Publications

A substantial proportion of patients implanted CIED developed newly diagnosed AF. Incident AF was associated with a higher risk of adverse events. The importance of awareness, early detection, and appropriate management of AF in patients with CIED should be emphasized.

We recommend the dual-outcome method for predicting the risk of two survival outcomes both occurring. It was the most robust to model misspecification, although was also the most prone to overfitting. The clinical example motivates the use of the methods considered in this study.

In a Japanese community-based AF cohort, CV death was not mainly related to stroke but to heart failure. Non-CV death, mainly malignancy and infection, comprised more than a half of all deaths, which increased substantially in accordance with aging. Clinical factors that were associated with CV and non-CV death were distinct.

In the originally published version of this manuscript, the names of authors Marcio Jansen de Oliveira Figueiredo and Manlio F. Márquez were incorrectly given. Both names have now been corrected online. In addition, the following affiliation was inadvertently omitted for author Manlio F. Márquez: Cardiology, Electrophysiology Service, American British Cowdray Medical Center, Mexico City, México This affiliation has now been added to the online version of the manuscript as affiliation 27 and all subsequent affiliations in this manuscript affected by this change have been updated accordingly.

Among patients undergoing coronary angiography, the CHA₂ DS₂ -VASc score predicted a future diagnosis of atrial fibrillation and the composite risk of ischaemic stroke, transient ischaemic attack or systemic embolism in patients without atrial fibrillation. A CHA₂ DS₂ -VASc score of 3 was associated with a risk that would justify prophylactic oral anticoagulation treatment in a patient with atrial fibrillation.

Abstract Devices that record single-lead ECGs, such as smartwatches and handheld ECG recorders, hold promise for detecting undiagnosed atrial fibrillation (AF). Accurately extracting RR-intervals from telehealth ECGs is key for heart rhythm assessment. The aim of this study was to develop an algo-rithm to extract RR-intervals from telehealth ECGs, and assess whether the extracted RR-intervals are accurate and therefore suitable for analysis. Two datasets of 30-second handheld ECGs were used: TELE ECG Database (250 ECGs) and SAFER ECG dataset (507 ECGs). One of three high-performance primary QRS detectors, selected based on previous evidence, was used to detect QRS complexes and extract RR-intervals. These detec-tions were compared to those from a secondary QRS detector to assess accu-racy. All pairs of 3 primary and 18 secondary QRS detectors were tested. Ac-curacy was quantified using mean absolute error (MAE) and the proportion of time RR-intervals were assessed as accurate (coverage). Best performance was achieved using unsw and nk as primary and secondary detectors, with MAEs of 19.8ms and 16.3ms, and coverages of 89% on TELE and SAFER respectively. Using a single detector alone produced higher MAEs (23.8ms and 43.9ms on TELE; 38.2ms and 41.7ms on SAFER). Accuracy was similar between AF and non-AF, but reduced on low-quality signals (50.8 vs. 7.7ms, p < 0.001). In conclusion, the recommended algorithm produced more accu-rate RR-intervals than using a single QRS detector, maintaining accuracy during AF, although accuracy was reduced on low-quality signals. Highlights Algorithm extracts RR-intervals from ECGs and assesses their accuracy Algorithm was developed using two datasets of ECGs collected using different devices The impacts of arrhythmia and noise on algorithm performance were assessed The algorithm uses a pair of openly available QRS detection algorithms

