariable adjustment, we found that exercise was associated with a lower risk of developing overall dementia. When compared to persistent non-exerciser, exercise starter and maintainer showed reduced risk of developing dementia (hazard ratio [HR] 0.80, 95% confidence interval [95% CI] 0.73–0.88 and HR 0.63, 95% CI 0.54–0.73, respectively, all p-value <0.0001), but exercise quitter showed no significant risk reduction (HR 0.95, 95% CI 0.88–1.03, Figure). Alzheimer's dementia showed consistent results: a 20% lower risk with exercise starter, and a 37% lower risk with exercise maintainer. Change of exercise habit, however, did not affect the risk of vascular dementia (all, p-value >0.05, Figure). Conclusions Regular exercise showed a lower risk of dementia in patients with new-onset AF. Starting exercise even after the diagnosis of AF was beneficial to patients who had little physical activity previously. These findings may support physicians to recommend that AF patients should start exercise or keep their physical activity to reduce the risk of dementia. Funding Acknowledgement Type of funding source: None

Patients with AF in China were mainly concerned about the safety and effectiveness of oral anticoagulant therapy. The preference weighting on food-drug interaction varied widely. Patients with lower educational attainment or income levels and less experience of bleeding or stroke had more reservations about paying for oral anticoagulant therapies with superior efficacy, safety, and convenience of use.

In hypertensive patients receiving monotherapy, ACEi and CCB showed a similar AF risk as ARBs, while beta-blockers and diuretics were associated with a higher risk. Among those receiving combination therapy, ARBs/CCBs and ARBs/diuretics had the lowest AF risk, whereas ARBs/beta-blockers showed the highest risk. Various types of ARBs have different associations with AF risk.

Most of the identified potential risk factors for cancer in the AF population are also associated with cardiovascular disease. The 1-year cancer prediction models showed moderate to good predictive performance and may help improve the management of patients with AF.

BMI had good predictive value for AF ablation outcomes with a cut off value of ≥26.36 kg/m². Apart from being obese/overweight, being underweight might also be a risk factor for AF recurrence post ablation.

Physical activity (PA) and obesity may alter the risks of cardiac conduction disease. Participants from the Kailuan cohort, who were free of cardiac conduction disease and with repeated measurements of electrocardiogram from 2006 to 2019, were included. The primary outcome was cardiac conduction disease. The secondary outcomes were atrioventricular block and intraventricular block. Cox regression was used to assess the association between obesity, PA, and the risks of the outcomes. Influences of PA on the associations between BMI and incident outcomes were evaluated. A total of 84,022 participants (mean age 50.15 years, SD 11.69; 80.3% male) were included. Over a median follow-up of 11.83 years (IQR 8.87-13.04), 3236 participants developed the primary outcome. After multivariable adjustment, a higher body mass index (BMI) and a higher waist circumference (WC) were associated with increased risks of conduction disease, but more PA was associated with a lower risk. For obese patients defined by BMI with low PA, the risk of conduction disease was higher than that of obese patients with high PA (HR: 1.42, CI: 1.21-1.66 vs. HR: 1.16, CI: 1.03-1.31). For central obese patients defined by WC with low PA, the risk of conduction disease was also higher compared to central obese patients with high PA (HR: 1.31, CI: 1.17-1.48 vs. HR: 1.12, CI: 1.03-1.23). Besides, compared to obesity with high PA, obesity with low PA was associated with a higher risk of atrioventricular block (HR: 1.70, CI: 1.28-2.27 vs. HR: 1.45, CI: 1.16-1.81) and intraventricular block (HR: 1.37, CI: 1.13-1.65 vs. HR: 1.03, CI: 0.92-1.15). Higher PA can reduce the risks of developing cardiac conduction disease, both in the obese and non-obese groups. (Clinical Trial Registration URL: https://www.chictr.org . Unique identifier: ChiCTRTNC-11001489).

This study was approved by the Ethics Review Committee of Faculty of Medicine at University of Jaffna. Written informed consent will be obtained from all participants. Findings will be disseminated through publication in a peer-reviewed journal and presentations at conferences. The findings will enable early treatment for new AF diagnoses and inform interventions to improve community-based management of AF in LMICs.