Primary research question For adults surviving spontaneous (non-traumatic) symptomatic intracranial haemorrhage with persistent/paroxysmal atrial fibrillation/flutter (AF), does starting full treatment dose oral anticoagulation (OAC) result in a beneficial net reduction of all serious vascular events compared with not starting OAC? Trial design Investigator-led, multicentre, randomised, open, assessor-masked, parallel group, clinical trial of investigational medicinal product (CTIMP) prescribing strategies. We plan for a pilot phase, followed by a safety phase. Objectives Pilot phase: ~30 hospital sites keep screening logs and recruit at least 60 participants >24 hours after spontaneous symptomatic intracranial haemorrhage with AF and a CHA2DS2-VASc score ≥2 to determine the acceptability and feasibility of recruiting the target sample size in a definitive trial in an acceptable timescale. Safety phase: ~60 hospital sites will recruit at least 190 participants to determine whether the risk of recurrent symptomatic intracranial haemorrhage is sufficiently low (non-inferior) to justify a definitive trial. Eligibility criteria Inclusion: Spontaneous symptomatic intracranial haemorrhage, AF and a CHA2DS2-VASc score ≥2. Exclusion: Patient age <18 years. Symptomatic intracranial haemorrhage within the last 24 hours. Brain imaging that first diagnosed the intracranial haemorrhage is not available. Intracranial haemorrhage is exclusively due to trauma or haemorrhagic transformation of ischaemic stroke. Patient or their doctor is certain about whether to start full dose OAC. Intention to implement the allocated treatment strategy for <1 year. Patient is not registered with a general practitioner. Patient is pregnant, breastfeeding, or of childbearing age and not taking contraception. Lactose intolerance. Patient and carer unable to understand spoken or written English. Previously randomised in SoSTART. Brain magnetic resonance imaging (MRI) sub-study: MRI must be done after intracranial haemorrhage but before randomisation. Sub-study participants must not have contraindications to MRI. Setting Recruitment in secondary care (inpatient and outpatient services in stroke, general internal medicine, medicine of the elderly, cardiology, neurology and neurosurgery) with follow-up in primary and secondary care. Randomisation Central, web-based randomisation, with 1:1 allocation of intervention: comparator, using a minimisation algorithm. Intervention Start long-term (≥1 year) full treatment dose OAC (either a non-vitamin K antagonist direct oral anticoagulant [DOAC] or vitamin K antagonist if a DOAC cannot be used), chosen by the patient’s physician before randomisation. ComparatorsDo not start OAC (standard clinical practice without OAC may include antiplatelet drug(s) or no antithrombotic drugs). Outcome measures Pilot phase: The proportions of eligible patients who are recruited, unsuitable, or decline to participate; the acceptability of the trial protocol to investigators and patients; and the rate of recruitment per site. Safety phase: Primary outcome: Recurrent, symptomatic, spontaneous intracranial haemorrhage. Exploratory outcomes: All symptomatic serious vascular events (i.e. major adverse cardiac or cerebrovascular events [MACCE]) including non-fatal stroke and spontaneous subdural haemorrhage, non-fatal myocardial infarction, vascular death, sudden death, or death of unknown cause. Individual symptomatic vascular events. Individual types of fatal events. Dependence according to the modified Rankin Scale. Follow up At least one year after randomisation, using annual questionnaires to participants and their GPs, including review of any medical records and brain imaging relating to outcomes. Sample size We plan to recruit at least 60 participants in a pilot phase and at least 190 participants in a safety phase (12% equivalence margin in the outcome of symptomatic intracranial haemorrhage, 1-sided p=0.025 and power 90%).

Acute coronary syndrome treatment regimen was associated with a reduction in the length of hospital stay without an excess in major bleeding. A larger trial is needed to evaluate mortality.

Abstract Background Renal function, as assessed by creatinine clearance (CrCl), plays a crucial role in determining the efficacy and safety of oral anticoagulant (OAC) therapy in patients with atrial fibrillation (AF). Purpose To investigate the relationships between CrCl and the risk of clinical adverse events in patients with AF receiving OAC therapy, comparing the safety profiles of vitamin K antagonists (VKA) and non-vitamin K antagonist oral anticoagulants (NOACs). Methods Anticoagulated AF patients from the prospective Global Registry on Long-Term Oral Anti-Thrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) registry Phase III were studied. CrCl was calculated for renal function, according to Cockcroft-Gault equation. Restricted cubic spline (RCS) were used to explore the nonlinear association between adverse end events and CrCl, comparing VKA and NOAC therapy. Cox regression models were used to analysis the associations between adverse end events and OAC therapy in patients with different CrCl levels, adjusted by clinical features and previous disease. Patients were followed up for the composite outcome (all-cause death, thromboembolism and major bleeding), all-cause death, cardiovascular disease (CVD), major bleeding, myocardial infarction (MI) and stroke. Results In 10,594 AF patients (mean age 70.35 ± 9.92 years; 55% male; 73% on NOAC), RCS analysis revealed decreased risks of all cause death, composite outcomes and CVD with increasing CrCl in patients with CrCl < 80 mL/min. Multivariate Cox models indicated that NOAC therapy associated with lower risk of all cause death (HR 0.68, 95% CI 0.58-0.78), composite outcomes (HR 0.77, 95% CI 0.68-0.86), CVD (HR 0.7, 95% CI 0.56-0.87), major bleeding (HR 0.74, 95% CI 0.61-0.91) in AF patients. For CrCl > 95 mL/min, a lower risk of all cause death (HR 0.56, 95% CI 0.38-0.82), composite outcomes (HR 0.68, 95% CI 0.51-0.91) and major bleeding (HR 0.54, 95% CI 0.35-0.85) were associated with NOAC therapy, vs. VKA. For CrCl < 30 mL/min, a lower risk of all cause death (HR 0.47, 95% CI 0.28-0.81), composite outcomes (HR 0.56, 95% CI 0.35-0.89) and CVD (HR 0.43, 95% CI 0.20-0.90) were related to NOAC therapy. No significant difference in outcomes between VKA and NOAC were found in patients with moderate CrCl. Conclusion Increasing CrCl were associated with decreased risk of adverse clinical events, including all-cause death and CVD in anticoagulated AF patients. For patients with CrCl >= 95 and < 30, NOAC therapy, was associated with lower risks of adverse outcomes.Figure 1Figure 2

In this observational study, patients with atrial flutter had a significantly higher all-cause mortality rate compared with those with AF after an ablation procedure, but similar thrombo-embolic event rates. Future studies should elucidate the reason for this difference in mortality.

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.

<p dir="ltr">Background: The association of insulin resistance (IR) with cardiovascular disease (CVD) and all-cause mortality in type 1 diabetes (T1D) remains unclear.</p><p dir="ltr">Purpose: To investigate whether IR is associated with CVD and all-cause mortality among individuals with T1D. </p><p dir="ltr">Data Sources: PubMed, EMBASE, and the Cochrane Library databases were searched from inception to 31 October 2023.</p><p dir="ltr">Study Selection: Observational studies reporting the associations between IR, as calculated by estimated glucose disposal rate (eGDR), and the risk of CVD and all-cause mortality in individuals with T1D were eligible for inclusion. </p><p dir="ltr">Data Extraction: Data from 8 selected studies were extracted, pooled by random- effects models, and results were presented as hazard ratios (95% CI).</p><p dir="ltr">Data Synthesis: Eight studies involving 21,930 individuals were included, of which 5 studies involving 19,960 T1D individuals reported the risk of CVD. During a median follow-up of 10 years, there were 2,149 cases of incident CVD. The pooled hazard ratio for composite CVD outcome per 1-unit increase in the eGDR index was 0.83 (95% CI 0.78–0.90, I2 = 58.9%). Five studies involving 19,403 T1D individuals reported the risk of all-cause mortality. During a median follow-up of 10 years, 1,279 deaths were observed. The pooled hazard ratio for all-cause mortality per 1-unit increase in the eGDR index was 0.84 (95% CI 0.81–0.87, I2 = 0%).</p><p dir="ltr">Limitations: The small number of available studies restricted our ability to perform meta-regression analyses or more detailed subgroup analyses.</p><p dir="ltr">Conclusions: IR, as calculated by eGDR, may be an additional risk factor for CVD and all-cause mortality in T1D. </p>

The two forms of dementia in AF patients are associated with different prognosis, with AD being associated with a higher risk of ICH, and vascular dementia with a higher risk of stroke/TIA, hospitalization, and mortality.